Zika The Ghost Map Summary

The relationship between medicine and public health has a complex aspect. They both are essential to keep communities safe from illnesses. However, medicine focuses on individuals who are ill and public health focuses on preventing illness. The two fields of study share epidemiology as a common source of knowledge to achieve their goals. The Ghost Map by Steven Johnson tells the story of John Snow, the man known as “the father of Epidemiology”. Donald McNeil JR. follows a modern day use of epidemiology as a basis for medicine and public health in his book Zika: The Emerging Epidemic. This essay details the role of epidemiology as a connector between prevention and treatment of an illness.

In 1854, London was the leading industrialized city in the world with a population of more than 2 million without an infrastructure that can support the residents. It was inevitable that an infectious disease outbreak such as Cholera can occur and overwhelm city officials and residents. Due to Snow’s critical thinking going against the norm, he tracked the source of cholera and developed a prevention strategy. As Johnson (p.160) discusses, despite all Snow’s skeptics, he recommended the removal of the Broad Street pump and the outbreak quickly subsided. Considering the time, Snow gave a new perspective on how disease was spread. He used evidence based knowledge to challenge the efforts put in prevention and treatment of a disease. According to Johnson (p. 146), Snow’s ability to observe urban life combined with his medical

skills helped him develop the core of epidemiology. Indeed, he also established the intertwined nature of medicine and public health.
In contrast, chapter 7 of Haiti: After the Earthquake by Paul Farmer, analyzes a different outbreak of cholera in modern age but similar circumstances to the London’s outbreak in 1854. The most common things between the two cholera outbreaks were crowded living space and failed infrastructure for two opposite reasons. However, by the time the Haiti cholera outbreak occurred, there was enough epidemiological information about the disease. Despite that, there were disagreements in ways of prevention and treatment among experts (Farmer, p.191). Although there were several reasons attributed to the disagreements, it is undeniable that the failure of both sciences to achieve their goals in keeping Haitians safe was the central argument. The outbreak was catastrophic to Haiti, already burdened by the earthquake. Farmer (p. 205) writes, “It was the public health experts, Haitian and especially transnational, who were in discord…many argued that it would be too difficult to launch comprehensive prevention and care efforts in post-quake Haiti.” However, the cholera experts’ recommendation to address both prevention and treatment was based on previous surveillance of the epidemic (Farmer, p. 199). Similar application of knowledge was used by Snow to stop the 1854 London cholera outbreak. It seems that the failed attempt to solve the cholera outbreak in Haiti was due to medicine and public health professionals following a separate route using the same epidemiolocal knowledge. However, as experts from both fields work together, they did efficiently apply the epidemiological knowledge to prevent and control cholera.
Similarly, McNeil explores the application of epidemiology to gather knowledge about an emerging epidemic Zika.

Through his book, he explained the connection between public health and medicine using disease epidemiology. Even though Zika emerged as a new threat, there was an epidemiological surveillance being conducted since its first discovery in 1947 (McNeil, p.17). Thus, both medicine and public health based their search for solutions on this

knowledge.
In addition, the line between prevention and treatment of Zika appears to be the same, particularly as a risk of microcephaly in newborns. Unlike Snow’s recommendation to remove the water pump to control cholera, the most effective prevention method suggested to prevent Zika paused a greater conflict in society. McNeil (p.135) writes the Zika experts suggestion, “Women needed simply to not be pregnant. Not when the virus was peaking where they lived. Later- yes, fine, great, have children. But in the face of this unique epidemic, conception was uniquely dangerous.” The recommendation was accepted by public health officials and medical doctors as the best way of prevention; however, both struggled to relay this information. In fact, delaying pregnancy as a way of preventing microcephaly was effectively used by medical doctors on an individual level rather than a public recommendation (McNeil, p. 148). As McNeil implies in his book, there is an eager need for better prevention and treatment steps for Zika to avoid risks such as microcephaly. Indeed, controlling Zika will require the combined efforts of public health and medical experts.
Although, all three books discuss different parts of the world at different times, there is a common theme that connects medicine and public in all three. Both fields highly draw from epidemiological knowledge and their missions are more alike than different. In the era of globalization, it is essential to recognize the interconnection between medicine and public health for effective results. For instance, Snow’s successful cholera prevention was a result of combining his medical practice and observation of population illness trend. The collaboration between the two sciences can keep communities safe from illness by connecting their separate goals with the same purpose. After all, epidemiology serves as a strong component for both sciences and can bridge the gap between medicine and public health for a better partnership.