Type 2 diabetes. The opioid crisis. Tobacco and alcohol use. What do they have in common? They’re among the top public health challenges in the U.S. today. They impact the health of our families, our communities and our country. They’re expensive to treat and contain. They raise the cost of insurance and medical care. The focus of public health programs is on eliminating them and improving the overall health of a population.
The term “public health” can be defined as government policies and actions whose goals are to improve the health of entire populations, primarily through preventive measures such as health information; immunization programs; and water, food and environmental safety.
Despite the long history of public health initiatives and the best efforts of public health officials, the aforementioned public health issues, and many others, remain prevalent. The reason is that the top public health threats don’t just come from a virus, bacteria or an illicit drug, but rather from social ills such as poverty, health inequity and misinformation.
Public health roles include: Restaurant inspector, epidemiologist, health educator, and community health worker.
Public health roles include: Restaurant inspector, epidemiologist, health educator, and community health worker.
What Is a Public Health Issue?
Public health issues include diseases and conditions that impact entire populations. These diseases may be chronic diseases, such as Type 2 diabetes, asthma or heart disease; infectious diseases, such as, COVID-19, measles, tuberculosis or influenza; diseases spread through unsanitary conditions, such as cholera or typhus; or conditions such as cancer or mental health disorders.
Other public health concerns include the following:
- Behaviors, such as drug, alcohol and tobacco use, that impact wellness and raise mortality rates, among other outcomes
- Environmental conditions that impact health, such as poor air, water and food quality
- Low immunization rates, possibly leading to diseases being spread to vulnerable populations
- Safety concerns, such as unsafe workplaces or infrastructure
- Climate concerns, such as high temperatures and violent weather
Some public health threats will require immediate action. COVID-19 mutations, for example, require health officials to constantly update their responses. Other health programs have long-term goals. For example, programs that educate people about the risks of colon cancer and the need for colonoscopies are ongoing.
Public health officials identify which issues to tackle based on different criteria. They’ll then determine the necessary response, which will vary depending on the data and as conditions change. The early pandemic response is an example: In early 2020, the Centers for Disease Control and Prevention (CDC) opposed mask-wearing, but by spring had changed its guidance.
Because resources are always limited, public health professionals use many factors to determine whether a health matter rises to the level of a public health concern.
How many people have the disease or the symptom in a given period of time? Diseases that are prevalent in certain areas or populations and significantly impact health, longevity and quality of life may require long-standing programs and actions to defeat. For example, rural communities suffer more heart disease than urban communities, making it a public health concern in those regions.
Severity involves issues such as the impact of a disease on the patient, how serious its symptoms are and how expensive it is to treat. For example, the common cold is prevalent and is certainly a nuisance. However, it’s rarely severe and just as likely to go away on its own as it is to respond to treatment. Flu, on the other hand, can be very severe depending on the strain and requires public health prevention methods.
Communicability and contagiousness are often conflated. However, a disease may be infectious but not contagious; for example, tetanus is an infection caused by bacteria. It can’t be transmitted to another person. On the other hand, strep throat is an infection that’s also caused by bacteria, but it’s very contagious and can be transmitted to others.
Immunizations and vaccines are the first line of defense in preventing many diseases. However, other conditions are more challenging. The reason is that behaviors and habits that are hard to break cause these conditions. Nicotine in tobacco is a highly addictive substance, and smoking is one of the toughest habits to break. In the case of tobacco, drug and alcohol use, or diseases caused by obesity, public health programs focus on education and community resources.
Similarly, diseases caused by poor air, water or food quality may not be preventable unless a government provides funding to fix necessary infrastructure.
Potential for Outbreak
How likely is an outbreak among a population? Public health agencies use various tools, including data modeling and statistical analysis, to identify potential disease outbreaks and determine a response. For example, the CDC’s Center for Forecasting and Outbreak Analytics used these techniques to forecast the severity of the Omicron variant of the coronavirus.
Infection control is a critical part of public health operations. Measures range from handwashing and simple hygiene to vigorous decontamination and quarantine. Other control measures are less simple. For example, the goal of a cigarette tax is to discourage smoking. Laws against selling alcohol to minors are meant to prevent teens and children from abusing alcohol. Control measures include seatbelt laws, speed limits and workplace safety regulations to prevent accidents.
