"Call the Midwife": Public Health in the 1950s and Today

Are other people in love with "Call the Midwife" like I am?  I started watching last year during a break between Downton Abbey seasons.  The show follows the lives and work of nurse/midwives working in the Poplar community of east London in the 1950s.  The community has a high poverty rate and limited resources.  The series is based on the memoirs of Jennifer Worth, who like the main character Jenny Lee, became a midwife at the age of 22.

Season 2 of Call the Midwife (airing in the U.S. March 31-May 19, 2013) has been packed with public health issues.  I have been struck by how many of the highlighted issues still challenge us today:

• Season 2, Episode 1: Jenny Lee begins to care for a young mother named Molly, pregnant with her second baby.  In the course of their visits, Jenny realizes that Molly is a victim of domestic violence.  In one especially poignant scene, Jenny soothes and encourages Molly via a conversation held through the family's mail slot. Molly has been ordered by her husband not to let Jenny in the house.

Domestic violence (or intimate partner violence- abuse by a current/former partner or spouse) is still a problem today.  The Centers for Disease Control & Prevention (CDC) estimates that it affects millions of Americans.  This violence has long-term economic and health consequences for individuals, families, and communities.  The CDC offers many resources focused on public health's role in the prevention of intimate partner violence.

• Season 2, Episode 5: Jenny Lee provides prenatal care to Nora, a mother of 8, living in poverty.  The family of 10 crowds into a 2 room flat.  When Nora finds out that she is pregnant again, she is desperate to end the pregnancy.  With the family's financial situation, she feels that it is impossible for her family to take care of another child.  Jenny confronts Nora after seeing evidence of self harm.  Jenny reminds her that there is only one way to terminate a pregnancy (abortion), but it is illegal.  Nora risks her life seeking the services of a local woman who performs abortions.

Abortion remains a hotly debated public health issue in the U.S. both at the state and federal level.  This episode of "Call the Midwife" is a grim reminder of what can happen when women do not have access to safe, legal abortions.

• Season 2, Episode 6:  After diagnosing several late-stage Tuberculosis (TB) infections in Poplar, the community physician (Dr. Turner) advocates for a screening program in the form of an x-ray van.  Dr. Turner and Sister Bernadette (a nun/midwife) make a wonderful public health argument for the resources they need.  They cite the risk factors, specifically poverty in their community, noting that families may have up to 12 people in one apartment.  The close living quarters increase the chance of spreading this infectious disease.  In fact, we meet one family in the episode that lost 6 children to TB.  As a public health professional, it was fascinating to see the promotional materials that the clinicians created to recruit people for the screening.  They papered local bars with flyers and set a large sign outside the van reading, "Stop. 2 minutes may save your life. Get a chest x-ray".

Infectious diseases and their screening, treatment, and vaccination remain key public health issues in the U.S. and around the world.  Many infectious diseases like measles or chickenpox can be prevented by vaccines.  Over the past 15 years, there has been much discussion between the public and public health communities about the safety of vaccines for children.  In January 2013, the Institute of Medicine released a report reaffirming that the current childhood vaccine schedule is safe.  In fact, they report that "vaccines are one of the safest public health options available".

Tell Me What You Think:

• What have been your favorite episodes of "Call the Midwife"?
• What other public health issues are portrayed in the 1950s that still challenge us today?

The Vaccine War: Public Health vs. The Media

A few weeks ago, I had the pleasure of speaking with Laurie Edwards, a writer and blogger who examines chronic illness, healthcare, life balance, public health history, and everything in between.  Among other topics, we talked about the role of social media and mainstream media in the vaccine debate.

So I thought of that conversation as I watched last night's re-run of PBS Frontline's special "The Vaccine War" (originally aired April 27, 2010).  I highly encourage advocates on both sides of the issue to check it out.

The piece was quite balanced with interviews on all sides.  For example, we heard from vaccine advocate Dr. Paul Offit, bioethicist Dr. Arthur Caplan, anti-vaccine advocate parents in Ashland, OR (with one of the lowest vaccine rates in the country),  Jenny McCarthy and her colleagues at Generation Rescue who continue to argue for evidence of the link between vaccines and autism, and from parents of a girl who almost died at 6 weeks from whooping cough.

It explored possible contributors to the fear of vaccines and/or the lowering vaccination rates:

• 1998 Lancet article by Dr. Andrew Wakefield that linked autism to childhood vaccines (*This article has since been retracted and MANY U.S. and International epidemiological studies have found no scientific evidence of a causal link)

• A new generation of parents that are too young to know the devastating effects of vaccine-preventable diseases like polio.  One interviewee used a term that I really like- "Community Recollection".  As Community Recollection of these diseases disappears, we can become complacent.

