We will soon enter the third year of the Covid-19 pandemic.

It is possible that the epidemiologist, infectious diseases (ID) physician and public health specialist are now the most famous occupations in the world, and will remain highly-visible for the foreseeable future.

Malaysia needs more epidemiologists, ID physicians and public health specialists, just like we need more virologists, vaccine experts and mathematicians to improve public health.

They help us understand and fight Covid-19 and other diseases, and we owe them a debt of gratitude for their skill and sacrifice.

But there are other specialists in public health who are equally important, but are not part of our daily conversations.

Today, we’ll look at three “invisible” public health heroes: the water engineer, the building engineer and the social scientist.

The water engineer

Firstly, the water and sanitation engineer is probably the most important public health specialist you’ve never heard of.

They are arguably responsible for one of the two most dramatic reductions in infectious diseases in history: the eradication of waterborne diseases like cholera, typhoid and dysentery.

(Vaccinations caused the other dramatic reduction in infectious diseases).

In 2021, we take clean water for granted and imagine that it has always existed (except, sadly, in parts of Kelantan and Sabah where Malaysians are still not receiving clean water).

However, the routine disinfection of public water supplies is relatively recent.

In 1902 – only 109 years ago – Middelkerke in Belgium was the first city in the world to chlorinate their water.

But disinfecting water is only one part of the solution for clean water.

Governments (federal, state or city) need to build water treatment plants and lay pipes from dams to treatment plants to millions of homes and buildings.

Water engineers dug up entire cities in the United States to lay pipes, changing the entire physical infrastructure of cities in the 1910s-30s.

Then US President Franklin D. Roosevelt’s New Deal (an infrastructure investment programme that ran in 1933-1939) built thousands of dams, reservoirs, water mains, water tanks and pumping stations, and laid millions of miles of pipes.

That’s just the water supply for drinking, cooking and washing.

Sewage treatment (from toilets), drainage (from rain) and flood prevention are three separate activities supervised and implemented by the water engineer, each of which is as complex as water supply.

In performing these engineering feats, the water engineer reduced cholera, typhoid, dysentery and other waterborne diseases.

Therefore, we can claim that the water engineer is the first true public health hero.

The building engineer

When building engineers do their job right, no one even realises the positive impacts it has on their health.When building engineers do their job right, no one even realises the positive impacts it has on their health.

Before the Industrial Revolution (roughly 1750-1850), construction was somewhat limited to homes, commercial spaces (like shops), civic spaces (like town halls or libraries) and government institutions (like army barracks or offices).

The Industrial Revolution created many factories, new transportation models like railways and canals, and more commercial spaces to support them all.

This construction boom was accelerated by a fast-growing world population.

In 1800, there were only one billion people worldwide.

It took 128 years to add another billion people.

Then we added another billion people in 32 years, then another billion in 15 years and then another billion every 11-12 years, finally reaching 7.7 billion people in 2019.

All these people needed new homes, offices and factories, schools and hospitals, and communal spaces like shopping malls, coffee shops and cinemas.

All that construction needed building engineers, which include architects, architectural engineers, civil engineers, structural engineers, construction specialists, ventilation experts and urban planners.

These building engineers are crucial for public health and safety because our homes, offices, factories and public spaces must be safe and health-promoting.

A non-exhaustive list includes fire safety, building ventilation, adequate lighting, and spaces that promote mental health and reduce physical injuries.

The construction process itself, the construction materials and the maintenance of buildings can either harm or help health.

For these reasons, building engineers are unsung heroes for public health.

When they do their job right, no one realises that they’ve done anything at all.

The social scientist

Social scientists, like the economists and political scientists who help formulate the annual Budget, are also crucial in advocating for health-promoting policies and initiatives.Social scientists, like the economists and political scientists who help formulate the annual Budget, are also crucial in advocating for health-promoting policies and initiatives.

We often think of public health as full of “hard sciences”, like medicine, surgery, biostatistics and epidemiology.

That is true; but it is also true that public health is equally full of the “soft sciences”, like the social sciences of sociology, economics, political science, ethics, law, philosophy, public administration and public policy.

These social sciences are important to public health for many reasons.

One, they help us understand society and human beings, which is important when we want to convince people to get vaccinated or pay insurance premiums to protect our family in the future.

Two, the social sciences help scientists allocate resources and make difficult decisions, like whether vaccine mandates are ethical, legal or desirable.

Three, the social sciences help patients and their doctors understand that medicine, technology and science can only cure us halfway, with the other half of the cure involving social, environmental and psychological factors.

The Covid-19 pandemic has proven that science alone is not enough.

It proves that we need many non-science elements to provide good health to all Malaysians, like eradicating poverty, promoting gender equality, and increasing health literacy by increasing education levels.

In this light, the economist helps the health system allocate resources by developing mathematical models to see where we can spend our money most efficiently.

The political scientist helps the Health Ministry build a case to increase taxes to fund healthcare, by analysing the social contract.

And the philosopher helps us decide who to prioritise for vaccinations.

In the 21st century, Malaysians are highly dependent on science and technology.

We expect miracle cures, and have placed all our hopes and desires in the magic of pills, surgeries and instant relief.

We think that science allows us to master the world.

When technology is so magical that we have food delivered to our doorstep with a few clicks on an app, we are seduced into thinking that technology will cure all our health problems.

This over-reliance on science, technology and modern medicine has seeped into public health.

We believe that vaccines, pills for Covid-19 and ventilators will save us, and we have disregarded the social aspects of medicine and pandemic control.

Yet, our social scientists try their best to get a seat at the decision-making table, and try to improve health outcomes alongside our scientists.

Therefore, they are the third invisible hero of public health.

Invisible heroes

Many of the heroes of public health are invisible, but they are equally important.

We’ve only discussed the water engineer, building engineer and social scientist in this column.

But there are many others, like the researcher working on the malaria parasite, the environmental health officer fogging against dengue, or the food safety officer monitoring the hygiene of restaurants.

Health and wellbeing are the highest human achievement.

We need to recognise all our public health heroes, especially those who are performing mundane, boring and invisible daily routines in seemingly non-health roles.

Editor’s note: Vital Signs will be published monthly from now. Watch out for the next Vital Signs on Jan 13 (2022).

Dr Khor Swee Kheng is a physician specialising in health policies and global health. He tweets as @DrKhorSK. The views expressed here are entirely his own. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.



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