The Top Public Health Issues of 2021

As 2021 comes to a close, we’re taking a look at some of the top public health problems that faced the world in the past year. While some are more obvious than others, they all tie together to form a picture of the biggest challenges facing humanity today and give us a clue as to what to expect in the future.

COVID-19

One of the most obvious current public health issues is the battle against COVID-19. On March, 11, 2020 the public health emergency initiated by the virus was declared a pandemic by the World Health Organization (WHO). ¹ As of the beginning of November 2021, more than 740 thousand people have died from SARS-CoV-2 virus in the United States and more than 45 million cases of contraction have been confirmed. The plight of this virus has been felt throughout the world with more than five million deaths confirmed from COVID-19 globally.²

Because of the virus’s rapid spread and massive impact to all parts of life, the COVID-19 pandemic has served as a sort-of lesson on common public health efforts when it comes to containing an infectious disease. Mask wearing, social distancing and diligent handwashing are accepted and consistently encouraged by public health officials and epidemiologists as some of the best ways to halt the spread of the virus.²

Now, after nearly two years of virus containment measures and with the availability of the vaccine that protects against the virus, COVID-19 might finally lose its place as the most critical public health problem. The impact of the virus will be felt for decades through its effects on community services, social interaction and the global economy.

Health Equity

Health equity is an all-encompassing public health issue encompassing many social issues. The Centers for Disease Control and Prevention (CDC) says that health equity is achieved when every person has the opportunity to attain their full health potential. Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment.³

You may have heard the term “health equity” or “health inequities” within the coverage of COVID-19. COVID-19 brought to light many concrete examples of this public health issue that might have been poorly understood previously. For example: the virus was observed affecting communities at different rates and again as the vaccine was released and distributed unequally across neighborhoods. In the first case, people who were considered “essential workers,” (primarily workers in the retail and service industries and those who couldn’t perform their work from home) in part represented lower-earning neighborhoods and were experiencing more cases of the virus. In the latter, these same individuals were less likely to have easy access to the vaccination whether due to difficulty of accessing vaccination appointments because of work schedules and geographical availability of clinics or pharmacies with the proper equipment to store and administer the vaccine. These are just two recent examples of the pervasive and broad issue of health equity.

Another way to understand health equity is to get an idea of the factors that can have an effect on health, also known as the social determinants of health. The American Public Health Association (APHA) puts an emphasis on the impact of racism and discrimination, education, income, housing and neighborhood conditions can have on someone’s health.⁴ As the worldwide fight for equal rights and treatment for all people continues, so too will a focus on health equity.

Environmental Health

One of those social determinants, and an essential part of public health is environmental health. According to the APHA, environmental health is the branch of public health that focuses on the relationships between people and their environment; promotes human health and well-being; and fosters healthy and safe communities. Critically, this study is on the effects the environment (natural and manmade) can have on humans rather than how humans impact the environment.

Some factors in environmental health such as crime rates, availability of safe parks, access to healthy food options, neighborhood appearance, and the quality and safety of streets and sidewalks,⁴ are designed or built factors that can affect the health of the people in the neighborhood. Others, like air quality and pollution, exposure to chemicals and noise might be naturally occuring. Either way, as urbanization increases and policies of policing and law continue to be at the forefront of societal concerns, environmental health will remain as a top public health concern.

Climate change, which is more about the damage humans inflict on the environment, is also considered a public health issue within environmental health. Many communities worldwide that are at-risk for disastrous weather events and drastic climate conditions. Natural disasters like floods and tropical storms bring up huge environmental public health issues as buildings become inhabitable, businesses and people move leaving neighborhoods to rebuild from vulnerable positions. When people are forced from their homes and into close-quarter situations like refugee camps, communicable disease becomes more likely to spread.

Mental Health

Over the years mental health has lost some of its stigma as more people publicly and casually share their struggles with conditions such as depression, anxiety, ADHD and other behavioral disorders. Additionally, clinicians and therapists have worked hard to educate the public on all the detriments of poor mental health including increased likelihood for conditions like diabetes, heart disease and stroke.⁶

The Affordable Care Act expanded mental health coverage, made it illegal to deny insurance coverage for people with pre-existing conditions, including mental illness, and expanded parity- in other words, giving mental health and substance abuse treatment equal importance as other medical and surgical care. Today public health agencies are focused on introducing policies that support parity, access and educating the political officials and general public on the topic.⁷

Mental health will remain a public health concern in the coming years as it becomes better understood and accepted as a real issue of importance and as individuals struggle to access care for mental health issues.

Substance Misuse

Substance misuse includes the use of illegal drugs including cocaine and methamphetamine, as well as inappropriate use of legal substances like alcohol and tobacco or prescribed substances like opioids. Once again, the COVID-19 pandemic is thought to have had an impact on the frequency of this public health issue as people were forced into stressful situations of uncertainty, solitude and illness.

Prescription opioids are used mostly to treat moderate to severe pain but can make people feel "high" - which is why they are sometimes used for non-medical reasons. Part of the danger of opioids is their highly addictive nature. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the nation remains in a prescription and illicit opioids crisis, as 81,230 drug overdose deaths occurred in the U.S.—the highest single year ever reported—in the 12 months ending in May 2020; most of the overdose deaths involved a prescription or illicit opioid.⁹

You might wonder why something that might seem like a personal issue is considered a public health crisis. For one thing, the National Institute on Drug Abuse estimates drug misuse costs the United States $232 billion in health care costs and $740 billion overall.¹⁰ The World Health Organization reports that alcohol consumption is linked to more than 200 disease and injury conditions. The APHA explains that all of these effects place a substantial burden on population health in terms of death and disability, making alcohol consumption one of the 10 leading factors with the most impact on population health.¹¹

Maternal and Child Health

According to the APHA, maternal and child health is an important public health issue because, “there’s a great opportunity to end preventable deaths among all women, children and adolescents, far too many women, infants and children worldwide still have little or no access to essential, quality health services and education, clean air and water, and adequate sanitation and nutrition, investments in prevention, health care and education last a lifetime.”

Health equity comes into play once again when it comes to maternal and child health. African American women are twice as likely to experience life-threatening pregnancy related complications compared with non-Hispanic white women. Further, African American mothers are twice as likely to have an infant who dies by their first birthday. The Center for American Progress explains that these disparities are rooted in racism. Issues of structural racism in health care and social service delivery means that African American women often receive poorer quality care and experience more frequent denial of care (especially when it comes to enduring pain) than white women. These stressors and the cumulative experience of racism and sexism have a long-term psychological toll that in turn puts African American women at higher risk for a range of medical conditions that threaten their lives and their infants’ lives.¹²

To battle these issues, public health agencies are working to increase investment in family support and health care programs to provide and improve the quality of care for African American women and other underserved communities. Further, there’s been a more recent push to create standardized assessments for women and infants and train providers to address bias and racism in patient care.¹²

Top Public Health Concerns of 2022: A Look Ahead

Public health issues are rarely cleanly resolved in one year. Many take years to address in countries such as the United States and decades to resolve globally. So while we anticipate encountering each of the issues listed above in 2022 and beyond, there are a few that we suspect we’ll see even more attention on in the future.

Upcoming Public Health Topics:

• Vaccines
• Emerging diseases
• Drug resistance
• Lasting effects of COVID-19/”Long Covid”

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