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COVID-19, pandemic influenza and tuberculosis are examples of the remarkable ability of infections to use the respiratory route of transmission. Infections which use this route can often spread very quickly, especially in crowded indoor environments. Human behaviours and engineering should be seen as much a part of our defences against respiratory infections as drugs and vaccines.
Some diseases are specialised in using sexual behaviour for transmission. Major pandemics including HIV and syphilis have been transmitted via this route, along with the cancer-causing infections Hepatitis B and HPV. Along with these are highly transmissible diseases such as gonorrhoea and herpes. Another way people share bodily fluids is via needles, and several diseases can be transmitted this way, including HIV and Hepatitis. Changing sexual behaviour is hard, so other methods have to be found to control these diseases.
Many major diseases are transmitted by food or drink. Cholera (water), brucellosis (milk), BSE/nvCJD, typhoid and many parasites are ingested as part of a normal diet.
Mathematics has been used as a tool to understand and control infectious disease for over a century, but Covid-19 brought along a whole epidemic of new challenges.
What the NHS has provided and had to treat over its existence has changed much more radically than most people realise. Some of this change is rightly the domain of politics, but much is driven in response to changing health needs, improvements in medical science and priorities of society.
Lymphoma, leukaemia and myeloma arise from different parts of the white blood cell system. Unlike solid tumours, they can be widely distributed in the body, and this means they need a different approach.
Food-related conditions – cancer, heart disease, and strokes – are the leading causes of preventable deaths in the UK. Common wisdom is that health reflects personal choices and will power.
It is widely accepted that the rising prevalence of obesity is a major threat to current and future health of individuals, the public, and the NHS. Obesity comes from a complex interaction of personal choices, genetics, economics, the food industry, and the environment, among other things.
Vaccination has transformed the outlook for many previously lethal infectious diseases. It has, however, caused controversy since its beginnings, even when used for widely feared diseases such as smallpox. For many infectious diseases we do not have a vaccine, and may never get one.
One of the most powerful tools in public health is screening – whether for cancers like cervical or breast cancer, genetic abnormalities, or infectious diseases. Screening can be transformational, detecting disease early and preventing it taking hold.