Drugs are one of the miracles of nature and science. It’s really amazing how use of a drug can relieve a woman of something as painful as childbirth or how a simple pill can relieve one of an unbearable headache. And yes, they are effective in almost anything, from deadly diseases to the simple anxiety you have before going up on stage. This ubiquitous value of drugs has made it an integral part of our lives but one should not be ignorant of their potential side effects or dangers.

Most of the attention has been on drugs of abuse like opiods, alcohol, marijuana, cocaine etc. These drugs of abuse littered everywhere with different names have a common feature of acting on the central nervous system to give various sensations leading to problems with dependence and addiction. However, some drugs like viagra can be abused for purely social reasons. The psychosocial effects of these drugs are so devastating and can even result in death directly from overdose or from risky behaviour induced by them. It would have been great if drugs of abuse were the only problem but nothing could be farther from the truth.

The father of toxicology, Paraclesus once said that any substance is a poison but the dose makes the difference, and drugs are no exception to this. Indeed, drugs (with no exception) are much more toxic than we think. For example, only 7g of the pain medication, acetaminophen (one of the most common drugs in suicide attempts and accidental overdose) can lead to serious liver damage. Drugs use is inevitable; however, they must be used only for the right purpose, at the right time and in the right quantity. Sadly, over the counter drugs which have the potential to be more toxic than the tightly restricted drugs of abuse are overused by individuals especially the elderly. The older age group tend to abuse drugs more because of fear of diseases and ignorance of drug toxicity, chronic conditions and for pain relief. Overuse is not solely from the part of the user but also from the health care giver. It can be due to over-prescription or prescribing to feel like one is doing something. Finally, overdose is an effect of the widespread availability of drugs.

Since all drugs are toxic, why are some drugs, especially the drugs of abuse, firmly regulated? Perhaps, because of their predisposition for addiction and dependence… Okay but what of the legalization of cannabis (marijuana) in Canada, and what does this mean for other leisure drugs? These questions are all connected to the problem of availability and distribution of drugs. After the exclusive use of prohibition control, governments may be slowly tending towards controlled restriction of drugs. The same ideology is behind the provision of safe injection sites for intravenous drug users. It is not to encourage drug use but to control the negative public health impacts of inappropriate use. This form of control provides drugs adequately through registered pharmacies and eliminates illicit drug use which can circulate fare, more harmful drugs. Irrespective of the preceding paragraphs, drugs remain miracles of nature and science… hence; the governments and health professionals must ensure that every individual has proper drug coverage and knowledge respectively.

The war against infectious diseases has stretched the health care systems beyond their limits and ushered in the widespread use of antibiotics and vaccines. It is a fact that infectious diseases kill very swiftly as evidenced by the fact that deaths due to tuberculosis exceed those from both world wars combined. However, most infectious agents are destroyed by antimicrobial drugs or vaccines. On the other hand, NCDs have no antibiotics or vaccine thus leaving preventive medicine and palliative care as the only solutions, at least for now. These diseases collectively known as NCDs not only account for 71% of all global mortality but also contribute to significant morbidity resulting in reduced health adjusted life years. There are many diseases under this umbrella but four of them are most common and significant due to the high prevalence and mortality rate associated with them. They include: Cardiovascular disease, Cancer, Respiratory disease and Diabetes.

NCDs are caused by an interplay of genome and exposome, the exposome is a more ethical and realistic target of control. As a result, these major NCDs share four common risk factors including alcohol abuse, tobacco use, physical inactivity and unhealthy diets. These modifiable risk factors are all lifestyle habits that when addressed can greatly reduce the burden of these diseases. The natural question now follows, how can these risk factors be modified to address the NCD epidemic? Apart from general public health education on the negative impacts of unhealthy lifestyle habits listed above, there needs to be policies to guide and promote individuals towards healthy living such as restricting the availability of alcohol, tobacco and unhealthy diets such as salty and sugary foods. These could involve increased taxation, clear stipulation of negative health warnings and gradual reduction in activities that negatively impact health. One might wonder: why beat about the problem, why not ban every harmful product? Well, things are never that simple or easy. Most governments, very influential individuals and companies invest in, and even own these some of these health deteriorating products. More so, straight prohibitions are not only ineffective to maintain but also gives room for illegal routes of entry which would further increase financial costs on the system. Physical inactivity and unhealthy diet as risk factors for NCDs have resulted in the recent obesity epidemic. Again, policies like building safe and long walk areas to steer the population towards more activity as well as increased accessibility to healthy foods such as fruits and vegetables will go a long way to address the problem.

