Health in the United States

Health in the United States is the overall health of the population of the United States.

Infectious disease

Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. CDC estimates that there are approximately 19 million new STD infections yearly. The two most commonly reported infectious diseases with 1.5 million total cases (2009) are chlamydia and gonorrhea. Adolescent girls (15–19 years of age) and young women (20–24 years of age) are especially affected by these two diseases.[1]

Chlamydia

Chlamydia remains the most commonly reported infectious disease in the United States. There were more than 1.2 million cases of chlamydia (1,244,180) reported to CDC in 2009, the largest number of cases ever reported to CDC for any condition.[1]

Gonorrhea

There were 301,174 reported cases of gonorrhea in 2009 (10 percent less than in 2008), making gonorrhea the second most commonly reported infectious disease in the U.S. In 2009, the gonorrhea rate for women was slightly higher than for men.[1]

Syphilis

In 2009, there were 13,997 reported cases of primary and secondary syphilis — the most infectious stages of the disease — the highest number of cases since 1995 and an increase over 2007 (11,466 cases).[1]

Specific outbreaks, plagues, and epidemics in the United States

Vaccination

The Advisory Committee on Immunization Practices makes scientific recommendations which are generally followed by the federal government, state governments, and private health insurance companies.

All 50 states in the U.S. mandate immunizations for children in order to enroll in public school, but various exemptions are available depending on the state. All states have exemptions for people who have medical contraindications to vaccines, and all states except for California, Maine, Mississippi, New York, and West Virginia allow religious exemptions,[2] while sixteen states allow parents to cite personal, conscientious, philosophical, or other objections.[3] An increasing number of parents are using religious and philosophical exemptions: researchers have cited this increased use of exemptions as contributing to loss of herd immunity within these communities, and hence an increasing number of disease outbreaks.[4][5]

The American Academy of Pediatrics (AAP) advises physicians to respect the refusal of parents to vaccinate their child after adequate discussion, unless the child is put at significant risk of harm (e.g., during an epidemic, or after a deep and contaminated puncture wound). Under such circumstances, the AAP states that parental refusal of immunization constitutes a form of medical neglect and should be reported to state child protective services agencies.[6]

See Vaccination schedule for the vaccination schedule used in the United States.

Immunizations are often compulsory for military enlistment in the U.S.[7]

All vaccines recommended by the U.S. government for its citizens are required for green card applicants.[8] This requirement stirred controversy when it was applied to the HPV vaccine in July 2008 because of the cost of the vaccine, and because the other thirteen required vaccines prevent diseases which are spread by a respiratory route and are considered highly contagious, while HPV is only spread through sexual contact.[9] In November 2009, this requirement was canceled.[10]

Schools

The United States has a long history of school vaccination requirements. The first school vaccination requirement was enacted in the 1850s in Massachusetts to prevent the spread of smallpox.[11] The school vaccination requirement was put in place after the compulsory school attendance law caused a rapid increase in the number of children in public schools, increasing the risk of smallpox outbreaks. The early movement towards school vaccination laws began at the local level including counties, cities, and boards of education. By 1827, Boston had become the first city to mandate that all children entering public schools show proof of vaccination.[12] In addition, in 1855 the Commonwealth of Massachusetts had established its own statewide vaccination requirements for all students entering school; this influenced other states to implement similar statewide vaccination laws in schools as seen in New York in 1862, Connecticut in 1872, Pennsylvania in 1895, and later the Midwest, South and Western US. By 1963, 20 states had school vaccination laws.[12]

These school vaccination resulted in political debates throughout the United States, as those opposed to vaccination sought to overturn local policies and state laws.[13] An example of this political controversy occurred in 1893 in Chicago, where less than 10 percent of the children were vaccinated despite the twelve-year-old state law.[12] Resistance was seen at the local level of the school district as some local school boards and superintendents opposed the state vaccination laws, leading the state board health inspectors to examine vaccination policies in schools. Resistance proceeded during the mid-1900s and in 1977 a nationwide Childhood Immunization Initiative was developed with the goal of increasing vaccination rates among children to 90% by 1979.[14] During the two-year period of observation, the initiative reviewed the immunization records of more than 28 million children and vaccinated children who had not received the recommended vaccines.

