As I was walking through the train station today, I couldn’t help but notice the wide variety of people walking with me. Philadelphia is a diverse city, and you could see it just from the people commuting in on the same train. There were those with darker skin, others with light skin. There were tall folks and shorter folks. There were slim and bigger people. A pair of scientists behind me talked about the biotech conference they were heading to in New York, while a pair of young adults were anxious about their upcoming exams. Most spoke English, some did not.
As a public health worker, I often find it hard to tailor my public health advice to fit all populations. During the pandemic, I thought of the marginalized and minoritized communities whose members could not take off from work if they were sick. Or I thought about single moms and dads who used school as daycare while they worked. I wondered if they could afford daycare if they were “essential” workers, or if they were workers whose bosses did not allow time off even during a pandemic that killed millions.
And then I thought deeper than that, to the genetic differences between us, which put some of us at higher risk of diseases and conditions. And I thought about the genetics that were protective for some of the bad outcomes that we were seeing during the pandemic. Then again, there were people with “good genes” in bad situations, and vice-versa.
If I stood on the train platform and gave out any public health advice, how many people would it apply to? Most importantly, how many people would heed it? So how do you give advice that will have the most impact, save the most lives, cost the less suffering?
On Average, and in the Long Run
In public health, you are mostly talking about means and standard deviations. For example, take the impact of COVID on children. While children were the least likely to have a severe outcome from COVID, the disease was still a leading cause of death in children during the pandemic. It is now also a leading cause of long-term physical and psychiatric disability from long COVID.
On the one hand, I can tell parents not to panic if their children test positive for COVID. But I also need to remind them to check with their pediatricians, especially if their children have underlying medical conditions or developmental delays. On average, and in the long run, most children with COVID will be okay. It’s those who will not be okay that worry me. And, because we cannot predict who will be okay and who won’t with 100% certainty, we recommend interventions like school closures, masking, and vaccination for everybody.
This Really Irks Antivaxxers and Other Such People
As you can imagine, the idea of a global recommendation on things like vaccination or masking is an anathema to certain people. Anti-vaccine activists often say COVID-19 vaccination is not necessary in children, because they don’t have high rates of disease and/or bad outcomes. They ignore those who have died, those who have been hospitalized (with all the costs and worries that hospitalization in the United States alone brings), and those who are now going through long COVID. (Vaccination lowers the risk of long COVID, by the way.)
Whether they choose to ignore those affected, or don’t know the real numbers, is kind of hazy. Some do outright lie about the impact of a disease like COVID, while others don’t know better. I’d like to give them the benefit of the doubt, but some in the anti-vaccine camp have made up stories about people being killed or injured by vaccines.
Others who “don’t like being told what to do” point to personal experience as a reason why public health recommendations don’t apply to them. “I’m healthy as a horse,” they’ll say. “I don’t know anyone who has died from it,” they claim. “Only obese and elderly people should get it. They’re the ones dying from it,” they’ll add.
Well, that may be the case in the social bubbles they inhabit, but the evidence points to everyone being at risk for infection, disease, and complications. It’s just that the risk gradient is different, and it depends on many factors. Teenage athletes with good lungs can probably lose some lung function without any problems after the disease. Elderly, lifelong smokers probably can’t. But some teenage athletes will die, and some elderly smokers won’t.
Trust, But Verify
Maybe I’m old fashioned, but I don’t think we should get our medical advice from random people on the internet. But I understand we are living in a new age of information. The truth is that healthcare is not available for everyone, but the internet is almost universal. So I don’t fault people who go to places like Reddit to ask questions about personal health matters.
That said, we need to be careful when we do that. It is difficult to verify if a person giving medical advice is a licensed healthcare provider. Misinformation and disinformation are rampant. And bad advice taken from the internet has hurt people when they take that bad advice and apply it to their specific situations.
This is why I’m always telling you that “your mileage may vary” when it comes to general public health advice I give. And that is why I need you to trust me, but verify what I’m telling you… Or what anyone else tells you. Look at our references, or the hyperlinks in our recommendations. But consult a healthcare provider in person (or at least via telehealth) whenever possible.
Trust me, I’m a doctor… of public health.
The key takeaway from this article is that public health advice, while generally beneficial, may not be universally applicable. Individual factors such as genetics, lifestyle, and social circumstances play a significant role in determining the effectiveness of any health recommendation.
We must embrace a nuanced approach to health, recognizing that a one-size-fits-all solution is often inadequate. By understanding the limitations of generalized public health advice and prioritizing personalized care, we can promote better health outcomes for everyone.
Always verify any public health advice you receive with a healthcare professional. Your health is unique, and your healthcare should be too.