The chronic nature of these diseases coupled with little hopes of definite treatment has caused serious problems with hospitalization. How do we weigh the scales… the chances of disease complication and then living one’s entire life in the hospital? It seems homecare; self-care and increased utilization of paramedics and preventive measures may help address the problem.

The World Health Organization defines mental health as the condition of well-being in which individuals realize their full potential, deal effectively with normal levels of life stresses, work productively, and contribute to their community. Mental health encompasses emotional, psychological, and social well-being which affects our thoughts, feelings and actions. It also determines how we handle stress, relate to others, and make choices. As a consequence, mental health is important at every stage of life, from childhood and adolescence through adulthood, mental health is influenced by Biological factors such as genes or brain chemistry, Life experiences such as trauma or abuse and Family history of mental health problems. Mental health problems can affect anyone, irrespective of age, gender or social class.

Mental health involves the general mental wellbeing of an individual, not just the absence of mental illness diagnoses. Considering this, its scope involves:

• Chronic disabling physical conditions
• Psychosomatic conditions
• Mental illnesses like depression, schizophrenia, Anxiety eating and sleep disorders
• Neurodegenerative disorders

There are several disturbing issues around mental health problems that require attention such as distribution and poor health coverage, labelling, stigmatization and institutionalization. Firstly, the distribution is quite disproportionate as is evidenced by the fact that people with poor socioeconomic conditions such as low income earners and minority groups tend to have more cases of mental health problems. A lot of psychiatry is about diagnoses but little about treatment with individuals being labelled to a particular group and stigmatized. It is not uncommon for employers to get rid of mentally ill workers; worse still, they find it difficult to get a job even after treatment and may end up abused and neglected.. Most primary health centres are unequipped and unprepared to tackle mental health problems and resolve to institutionalization which worsens the situation. Mental health problems are perhaps the oldest significant public health burden with relatively ineffective solutions that are devised due to the ideologies of time- religion for the old times, institutionalization for the late 19th and 20th centuries, 21st century medicalization of diseases and current holistic approaches.

Generally, good lifestyle habits such as eating healthy diet, physical activity, not only translate into good mental well-being but also give individuals a sense of control over their health. Support groups and other forms of psychotherapy are great ways of dealing with some problems. Also, there is increasing involvement of alternative approaches like musical therapy, expressive arts, yoga and other forms of physical therapy in mental health treatment. Indeed, even little things like taking a walk or meditation in this globalized, busy and fast paced 21st century world punctuated with activities can benefit ones mental well-being.

With the increase in the knowledge and importance of oral health to overall wellbeing, two vital questions come to mind: First, why was oral health omitted from the UN SDGs to improve global health care on September 27, 2018 at Brussels? And, by direct extension, why was dental health omitted from the public health insurance schemes of many developed countries?

Dental Health, according to WHO is freedom from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that hinders or limits one’s capacity to bite, chew, smile and speak. Poor dental health which hinders psychological wellbeing, is an increasingly neglected public health menace that mostly affects low socioeconomic individuals who cannot afford out of pocket visits to the dentist; dependent population including children, seniors and people living with disability; and of course people ignorant of the need for good dental health. There are several benefits of good dental health such as prevention of common dental problems including tooth ache, dental caries, tooth decay, halitosis etc which cause significant discomfort and morbidity. There is also serious correlation between poor dental health and heart disease as well as depression. Further, systemic diseases such as AIDS, diabetes and genetic conditions like oro-facial clefts can impact oral health providing clinicians with diagnostic mirrors. Aside these medical issues, good dental health improves psychosocial wellbeing as your regular teenager with good dental health would laugh more comfortably than one without.

It is important to address some of the issues that affect dental health such as lifestyle practices including sugar and alcohol intake, tobacco chewing, smoking, vaping, use of dental amalgam, dental fluorosis and poor dental coverage.

