Confronting Zika with a Population Health Paradigm

With the arrival of the Zika virus in the United States, the nation and its medical organizations are mobilizing to prevent its spread. Integral to this process is sound population health practices.

Seemingly Innocuous

image of a mosquito on skin

Meet Aedes Aegypti, the main courier of Zika / WHO

If you haven’t heard, the Zika virus is one of the biggest infectious diseases to roll into the states since the likes of West Nile and H1N1. Although the disease can be sexually transmitted, what’s more troubling is that it is known to spread via Aedes aegypti mosquitoes.

At first glance, Zika doesn’t seem like that threatening of a harbinger. The initial symptoms of the virus are for all intents and purposes relatively innocuous: headache, muscle pain, fever, rash, conjunctivitis. In fact the symptoms are so mild that in many cases those infected with Zika are completely unaware of it. The thing is: it’s not those who are infected that are at risk. It’s their offspring.

Zika is known to cause birth defects such as microcephaly, in the children of mother’s who’ve conducted the virus. The danger is not just for our generation, it’s for future ones.

Not Enough Funds

The United States government recently started putting funds towards combatting Zika. President Obama initially asked for $1.9 billion to combat the disease. The House of Representatives instead opted for a bill that wold send a meager $622 million, most of which is currently going to other Health Department like programs like those that are confronting ebola. The Senate’s package on the other hand proposes $1.1 billion, which will not only give the Health Department ample funds to educate and prepare Americans, but also will give the CDC the amount of funds they’re asking for research–research that includes the discovery of a vaccine.

image of Dr. Frieden speaking at Senate.

Dr. Frieden urging the Senate to approve more funding to combat Zika. (AP Photo/Manuel Balce Ceneta)

Today Dr. Tom Frieden of the CDC urged the nation’s officials to act and act soon: “We have a narrow window of opportunity to scale up effective Zika prevention measures, and that window of opportunity is closing.” But with the House and Senate empty during Memorial Day weekend holiday, the unofficial start of mosquito season, it looks like any action is to be delayed.

Population Health in Action

For instance, in New York, Governor Andrew Cuomo has initiated a state-wide initiative to prepare for Zika. In addition to aggressively pursuing methods of staving off Zika by deploying mosquito traps and staying vigilant for any outbreaks, the state has put forth a number of initiatives that directly assist residents. Such as issuing Zika protection kits to pregnant women who recently traveled or lived outside the country.

Of course the strength of population oriented health program is not just in having the care-providing agency (in this case government) provide aid itself; it’s in training individuals to be Zika-fighting agents on their own. In New York this is being seen in efforts that educate residents to reduce standing water, use larvicide tablets where standing water does exist, and assiduously utilize mosquito deterrents such as mosquito repellant. Most importantly, the state is asking residents to point out large outbreaks of mosquitos. Granted, it might be hard for the average person to figure out what a large outbreak is, in comparison to an average outbreak. But by putting out feelers, by activating more individuals to report data, the state is enacting the fundamentals of an effective population health campaign.

New York is not alone in gearing up for the arrival of Zika. Bringing further aid, the CDC has made it possible for states and province to apply for additional funding to combat Zika locally.

Micro to Macro

At the core of modern population health practices is the triple aim:

  • Increasing the prevalence of evidence-based, preventive health services and behaviors
  • Improving care quality and patient safety
  • Advancing care coordination across the health care continuum

It doesn’t take that much of any eye-squinting to see how the fundamentals of the triple aim can been seen in the government’s mobilization against Zika.

  • Increasing the prevalence of evidence-based, preventive health services and behaviors

By educating people on the risks of Zika and empowering them with the means to prevent it, the government is using the research at their disposal (evidence-based knowledge) to spread preventive health services and behaviors.

  • Improving care quality and patient safety

The more that the government learns about Zika, the more empowered it is to combat it–one of the reasons why additional funding for government agencies is so important. The ultimate boon here being a vaccine.

  • Advancing care coordination across the health care continuum

Similarly to the first aim, this includes empowering citizens to take on Zika themselves. However that this just one point on the healthcare continuum. Under the the larger government’s guidance, we are seeing individual government agencies (like the CDC) collaborate, in addition to a number of private sector organizations (including Gilead Sciences Inc., Inovio Pharmaceuticals Inc., and Intrexon Corp. With the government’s oversight, these organizations are acting less in silo, and more as individual fingers of the same hand.

an infograph depicting what people should to protect themselves from ZIka

An example of the sort of materials being circulated by government agencies, in this case the CDC, in order to educate.

As idea of population health grows in popularity, we’re seeing more and more hospitals take health to the people. It’s not just enough to wait and see who comes. It’s a matter of going into the community. It’s about seeking an integrated, holistic and widespread approach.

Mark Behl