Type of Surveillance
Local, state and federal public health agencies monitor COVID-19 cases to keep ahead of outbreaks. Other surveillance operations help track lead poisoning, foodborne outbreaks, hepatitis and other illnesses. Disease surveillance is an early warning system that can identify public health issues before they reach crisis mode.
Examples of Public Health Issues
As mentioned, tobacco, drug and alcohol use are examples of public health issues. These behaviors can have a severe impact on individuals and their communities, hence their designation as public health concerns. Similarly, Type 2 diabetes, which is prevalent in many underserved communities, is linked to poor quality of life and lower life expectancy. Other issues include the following:
From the beginning of the AIDS epidemic in the 1980s, HIV has infected 84 million people and killed 40 million people worldwide. Currently 38.4 million people live with HIV/AIDS. The disease continues to wreak havoc. A vaccine is currently in development. The treatment and prevention of HIV/AIDS was stymied for years due to prejudice against gay men, who were at higher risk for contracting the disease.
Public health measures to treat and prevent AIDS include research funding, education and testing programs. Drug protocols have turned AIDS into a chronic disease for many sufferers.
Heart disease is the leading cause of death in the U.S. Stroke is the fifth-leading cause. The goal of public health is to reduce the toll that heart disease takes on patients and their families through education and programs and to improve people’s eating and exercise habits.
An example of a public health intervention is the move to reduce salt intake, as sodium is linked to high blood pressure, a leading indicator of heart disease and stroke. Another measure has been to include calorie counts on restaurant menus. However, results have been mixed.
Obesity correlates with many health issues, especially chronic conditions including diabetes, heart disease, depression, stroke and cancer. It can lead to gestational diabetes in pregnant women and is also connected to infant mortality.
According to the CDC, the annual medical cost of obesity is more than $170 billion. Public health measures such as banning sugary soft drinks from kids’ menus have been controversial. Obesity also correlates to food insecurity. Many public health programs seek to address food hunger issues, especially among children.
In 1993, 700 people got sick from eating hamburgers contaminated with E. coli bacteria. Four children died. Food recalls have become a common occurrence, as food may be contaminated during processing and shipping. Local, state and federal public health agencies monitor foodborne illnesses to identify outbreaks and causes. Surveillance and regulations help prevent illness and death. Public agencies work with private companies to identify food hazards and prevent them from entering the food supply.
10 Current Public Health Issues in 2022
As these examples of public health issues illustrate, every era has its public health challenges. These challenges are often complex and not easily overcome. Since public health, policy and public discourse intersect, a lack of acceptance by people, politicians and business leaders may constrain public activities.
In addition to the aforementioned public health examples, public health officials in 2022 face several challenges. These health challenges are thorny and deep-rooted. In some cases, it took the pandemic to bring them to the attention of the general public. Some of these current issues aren’t even specifically health or medical in nature. However, they’ve had a great impact on the well-being of millions of people and have either enhanced or hampered the effectiveness of public agencies.
Health misinformation is a public health crisis, with consequences including: Confusing people about what information is accurate; leading people to decline vaccines; prompting people to try unproven treatments; and leading people to reject common-sense health measures, such as masking.
A discussion of current public health issues wouldn’t be complete without covering the impact of the COVID-19 pandemic. More than one million Americans have died of COVID-19 since the beginning of the pandemic, and that number continues to rise. The disease has tested the effectiveness of public health initiatives designed to prevent disease spread, reduce infections and deaths and bolster vaccination programs.
Public health experts have learned a great deal about what works, what doesn’t work, and what’s been surprising about the response of individuals and communities to the pandemic. Their findings include the following:
- Individual behavior has a powerful effect. Government policies established lockdowns and accelerated vaccine development. However, individuals resisted lockdowns and mask-wearing, and when the vaccines came out, widespread vaccine hesitancy slowed adoption and hampered herd immunity.
- Vaccine development showed what science could do. Never before have scientists developed safe, effective vaccines so quickly. During the next pandemic, vaccines may come online much quicker, saving lives and preventing the spread of infection.
- Speed is essential but can cause confusion. Getting in front of variants and mutations became a moving target. As data came in, public health responses changed, which caused confusion and may have reduced credibility in some communities.
- Issues of health equity became apparent. The toll of the pandemic in poor communities and among persons of color was far greater than in wealthier communities. This highlighted health disparities and contributed to the lack of confidence in public health initiatives.
- School took center stage. The impact of the pandemic and lockdown on schools showed how important functioning schools are to society. Parents, especially mothers, had to juggle working from home and supporting their children’s education. Many chose to quit and focus on their children.