Excessive consumption of sugary foods has long been known to predispose one to dental caries, decay, infections and abscess if untreated.

Alcohol and tobacco are serious risk factors for oral carcinoma which is the third most prevalent cancer in Asia.

Vaping has been suggested as an alternative to smoking tobacco due to the well-known negative health impacts of smoking; however, there is inconclusive research about whether it is better for oral health.

There have been concerns over the use of the mercury containing dental amalgam to fill cavities due to negative effects of mercury on health- the 2013 Mina Mata convention and phase down on dental amalgam was part of the move from restorative to preventive oral care.

Despite widespread evidence of the reduction of dental caries by fluoridation, there is increasing challenge to this due to fluorosis and other negative health impacts like increased hip fractures.

Finally, and most worrisome is poor dental coverage reflected by the omission of oral health in public health insurance. Can we expect to tackle the oral health problem without coverage? Of course not… The first step to addressing oral health problems is coverage with specific attention to the high risk groups and individuals with conditions like diabetes, pregnancy etc. The government can help to slowly modify lifestyle habits by setting public health policies geared towards good oral health like increased taxation of sugary foods and reduced availability to school canteens, gradual reduction in amount of tobacco in cigarettes. More so, the general public should be educated in regular ways to achieve good oral health such as brushing twice or thrice daily, regular flossing and annual dental check-ups.

The term, Alternative medicine is used to describe a wide range of medical systems or processes, diverse therapeutic practices and health care systems that fall outside the boundaries of conventional biomedicine because they lack biological plausibility (proof). Alternative medicine can also be called complementary medicine, pseudo-medicine, unorthodox medicine, unconventional medicine, holistic medicine or new age medicine.

Alternative medicine has been around for hundreds of centuries with its rise in the west attributed to the counterculture movement of the 1960s. By mid-1970, the expression “alternative medicine” had become a household name and was seen as natural, effective treatments or substitutes to science based medicine. Alternative medicine has since gained popularity and some studies and research agree to its efficacy. Today, a lot of practices, products and therapies which are integral to health can be classified as Alternative or Complementary medicine. They are also beneficial to public health, and include: acupuncture, acupressure, naturopathy, homeopathy, reiki, color therapy, shamanism, reflexo-therapy, Chiropathy, music therapy, regular massages, hot yoga etc. Individuals whose primary profession involves one or more complementary or alternative therapy are known as complementary therapists.

Some alternative treatments such as folk medicine and herbal products have been used for millennia to combat a whole range of ailments. Examples include the use of herbs such as cilantro as folk medicine anticonvulsant; Exercise is used as a fundamental treatment and intervention method within psychiatric patients as it helps them manage and reduce their anger, depression and other symptoms. Studies have shown that compounds from elder berries can directly inhibit viral infection in human cells and help strengthen a person’s immune response to viruses, thus can be used in cases of flu. The American heart association once studied the effect of hot yoga on blood pressure and found out that after 3 months, individuals being studied had lower blood pressure. These examples seem to approve the use of alternative medicine as a substitute to conventional medicine; however, caution should be applied as alternative medicine could also cause harm given its important characteristic of lacking scientific validation, compared to conventional medicine. Significant drug interactions caused by alternative therapies may negatively affect functional treatments by making prescription drugs less effective. In addition, it is difficult to test the efficacy of alternative therapies using clinical trials.

Due to the popularity of alternative medicine, its practices and products should be adequately regulated as it is always painted positive given that many patients are willing to choose the friendly colorful images of herbs and herbal treatments over the more threatening presentation of drugs. Another reason for this preference over conventional medicine is the ease of accessibility in the developing countries where one- third of the population lack access to the essentials of medicine and this becomes the only way. About 80 percent of people consider alternative medicine better than conventional medicine because it is perceived to have less risks and side effects associated with drugs and therapies used in managing diseases. A survey of Americans found out that 88 percent of the population thought that “there are good forms of treatments that medical science did not recognize”. As a consequence, agencies like the FDA Should help create more policies to regulate the practices of alternative medicine and educate the general public on their facts, theories and limitations.