In 1922 the constitutionality of childhood vaccination was examined in the Supreme Court case Zucht v. King. The court decided that a school could deny admission to children who failed to provide a certification of vaccination for the protection of the public health.[14] In 1987, a measles epidemic occurred in Maricopa County, Arizona, and another court case, Maricopa County Health Department vs. Harmon, examined the arguments of an individual's right to education over the state's need to protect against the spread of disease. The court decided that it is prudent to take action to combat the spread of disease by denying un-vaccinated children a place in school until the risk for the spread of measles has passed.[14]

Schools in the United States require an updated immunization record for all incoming and returning students. While all states require an immunization record, this does not mean that all students must get vaccinated. Opt-out criteria are determined at a state level. In the United States, opt-outs take one of three forms: medical, in which a vaccine is contraindicated due to a component ingredient allergy or existing medical condition; religious; and personal philosophical opposition. As of 2019, 46 states allow religious exemptions, with some states requiring proof of religious membership. Only Mississippi, West Virginia, California and New York do not permit religious exemptions.[2][15] 18 states allow personal or philosophical opposition to vaccination.[3]

Over the last decade vaccination rates have been declining in the United States. Although the rate is fairly limited on a larger scale, vaccine-preventable disease outbreaks are occurring in pockets across the U.S. “In 2012, exemption rates ranged from a low of approximately 0.45 percent in New Mexico, to a high of 6.5 percent in Oregon.[16] The outbreaks have significant correlations with unvaccinated children, and state policy exemption processes. California, which is currently in the process of changing its state exemption policies, dealt with a 2015 measles outbreak stemming from the popular Disneyland park. Significantly, most of the afflicted were unvaccinated, which eventually spread to over 17 separate states across the U.S.[17] If the federal government works to provide an equal vaccination regulation nationally, immunization rates should begin to rise, while preventable outbreaks should diminish.

Old age

In 1790, people over the age of 65 were less than 2% of the American population. In 2017, they were about 14%.[18]

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See also

References
  1. Chlamydia and Gonorrhea — Two Most Commonly Reported Infectious Diseases in the United States, CDC, April 22, 2011
  2. "Measles Outbreak: N.Y. Eliminates Religious Exemptions for Vaccinations". New York Times. June 13, 2019. Archived from the original on June 14, 2019.
  3. "States with Religious and Philosophical Exemptions from School Immunization Requirements". National Conference of State Legislatures. Retrieved 1 July 2015.
  4. Ciolli A (September 2008). "Mandatory school vaccinations: the role of tort law". The Yale Journal of Biology and Medicine. 81 (3): 129–37. PMC 2553651. PMID 18827888.
  5. May T, Silverman RD (March 2003). "'Clustering of exemptions' as a collective action threat to herd immunity" (PDF). Vaccine. 21 (11–12): 1048–51. doi:10.1016/S0264-410X(02)00627-8. hdl:1805/6156. PMID 12559778.
  6. Diekema DS (May 2005). "Responding to parental refusals of immunization of children". Pediatrics. 115 (5): 1428–31. doi:10.1542/peds.2005-0316. PMID 15867060.
  7. United States Department of Defense. "MilVax homepage". Archived from the original on 2007-07-06. Retrieved 2007-07-25.
  8. "Report of Medical Examination and Vaccination Record". USCIS.
  9. Jordan M (2008-10-01). "Gardasil requirement for immigrants stirs backlash". Wall Street Journal. Retrieved 2009-01-18.
  10. "HPV vaccine no longer required for green cards". nbcnews.com. 17 November 2009.
  11. McAllister-Grum K (2017). "Pigments and Vaccines: Evaluating the Constitutionality of Targeting Melanin Groups for Mandatory Vaccination". The Journal of Legal Medicine. 37 (1–2): 217–247. doi:10.1080/01947648.2017.1303288. PMID 28910223.
  12. Hodge JG, Gostin LO (2001). "School vaccination requirements: historical, social, and legal perspectives". Kentucky Law Journal. 90 (4): 831–90. PMID 15868682.
  13. Tolley, Kim (May 2019). "School Vaccination Wars". History of Education Quarterly. 59 (2): 161–194. doi:10.1017/heq.2019.3.
  14. Malone, Kevin M; Hinman, Alan R (2003). "The Public Health Imperative and Individual Rights". Law in Public Health Practice: 262–84.
  15. Horowitz, Julia (30 June 2015). "California governor signs strict school vaccine legislation". Associated Press. Retrieved 30 June 2015.
  16. Bradford, W. David; Mandich, Anne (August 2015). "Some State Vaccination Laws Contribute To Greater Exemption Rates And Disease Outbreaks In The United States". Health Affairs. 34 (8): 1383–1390. doi:10.1377/hlthaff.2014.1428. ISSN 0278-2715. PMID 26240253.
  17. Oster, Emily (July 2016). "Does Disease Cause Vaccination? Disease Outbreaks and Vaccination Response" (PDF). Cambridge, MA. doi:10.3386/w22464. Cite journal requires |journal= (help)
  18. Gawande, Atul (2014). Being Mortal. London: Profile Books. p. 18. ISBN 9781846685828.
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