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The Veterinarian's Role in Public Health
Most pet owners think of their veterinarian as simply their pets’ doctor. Few are aware of the significant role vets play in public health matters, and are surprised to learn that veterinary professionals are an important link in the chain of officials who monitor public health.
And now, veterinarians with pet animal practices are being encouraged to take an even more proactive role. A number of health agencies are looking to keep them in the loop, so to speak.
The concern is zoonoses (pronounced zoo-no’-seez), the spread of disease from animals to humans, and it concerns organizations such as the Centers For Disease Control and Prevention (CDC), National Institutes of Health (NIH), the World Health Organization (WHO) and others.
For the most part, the worldwide focus has been on the transfer of diseases from livestock to humans. In recent memory, for example, we’ve had to deal with such threats as mad cow disease, swine flu, avian flu, and West Nile virus.
A Stepped-up Focus On Pets
While livestock remains a key target in monitoring zoonoses, officials are taking a closer look at companion animals, and hoping to advance the monitoring and reporting of zoonoses on that front.
Pet owning families are subject to a number of diseases that can pass from our pets to us and others in the household. Fleas and rabies are probably the knee-jerk response when pet owners consider diseases we can catch from our pets, but there are so many others.
Cat owners may think of cat scratch fever or toxoplasmosis, although the latter is probably more widely spread through the careless handling of raw meat. In addition to bacteria and viruses, our pets can infect us with all sorts of nasty varmints.
There are the creepy crawly parasites such as fleas, ticks and ear mites; and also the parasites we don’t see, such as tapeworms, hookworms and roundworms. And then there’s ringworm. It’s not actually a worm, but a highly contagious fungus we can catch from our pets. It gets its name from its appearance: a round, scaly red patch with a raised border.
The Concept of Comparative Medicine
Comparative medicine studies how diseases move from species to species, including humans, and relies on the efforts of veterinarians, physicians and public health officials. The hope is that there will be increased collaboration among these professionals in three main areas: individual health, population health, and research.
Individual Health doesn’t only concern itself with people who own or work with animals. People who receive organ transplants from donors who own or work with animals are also at risk, for example.
And the risk isn’t only from cats and dogs, or to people with compromised immune systems. Pet birds, rodents, amphibians and reptiles can also pass a variety of diseases on to humans; the healthy as well as the immunocompromised.
But there's a little roadblock in this area. Physicians and veterinarians are the key players, yet many physicians hesitate when it comes to discussing the role animals play in the spread of zoonoses, and few sick people think of veterinarians as having a role in human health, so don't think to consult one.
According to the CDC, “veterinarians who treat animals that suddenly become ill with confirmed infections should assess the risk for zoonotic potential and inform the animals' owners accordingly.
From a medical-legal standpoint, veterinarians are obligated to do this, but the extent to which they should inform animal owners and ensure that they seek medical attention varies depending on the circumstances.”
The veterinarian can play an important role in human health by collaborating with physicians. For example, a physician may have a patient whose immune system is compromised, but who insists on keeping their pet.
But roles must be clearly defined first, lest the vet be put in a position of appearing to be practicing medicine. The vet could monitor the animal’s health by providing regular check-ups and keeping the physician updated.
Population health can be a real bucket of worms. For instance, some states may place the responsibility for tracking, say rabies, with local boards of health, while tracking livestock health falls under the state’s agricultural authority and wildlife concerns fall under the state’s environmental authority.
Relatively few states require veterinarians to report zoonoses to their local public health authorities. A CDC inquiry found that only 8 of 43 responding states had such a requirement, and two of those only required the reporting of rabies.
One problem is that most state departments of agriculture and environment suffer from a lack of funding, and therefore do not have the financial or human resources to proactively engage in prevention and control. Also, many such agencies have historically been in business primarily to promote agriculture or conservation.
Public health officials are hoping to see not only collaboration between animal and human medicine, but also between state and local agencies so that the efforts of medicine, veterinary medicine and public health will overlap.
Research by collaborating human and animal medicine practitioners seems to be nearly hamstrung. The number of physician-scientists applying for NIH support has been pretty much stagnant since the 1970’s while the number of veterinarian-scientists is presently considered dire.
According to the CDC the reasons are similar for both medical and veterinary students: an emphasis on clinical care, student-loan debt, and a lack of mentors and research opportunities.
Medical schools now emphasize primary care and care for the underserved, while vet schools, because society has said to, have shifted their focus from comparative medicine research and livestock medicine to companion animal medicine.
We’d all benefit greatly if physicians and veterinarians collaborated on comparative medicine research projects that focused on the relationship between diseases and their hosts, while worldwide, public health organizations are hoping that veterinarians, physicians, and public health officials will work more closely together to understand, control, and prevent zoonotic diseases.
One step the CDC suggests is for medical, veterinary and public health schools to offer courses on zoonotic risks that integrate individual health, population health and research perspective.
Professional journals serving human and veterinary medicine are likely reporting on the subject, so your veterinarian might be familiar with the stirrings that are occurring all over the globe. It might be interesting to learn if their practice or professional association is doing something about reporting zoonoses and being kept in the loop.