Cosmetics and beauty care products are one of the most consumed products in the world. There are many types and forms of these products found in constant distribution throughout the globe. According to an Article by the European Union, cosmetic is a general term that refers to any substance or mixture intended to be placed in contact with the external part of the human body such as the epidermis, hair, nails, lips and external genital organs. They can also be applied on the teeth and the mucous membranes of the oral cavity with the aim of exclusively or mainly cleaning them, changing their appearance, protecting them , keeping them in good condition or correcting odors.  Cosmetics are generally divided into leave on and rinse off products. A leave on product is a one that needs to remain on the surface to which it is applied for an extended period of time in order to effectively achieve it’s function, examples include perfumes, body and face creams, oils and ointments, leave=n conditioners, powders, lotions, antiperspirant etc. on the other hand, the rinse off cosmetics are those products intended to be washed off after a short stay on the skin or mucous membranes examples include shampoo, soaps , toothpaste and some conditioners .

Given their functions and significance in everyday use, cosmetics are made with the general intention of beautification and correction. However, many of these products contain numerous substances and chemicals that can be toxic to both human health and environment. Sometimes, the concept of going natural doesn’t ensure safety as some products still contain heavy metals that can still can still cause harm. Common toxic ingredients used in some cosmetics include Parabens- found in lotions and soaps; Asbestos- associated with talc found in baby powders; Parfum- in perfumes; Toluene- in nail polish and hair dyes, Polyethylene glycol- in shampoos an d sunscreen; Formaldehyde  and many others . These substances can potentially cause several health complications including endocrine disruption, allergies, irritation, , birth defects, respiratory problems , reproductive problems and cancer. For example, studies have shown that 99% of all cancerous breast tumor samples contained parabens. In addition to the health effects of cosmetics, they also pose some threat to the environment because they constitute chemicals that do not undergo decomposition or metabolic transformation after getting into the environment from body surfaces through bathing and washing. Chemicals from cosmetics are found in large quantities in comparison to other chemicals, and they are constantly released into the aquatic and terrestrial environment thus leading to pollution and intoxication.

With knowledge of the large quantities of cosmetics produced, circulated and used, one would expect or even assume that enough measures and regulations are taken towards ensuring their safety. Unfortunately, this is actually far from the truth… Health advocates say that the lack of strong regulation is a major problem as there are few laws that keep cosmetic companies and manufacturers in check and these laws are hardly reviewed allowing this problem to continue. Furthermore, some countries have no laws that require manufacturers to test the safety of the cosmetic ingredients and products before they go into the market. Needless to say, the governments, in association with global, public and international health organizations have to take measures regarding this issue. Health workers may also help with tackling this issue by moving motions for the quick review of the rules and laws covering the production of cosmetics. People should be informed about the dangers that these products could cause and seek advice on personal care products… we have the right to know!

The increasing population and industrialisation of the modern world has led to a vast increase in production of wastes which has drawn much public health attention. Waste management involves collection, transportation and disposal of wastes, which according to UNEP are substances or objects that are disposed of, are intended to be disposed of or are required to be disposed of by the provisions of national law. There are many types of waste but the most important ones are the municipal wastes which include house-hold and commercial wastes, biomedical wastes from health care centres and hazardous waste including electronic, explosive and radioactive wastes. Waste collection generally involves use of collection bins and bags- which are sometimes colour coded depending on the region or country, and are then transported with trucks to the disposal site. They are then burnt in an incinerator to reduce waste volume, or are buried in landfills which are typically distant from residential areas.

Aside the aesthetic importance of proper waste management, there are several important health and environmental consequences. Wastes dumped close to residential areas such as along the streets, roadsides, farm lands and in rivers could easily lead to all forms of pollution, which is another grave problem. Water pollution poisons the water we drink and harms aquatic life while Air pollution results in other environmental health problems like global warming and climate change. Land pollution from wastes and other hazardous wastes can lead to long term devastating effects on the population. Poor waste disposal can also increase vector-borne disease burden. Although nobody still thinks that wastes can suddenly turn into organisms like the 18th century man once thought, improper waste management could still lead to accumulation of disease causing organisms or vectors like mosquitoes, houseflies etc. Health care wastes can harbour potentially lethal infectious organisms like HIV, hepatitis viruses etc. Exposure to radioactive wastes could lead to birth defects, cancer and even death.