- Work changed forever. Many employees who worked from home during the pandemic are choosing not to return to the office. This is causing tensions with employers who want workers to come back to work. Additionally, the U.S. Bureau of Labor Statistics (BLS) has seen the highest rate of job quits since it began keeping track in 2020. This so-called Great Resignation has led to a shortage of workers in many industries, especially hospitality and food service.
2. Opioid Crisis
Drug companies developed powerful opioid painkillers in the 1990s, leading to widespread misuse over the next two decades. More than 760,000 people have died of opioid abuse since 1999. Between July 2021 and July 2022 alone, more than 100,000 people died of a drug overdose.
The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency in 2017. Local and state public health agencies have been rolling out treatment and prevention programs that include medication-assisted treatment such as methadone clinics and naloxone treatment.
3. Social Media Misinformation/Disinformation Campaigns
Public health experts cite dangerous misinformation campaigns as leading public health issues. Researchers have found that social media disinformation, including from foreign actors, led to COVID vaccine hesitancy, despite evidence of vaccine safety and effectiveness. This was only the latest example of vaccine hesitancy.
The controversy around vaccines and autism continues to have a negative impact on the childhood vaccination rate. This can impact herd immunity and cause the spread of diseases that can lead to serious illness and death.
Health misinformation is widespread on social media, and countering it effectively is challenging. Tactics include the following:
- Monitor messaging across platforms. Health researchers must stay on top of health messaging across many platforms, not just Facebook. TikTok, Reddit, Tumblr and others are all sources of health memes and videos that spread false claims.
- Understand motivations. Why does disinformation spread so easily, and why is it so hard to counter? Understanding the psychological drivers behind this type of campaign is the first step toward effective countermeasures.
- Assess the impact. Misinformation can have a serious impact on public health. It can create the impression that no scientific consensus on best practices exists. It can lead to individuals deciding that no information can be trusted, and that can have serious effects on their health.
- Identify vulnerable populations. Which populations are susceptible to misinformation? Even individuals who are well-educated may be vulnerable, due to confirmation bias and other factors.
- Develop and test messaging. Public health officials should develop messaging that takes all this research into consideration, and then assess the results, changing the messaging as needed. They may need to launch educational campaigns. Tactics may also include supporting legislation that requires platforms to remove false claims.
4. Health Equity
The pandemic starkly illustrated the unequal access to health care in the U.S. Issues include the following:
- Social determinants of health. An address may have more impact on a person’s health outcomes than any medical treatment. Access to safe housing, education, nutrition and environmental factors all contribute to a person’s overall health.
- Health professional shortage areas. Some 96 million Americans live in a designated health professional shortage area. This means that they may lack access to general medical or specialized care.
- Education. Good grades and higher education are predictors of better health outcomes for youth. Poor health, such as obesity, lack of exercise, teen pregnancy and drug use, are correlated with lower income levels and poorer overall health.
5. Food Insecurity and Food Deserts
The term “food insecurity” is defined as having access to adequate nutrition for healthy activity. The U.S. Department of Agriculture classifies more than 5 million households as having very low food security, making it a major public health issue. Children are especially vulnerable to food insecurity; nearly 15% of households with children were food insecure. Lacking access to nutritious food places a burden on public health and social costs as it leads to obesity, heart disease and high blood pressure.
Food deserts are neighborhoods that lack supermarkets and access to fresh foods. Instead, residents have choices that are high in salt and sugar and low in nutritional value. Nearly 54 million people live in low-income and low-access areas.
6. Mental Health / Social Isolation
Before the pandemic, nearly 20% of adults experienced a mental illness. Suicide, mental illness in children and teens and other mental health challenges have increased due to the pandemic, with some figures suggesting a 25% increase worldwide in anxiety and depression.
The pandemic also increased the number of people who experience social isolation, a dangerous mental health issue. Social isolation is a risk factor for heart disease, depression and cognitive decline. Older people are especially vulnerable to experiencing social isolation.
7. Data Modernization and Privacy
The health care industry has become increasingly focused on data, as patients and providers generate vast quantities of health and medical information every day. Some of this data is public health information, such as population health metrics. Public health experts must manage the collection and analysis of this data to respect the privacy of individuals under federal privacy laws.
However, this data is critical in developing solutions to health crises and improving the health and safety of the population. Modernizing data collection and analysis is an important part of public health activities.