• A false sense of security because many of these diseases are not seen frequently in the United States.  However, we forget that with the ease of air travel, borders are almost non-existent.  For example, the piece followed an outbreak of measles in San Diego that started when a non-vaccinated 7 year old from the US contracted it while vacationing in Switzerland and brought it home to classmates.

• The Internet.  While it also offers many positive benefits regarding healthcare (e.g., access to information/publications; online support groups and connections with a "community" of individuals with similar diagnoses)- it also has its potential downfalls.
• It can keep controversy alive- even after it has been disproven (e.g., the Wakefield article)
• False or unproven information can go viral and it is hard to retract!  They use the example of the youtube video of Desiree Jennings (a 25 year-old Washington Redskins cheerleader) that claimed that a flu shot caused her debilitating muscle disorder.  

So how can Public Health compete with the Media and the Internet?

• Let's not compete.  Let's collaborate.  Let's learn (either through our own capacity or collaboration) to effectively communicate public health information online.  Our biggest audience (the public) is not usually reading our peer reviewed journals or attending our annual conferences.  This is already starting to happen.  Public health organizations have active Facebook and twitter accounts, blogs, videos.  Let's keep going.  And let's train our public health colleagues/students in health communication.

• Let's remember to share the spotlight with celebrities and other spokespeople that have influence over the public.  Like it or not, the way people get their health information and make decisions is changing.  They do not just agree with doctors or scientists.  I almost always see these debates featuring Public Health (scientist speaking in jargon) vs. Celebrity/Parent with moving emotional story about their child being injured by a vaccine.  That is hard to compete with!  Believe it or not (because we seem to only hear from Jenny McCarthy), there are also pro-vaccine celebrities.  Jennifer Garner and Kristi Yamaguchi have been flu vaccine advocates.  Jennifer Lopez and Keri Russell have been pertussis vaccine advocates.  Let's make sure the public knows that. 

• Let's think about the framing and marketing of vaccination messages.  When the HPV vaccine is framed as a Cancer Vaccine for both boys and girls...versus an STD Vaccine for just girls/young women it is perceived very differently by the public.

Tell me what you think:

• What can we do to change the current "Community Recollection" about vaccinations?
• Other suggestions regarding how public health can collaborate with the media/internet sites to communicate more effectively with the public?

Celebrities and their Health Causes: What Happens When They Do More Harm Than Good?

Often on this blog I have spoken about the role of celebrities as the spokesperson or "champion" for various public health issues. Many celebrity names are synonymous with particular health causes (Katie Couric- Colon Cancer; Michael J. Fox- Parkinson's Disease; Lance Armstrong- Testicular Cancer; to name a few).

Over the past few weeks, several stories have emerged which beg the question, "what happens if celebrities do more harm than good?" Those in the public eye have such a broad and extensive platform to communicate with the public...what if they disseminate erroneous information or even worse- cause a panic?

The week of September 12 was quite busy! In the Republican Presidential Debate (in the context of discussing mandated HPV vaccines for children), Rep. Michelle Bachmann claimed that the HPV (Human Papillomavirus) vaccine is linked to mental retardation. To support her claims, Bachmann repeatedly told the story of being approached by a woman whose daughter suffered mental retardation after taking the vaccine. As those of us in science well know, one self-reported story does not equal a true incident. Even if true, one incident does not equal a trend or an epidemic. This story has been quickly picked up by scientists who are even offering money if it is proven true.

This same week, Dr. Mehmet Oz of the Dr. Oz Show (you may remember him from numerous appearances on the Oprah Winfrey Show), claimed that apple juice contains unsafe levels of arsenic. These claims followed research conducted by the Show which had a laboratory examine three dozen samples from five different brands across the United States. The samples were compared to the limits of arsenic set for drinking water by the EPA. Since the claims, many scientists have spoken out regarding concerns about the study's protocols and conclusions (for example, not differentiating between organic and inorganic types of arsenic). Many were concerned about the widespread panic caused by these claims and likened it to shouting "fire" in a crowded theater.

Of course, this is not the first time celebrities have caused a scandal following potentially false and dangerous claims. Jenny McCarthy has dedicated her life to proving the cause between childhood vaccines and autism. Shortly after Brooke Shields released her book, "Down Came The Rain", which chronicled her battle with postpartum depression- actor Tom Cruise (a Scientologist) publicly criticized her for taking antidepressant medication.

So what happens when these celebrities cause more harm than good? What happens when their claims are misguided, misinformed, and/or not based on evidence or science? The answer: they can have huge and far-reaching public health consequences. For example, as we begin to see illnesses like measles reappear- we have to wonder- "Is this the Jenny McCarthy effect?"