Given the vast amount of wastes churned out on a daily basis, the task of waste management is quite a challenging one. This seemingly challenging problem has actually given rise to a fast growing industry- the waste management industry which creates employment for a large number of people. Armed with principles of proper waste management- reduce, reuse and recycle, and seen in policies such as: “don’t waste your waste” and “zero waste campaigns”, these industries focus on recycling and conversion of wastes to energy. Unfortunately, this is not existent in developing countries and is not very effective in some developed nations; indeed only few countries like Sweden have waste industries so effective that they even import wastes. This Swedish success is partly due to government policies like progressive payment with more wastes that discourage waste generation.

Government can help by providing more waste storage and transport facilities to remove wastes from residential areas. Also, placing huge fines and setting up laws against improper waste disposal could help dissuade the public from dumping wastes carelessly. Public health officials can also help to educate the general public on the importance of waste management. If the health risks are effectively communicated and that everyone in their own little way can help, it becomes an easier task. Research into the long term environmental effects of current waste management methods has favoured reduction and recycling to be the most appropriate ways to handle wastes. International bodies like the EU should raise the minimum recycle targets to nudge member states towards this direction.

The effects of vector borne diseases have been strongly felt throughout the course of human history even though the relationship between vectors and diseases was not established until 1890s. Ever since then, they have been recognized as important global disease burden accounting for about 17% of all infectious diseases. Vector borne diseases are diseases that are transmitted by vectors- insects that harbour infectious agents. Vectors can harbour virtually any infectious agent including bacteria, viruses, protozoa and can transmit more than one infectious agent e.g. mosquito which transmits malaria and filariasis. Vectors also tend to be distributed based on the environmental parameters leading to unequal disease distribution, for e.g. mosquitoes in tropics and sand flies in Asia. However, the drastic effects of climate change coupled with advances in human transportation and industrialisation is blurring this line.

Despite being public health threats, vectors are also part of our ecosystem and help to create balance. Environmental parameters like climate change are perhaps the most significant causes of imbalance which accounts for the increased incidence of diseases. Also, pollution can serve as a breeding ground as seen in mosquitos or housefly in improperly disposed sewage. This reason coupled with weak public health response is why poorer communities, especially in Africa, tend to have more vector burden compared to the developed world. Another factor is seen in the late 20th century when the war over vectors was thought to be almost over. A shocking incidence followed- mosquitoes suddenly developed resistance over insecticides like DDT which was effectively used to control them. This is even worsened by the infectious agents that can also become resistant to drugs, and can even mutate to more pathogenic strains as seen in influenza. There seems to be really no way around these mechanisms of microbial adaptation, mutation and evolution.

Whether it’s the vectors or the organisms themselves, it takes time for these survival mechanisms to develop and it is within this time lag that public health responses and efforts can be useful to control the spread of these diseases. This is illustrated by the significant reduction of these diseases during the widespread public health campaigns in early 1900s. Generally vector borne diseases are controlled by educating the public on the importance of the environment on health; reducing pollution, better housing and sanitation could reduce disease spread. In addition, removing the source of these organisms like stagnant water and providing materials like nets to prevent their contact with people would go a long way in reducing spread. There should be increased provision and availability of vaccines for better coverage against infection as well as research into newer vaccines to include newer types of organisms. Funding of public health services in remote areas with higher prevalence is essential to educate people on the lifecycle of vectors and where we can intervene to limit their spread. Research into more efficient ways of vector control has led to novel approaches involving biological control like use nanotechnology such as nanoparticles and genetic engineering as well as the Oxitec friendly mosquitoes.

Human history is littered with horrors of disease outbreaks ranging from as far back as the Justinian plague to the recent Ebola outbreaks. These outbreaks could be global- known as pandemics like the 1918 influenza pandemic; or localized involving a large part of a continent-known as epidemics  like the 14th century bubonic plague that almost wiped out half of Europe. Most of these outbreaks are caused by viruses but some are also caused by bacteria and parasites. These infectious agents are mostly communicable, spreading quickly by air like influenza; localizing in body fluids like blood and saliva e.g. HIV or travel via vectors like mosquitoes as in the case of Zika virus and malaria parasite. Given the death toll from these outbreaks as evidenced by the fact that the bubonic plague claimed more lives than the First World War, it is important to understand why they happen and how to prevent, control or manage their occurrence.