8. Environmental Impact on Health
Given the toll taken by climate change, aging water and sewer infrastructure, and exposure to per- and polyfluoroalkyl substances (PFAS), the environmental impact on public health can’t be underestimated. For example, PFAS are artificial substances that accumulate over time in the environment. Exposure to these “forever chemicals” has been linked to cancer and adverse effects on pregnancy.
Untreated sewage can cause a host of infectious diseases, including meningitis, cholera and dysentery. Extreme heat events can lead to death among the most vulnerable. Warmer temperatures due to climate change can cause flooding and the growth of harmful bacteria, which can also cause disease and death.
In many cities, water and wastewater infrastructure dates back more than a century and requires upgrades to continue serving communities effectively. Poor water quality can result in infectious diseases, as illustrated above, as well as exposure to harmful elements such as lead or forever chemicals such as PFAS.
Although e-cigarettes were developed as an alternative to tobacco use and a method to quit smoking, they’ve evolved into a public health issue. E-cigarettes and vaping expose users to toxic substances including nicotine salts and metals. Some 3.6 million teens reported using e-cigarettes in 2020. Lawsuits against manufacturers claim that they targeted teens and children with advertising. The U.S. Food and Drug Administration (FDA) ordered a ban on vape products in 2020 and may extend the ban in 2022.
10. Cannabis Legalization
The legalization of cannabis is moving forward on a state-by-state basis and has bipartisan support among politicians. In some states, cannabis is legal for medical use; in others, for recreational use. Side effects of cannabis use include adverse effects on pregnant mothers and infants and cognitive defects in users. The use of cannabis also has a complicated legal history: Black people and other people of color were arrested and incarcerated for the use and sale of marijuana at higher rates than white people.
Although cannabis is generally considered to be less harmful than other illicit drugs, public health experts are calling for the regulation of legal cannabis to prevent abuse.
Public Health Ethical Issues
Even though the goal of public health is to increase the health and wellness of communities, ethical challenges abound. Public health programs can clash with the need for individual autonomy over personal health decisions, data privacy, health access and equity and health and wellness advice. Many chronic health conditions have a complex set of causes, so simple solutions can be ineffective — and sometimes offensive.
Officials must be mindful of the following public health ethical issues:
Avoiding the Use of Shame as a Motivator
Shaming people who have unhealthy diets, are obese, or use tobacco or other drugs is an ineffective motivator. Many times, people double down on their behavior due to resentment. Feelings of shame may keep them from making positive changes. Instead, recognizing the difficulties of changing patterns of addiction and using interventions based on science may be more effective.
Avoiding the Stigmatization of Individuals or Communities
Stigmatizing individuals and their communities is another way to try to use shame as a motivator. Blaming people and groups for their own failures doesn’t take into account complex factors such as a genetic predisposition toward obesity or the powerful impact of social determinants of health on chronic disease. Stigma can also cause people to downplay their illnesses and avoid seeking health care.
Considering the Impact of Taxes and Other Interventions
Taxes on alcohol, tobacco and sugary drinks — sometimes known as sin taxes — are designed to change behaviors and encourage healthy choices. However, they disproportionately impact low-income communities. They also take away an individual’s right to make their own health determinations. Another factor is that these taxes bring in state revenues, which may take precedence over their effectiveness at changing unhealthy behaviors.
What Does a Career in Public Health Involve?
Current public health issues highlight the need for experienced public health professionals to take the lead in solving these challenges. Public health careers require a background in science, statistics and social sciences, as well as public policy and governance. Careers include the following:
- Epidemiologist. Epidemiologists investigate the causes of diseases and outbreaks. The annual pay for the top 10% of earners was more than $130,050 in 2021, according to the BLS.
- Public health director. Public health directors lead programs and agencies and develop public policy. The annual salary for the top 10% of earners was $143,000 as of April 2022, according to salary research site Payscale.
- Biostatistician. Biostatisticians conduct statistical analyses and interpret results. They work with biological and health data. The annual salary for the top 10% of earners was $117,000 as of June 2022, according to Payscale.
- Health informatics specialist. Health informatics specialists develop information technology systems and ensure that they comply with regulations. The annual salary for the top 10% of earners was $108,000 as of July 2022, according to Payscale.
For many public health professionals, the chance to improve the health and wellness of whole communities makes for a rewarding and challenging career.
8News Now, “Clark County Declares COVID Misinformation a ‘Public Health Crisis’”