The family loads up the minivan with air mattresses, water toys, towels,
a picnic lunch and bottles of sunscreen. It's a sweltering day and everyone
is looking forward to a refreshing dip in the lake.
Unfortunately, when they pull up to the beach and unload their belongings,
they notice that no one is in the water. A sign is posted stating that the
beach is closed by order of the public health director.
Tim Hilderman is a public health director. He says directors specialize
in the protection of the public's health. "For example, we're responsible
for closing a beach if it isn't safe for swimming."
If the coliform (a type of bacteria) count is too high in public swimming
waters, the beaches must be closed. That's because ingesting the water
can make people ill.
"All the issues that affect the public's health are of interest to
us," says Hilderman. "We investigate outbreaks of disease such as meningitis,
water-borne diseases and the West Nile virus."
"Our work has an impact on everybody," says Mimi Fields. She is a medical
officer in Washington. "Our area of concern covers the food we eat, the water
we drink and even the air we breathe."
Issues of public health go beyond reminding the public to get their flu
shots. If a train derails and spills chemicals into the soil and the air,
the public health director must get involved. "We're also responsible
for the protection of the environment, which involves environmental spills
and pollution issues," says Hilderman.
North Americans often take clean drinking water for granted. But in the
past few years, outbreaks of illness in two towns in Canada have got people
thinking twice. "Drinking water is also our responsibility," says Hilderman.
"We're the ones who decide to issue boil water orders."
Donald Lyman is the chief of chronic disease and injury control for the
California Department of Health. He works at preventing other types of illnesses,
such as cardiovascular disease and cancer.
"These two [diseases] are caused in turn by just three leading factors:
tobacco, nutrition -- folks who eat too little fruits and vegetables and too
much fat -- and by a lack of physical activity," says Lyman. "Some folks are
couch potatoes."
Does looking after all these health concerns sound like too much for one
person to handle? It is. "It's a very broad field of medical care," says
Fields. "We have to come up with some very creative responses to different
issues."
Public health directors are assisted by a team of public health nurses
and inspectors, who alert them to different problems in the community.
"We have a huge team involved in protecting the public's health,"
says Hilderman. "Inspectors and public health nurses do most of the work."
Public health nurses report outbreaks of new diseases, administer vaccines
and go to community centers and schools to educate people about health issues.
"We need educators who can transmit the messages," says Lyman. He also
notes that public health directors look after issues such as child health,
HIV and AIDS, and family planning. "We work together as a team to ensure a
healthy community."
Public health directors are constantly dealing with different issues and
having to make decisions. For example, a director doesn't want to alarm
the public if an outbreak is extremely small and contained. However, they
don't want to put the public's health at risk by not controlling
the spread of the disease.
"We have to think about what to do to protect [people]," says Hilderman.
"We keep reassessing the risk."
Hilderman has set up a system to warn him of the spread of diseases like
West Nile virus, for example. "West Nile virus affects birds, so we've
set up a surveillance system and investigate all dead crows," he says.
"We also have to think about decreasing the mosquito population, which
opens other debates such as the use of pesticides. Decision making in this
career can be very complex."
Looking after such a diverse number of issues is what Hilderman finds pleasurable
about his work. "You can make a difference at a broad level," he says. "It's
not just one person's health, it's an entire community. You can
really work to improve the health of a whole population."
Fields agrees. "The enjoyable part of this work is that you get to look
at the big picture," she says. "It's not about going in and looking at
one organ or part of the body. We have every individual in the community in
mind."
Of course, it isn't always easy to make the changes. Persuading individuals
to look after their health and convincing local politicians that changes need
to be made can be difficult.
For example, if word gets out that a town's drinking supply is contaminated,
it's likely that tourists won't be flocking to visit the area. Or
if toxins such as arsenic and lead are found in the town's soil, it could
mean that the government must take drastic measures.
"If you find a health issue, you often have to be very persistent to get
the changes made," says Hilderman. "You can't just expect that changes
will be made. Often, political attitudes have to change and new legislation
has to be created. That doesn't happen overnight. It's not an easy
thing to do."
"Public health is really fun," says Lyman. "The rewards are
wonderful in seeing family, neighbors and others healthy and free of disease
and disabilities."