There are several reasons that account for outbreaks. Firstly, infectious agents can become resistant to already available treatments and vaccines, something known as antimicrobial resistance. They do this by several forms of genetic adaptations like the antigenic shifts and drifts seen in influenza virus. Also, some infectious agents can create conditions for spread of other agents as exemplified in the resurgence of TB due to HIV. Secondly, environmental modification such as climate change can cause spread of pathogens via vectors from a resistant human population to a vulnerable population like the increasing incidence of dengue fever in the United States. Additionally, increased population pressure could lead to movement to uninhabited areas which results in exposure to newer pathogens and vectors. Improper waste disposal and sanitation practices could also lead to increased spread of these agents. There are also cases of biological warfare like the US anthrax attack in 2001. Finally, the higher rate of globalization and human travel can lead to a faster spread of these diseases before they can be controlled.

Most outbreaks are caused by novel agents or known agents which are resistant to already available modes of treatment. Consequently, they often constitute a public health emergency. With threats to health care givers and patients In hospitals, hospitalized care is paralyzed leaving public health prevention practices as the only safe and reliable method of control and prevention. Widespread education and awareness programs about disease symptoms, route of spread and vectors- if any, are important for identification and prevention of disease outbreaks. As stated in SDG goal 4, the importance of the environment to heath should be stressed to reduce the rate of climate change. More so, better sanitation practices would reduce the rate of spread. Government must also place strict restrictions to immigration, especially people from known affected areas and also quarantine if needed until effective treatments are discovered. There is really nothing to do about genetic adaptations but to keep on researching and providing drugs and vaccines to cover resistant organisms. Sadly, outbreaks will keep occurring probably because it is an evolutionary and survival mechanism for these organisms but we must also fight for our survival by being prepared and ready to control them.

Birth defects, also known as congenital anomalies, are growing public health problems which cause structural and functional disorders that result in malformations, malfunctions or syndromes that may present in-utero or after birth. Birth defects cause significant morbidity and mortality with increase in health care expenditure and psychosocial problems for the child and family throughout life. It is the leading cause of infant mortality and occurs worldwide with about 3% live births. In general, different birth defects are existent in different rates in different parts of the world probably due to differences in distribution of risk factors.

In the early 1940s, scientists thought that genetic factors, which are out of the control of health workers, were the only predisposing factors to birth defects. However, the discovery that German measles affecting pregnant mothers led to birth defect showed that relevant public health measures could be put in place to reduce these disorders and defects. Shortly afterwards, it was also observed that the use of the sedative drug- thalidomide, by pregnant women led to increase in Amelia in embryos while the anti-acne drug, isotretinoin commonly known by its trade name Accutane causes oro-facial clefts. These findings showed that drugs could also lead to birth defects. Subsequently, the number of agents that cause birth defects- known as teratogens, continued to increase due to widespread surveillance, monitoring and observation. Other infectious causes include protozoans e.g. toxoplasmosis; bacteria e.g. syphilis; and viruses e.g. HIV. Besides drugs and infectious agents, birth defects can also be caused by exposure to environmental teratogens such as radiation and heavy metals or issues with maternal health such as obesity, diabetes, pregnancy before 18 years or after 35 years, smoking and substance abuse especially alcohol which causes foetal alcohol syndrome.

Although many birth defects, especially those of genetic origin, are difficult to treat or prevent, public health has focussed more on educating the public through awareness programmes on those that can be prevented. Several research studies worldwide have unequivocally demonstrated that increased folic acid intake (above the given FDA range) reduces the risk of neural tube defects. Public health officers also partner and work with the FDA to ensure that there is a black box warning against use of potential teratogens. More so, awareness is continuously created for other causes of birth defects such as radiation and poor hygiene or sanitation practices. Most awareness campaigns are targeted towards the prevention of infection and have proven to be effective in addressing some causes of birth defects. Screening and advanced testing such as karyotyping or PCR are essential to the diagnosis of genetic defects like Down syndrome as well as to counsel parents on what to expect. Stem cell research and gene therapy, on the other hand, continues to give hope to families of children with genetic disorders.