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Fifty years ago this month, in April 1974, Minneapolis experienced an outbreak of foodborne viral hepatitis, with 107 documented cases and probably more than 1,000 people exposed to the implicated hepatitis A virus from food they had eaten at a downtown restaurant.
As a medical epidemiologist with the Minnesota Department of Health and the U.S. Centers for Disease Control then, I led the investigation and control of the outbreak with colleagues at the Minneapolis Health Department and the Minnesota Department of Health. Within five days, we performed an epidemiologic study that identified the contaminated food items, traced the source to an infected food handler, organized hundreds of immunizations, implemented other immediate control measures, and took steps to reduce the future risk of foodborne transmission of viruses and other microorganisms. This newspaper played a vital role as a trustworthy source of information throughout the outbreak investigation.
Then, as now, public health agencies — at the local, state and federal levels — can quickly mobilize to control outbreaks of disease. But far less visibly, they work throughout the year to prevent disease and injury by ensuring safe food and water, promoting clean air and workplace safety, educating and informing the public, promoting maternal and child health, and protecting health and safety in many other ways. Public health agencies are most successful when disease outbreaks and other preventable illnesses and injuries do not occur — when the work of public health is invisible. But when it is invisible, we, as a society, tend to undervalue — and underfund — public health.
Many public health challenges have arisen or intensified since 1974, including the AIDS and COVID-19 pandemics, the increased prevalence of obesity and diabetes, gun-related violence, climate change, racial and ethnic disparities in health status, and the threat of nuclear war. In response, new vaccines and medications have been developed, epidemiologic methods have been improved, social determinants of health have been widely recognized, public policies have been implemented, the public has become more educated, and individuals and nongovernmental organizations have become more engaged in public health issues.
A major recent challenge has been reduced trust in public health agencies — a significant issue because trust is essential for everything that we do in public health. In April 1974, trust was essential for hepatitis patients to provide personal health information that helped to control the outbreak, for physicians to report suspected outbreak cases to the health department, for the managers of the implicated restaurant to share information on how food was prepared and possibly contaminated, for people who had been exposed to the virus to heed health department advice and receive immunizations, and for patrons to return to the restaurant after the investigation was complete and the health department had assured the public that it was safe to eat there. Without trust, many more people would have contracted hepatitis.
Public health — what we, as a society, do collectively to assure the conditions in which people can be healthy — depends on trust. So does the public's health. We need to work together to restore trust in public health agencies, and public health agencies need to continue to earn that trust. Our health — as individuals, as communities and as a nation — depends on it.
Barry S. Levy, M.D., M.P.H., is an adjunct professor of public health at Tufts University School of Medicine in Boston and a past president of the American Public Health Association. He is the editor or author of 22 books on the public health impacts of environmental and occupational hazards, war, climate change and social injustice. From 1973 to 1976, he served as a medical epidemiologist with the Minnesota Department of Health and the U.S. Centers for Disease Control, and, as part of his work from 1975 to 1976, he served as acting state epidemiologist.
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Opinion editor's note: For more on the subject of trust in public health efforts, see also the John Rash column "Osterholm: As politics infect science, new tactics critical," published March 23.
