Local Health Threats

* It is indeed ironic that you published Gregg Easterbrook’s perceptive piece on public fear of exotic diseases (“High Anxiety,” Opinion, July 9) at a time when Los Angeles County is engaged in the wholesale dismantling of its public health structure. Fearing a distant outbreak of Ebola virus that killed a few hundred is ridiculous, but there is not enough concern over tuberculosis, cholera, plague, measles, influenza and AIDS in our country.

Between 1988 and 1991 in our country we had over 7,000 reported cases of measles resulting in 2,700 expensive hospitalizations and 40 deaths. Why? Because our immunization rate declined. There are approximately 200,000 births per year in our country. That’s a million in five years. So when we let our guard down, it doesn’t take long to build up a pool of unimmunized children to fuel an epidemic. What Easterbrook calls “a mild resurgence” of tuberculosis, we in the medical community call an epidemic. We had 1,800 cases in 1994 and more than 1,900 the year before. Although TB has probably peaked, it may not have. Budget cuts have resulted in county clinics seeing 10% to 15% fewer patients so the decline in TB might simply be a decline in reporting. Cholera used to be a distant scourge affecting unfortunate souls in South America, but it is now in Mexico knocking on our back door. Plague is commonly found in rodents in the foothills of Los Angeles. AIDS has killed almost 20,000 people so far in our county.

The current county budget plan to cut public health 20% looks innocuous until you consider that public health has been severely reduced and “reorganized” in past years. In 1972 the county’s 25 health districts each had a health officer and a deputy health officer, both physicians, and budget to hire private physicians as needed. Since then the population has risen from 7 million to more than 9 million and there are now only a dozen health officers who have to beg for services and supplies from the hard-pressed clinics. Slated to be eliminated in the budget this year are health educators who annually organize the program to give seniors influenza shots. The county inoculated 150,000 seniors last year and without the program, a heavy flu season could result in hundreds, even thousands of deaths this winter.

VINCENT GUALTIERI MD

President, L.A. County Medical Assn.