Throughout history, we have seen many different trends in disease. While our great-grandparents worried about polio, whooping cough, mumps and measles, we rarely see those diseases today. Now, we are far more likely to have heart disease, diabetes and asthma than our ancestors were.
Discover Rush recently sat down with Miguel Salas, MD, MPH, a family practitioner at Rush University Medical Center who has practiced medicine in his native Colombia and the United States for more than two decades, to discuss how diseases have changed and what is responsible for the new trends.
Go directly to Web-exclusive questions and answers.
Q. Which diseases do you see frequently now that weren't as common 50 or 60 years ago, and why are these diseases on the rise?
A. We obviously did not see HIV/AIDS at all; today, it is a worldwide epidemic. And because of globalization, which enables people to travel around the world, we've seen more viral and respiratory diseases, such as SARS and malaria, coming into the United States from abroad.
Industrialization is another factor that has dramatically changed the trends in disease over time. As a society becomes increasingly modernized, it has to find ways to keep pace with the growing demand for manufactured goods and services. This emphasis on growth and innovation creates a number of secondary effects, which, over time, become triggers of diseases.
Q. What are those effects?
A. There are more buildings and factories, more vehicles, innovations such as plastic and air conditioning, etc., that have gradually polluted the air, contaminated the water and increased people's exposure to chemicals. This has contributed to a dramatic rise in the number of cases of asthma, allergies, respiratory illnesses and metal poisoning since the 1960s.
Also, with the increased emphasis on convenience, people are now consuming more processed foods and fast foods, which are high in fat, sodium and sugar. This greatly increases their risk for diabetes, high blood pressure and heart disease. All of these diseases have reached disturbingly high levels in this country, particularly among people who are black or Hispanic and from low-income neighborhoods. These problems are due partly to genetics but also to environmental factors: poverty, low education levels, sedentary lifestyles, lack of fresh foods and limited access to health care.
Q. How do you determine when a disease has become reason for collective concern?
A. If at a given time the total number of cases in the population is increasing, and the incidence of that disease the number of new cases is decreasing, it means doctors are doing a better job of diagnosing it and staying on top of the problem. But if the incidence is also increasing, you have to say something is wrong; the medical community is not doing a good job of preventing, diagnosing or treating it, and then it becomes a problem that needs to be addressed.
Q. Moving forward, what do you see as the greatest public health challenges?
A. I think we will continue to see increases in the conditions obesity, diabetes, high blood pressure, heart disease, respiratory infections associated with industrialization. We'll need to find effective ways of preventing and managing these problems. The good news is that medicine has made great progress so far, and we will continue to find more answers in the future.
Q. What are health care providers doing to address today's health epidemics?
A. We are addressing diseases on multiple fronts. First, there is a greater focus on prevention. As family practitioners, we are trying to increase awareness and educate people about how to prevent these diseases rather than simply treating them once they are already sick. For instance, the trend in breast cancer has been steady not decreased, but steady because women are more aware about how to detect it early. And the trend for cervical cancer has actually decreased because we have been able to screen for it using PAP tests and, more recently, prevent it with vaccines.
Second, doctors are conducting research to find better ways of preventing and managing chronic health problems. Take diabetes, for instance. There are some interesting studies going on at Rush right now looking at the type of diet and amount of exercise people need to effectively control their diabetes.
Doctors at Rush are also conducting a large-scale, community-based, prevention-focused study in which health care providers are partnering with Chicago's Humboldt Park neighborhood to address diabetes, which is an epidemic among Latino residents in Humboldt Park. The goal of this grassroots intervention is to help implement lasting changes in behaviors, attitudes and resources exercise facilities, fresh foods, etc. that will improve the health not only of this generation but of future generations.
The information from these types of studies will ultimately help health care providers find solutions for larger populations.
Q. Which medical advances have had the greatest impact on disease trends?
A. Vaccines have obviously had a huge effect on disease. Largely thanks to vaccinations, over the past 50 years we have been able to decrease, control or even eradicate a great many diseases that were once widespread: polio, whooping cough, smallpox, mumps, measles. These diseases claimed millions of lives globally; now, in industrialized countries such as the United States, they are rarely seen because we are now able to prevent them.
In addition, the evolution of imaging (creating images of the body or parts of it) has led to a dramatic improvement in our ability to diagnose and treat problems. In the past, we had only X-rays. Today we have numerous types of diagnostic tests, which is one of the main reasons that we are diagnosing more now than in the past.
For instance, 20 or 30 years ago when you had abdominal pain and you didn't know what was causing it, you had to do a scope sedate the patient and insert a flexible tube into the mouth and down to the gastrointestinal tract. Nowadays, you order a CT or an MRI and you can immediately see whether there is an inflamed or obstructed organ. Doctors are more prompt to diagnose and, as a result, to treat and sometimes reverse the process of an illness.
Q. How has the electronic age changed health care?
A. Certainly with the Internet, there is a great deal of information readily available now that most people didn't have access to 20 years ago. I think that's a good trend because people are now more aware of diseases and how to prevent them. They can go online and look up heart disease and see what the risk factors are and how much exercise is recommended to keep their heart healthy and which foods promote heart health. They aren't just getting health advice once a year at their doctor's office.
Of course, the Internet is not meant to replace talking to a doctor, but it's a good place to find information on a variety of health topics and even to find the right doctor for your needs.
Another benefit to electronic communication is that it enables health care providers to better communicate with each other. Doctors have more opportunity to discuss cases with other doctors, including specialists. We can share information, test results and opinions much more easily and much faster than ever before, and we can meet without having to physically be in the same place.
And obviously, with an electronic medical records system such as we have at Rush, health providers can immediately access a patient's medical history and share that information with other clinicians who need it. It all means more efficient, effective care for patients.
Miguel Salas, MD, MPH, is a family practitioner with Rush University Family Physicians. His clinical interests include comprehensive preventive services for adolescents and adults, women's health, and community outreach and education.
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