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The World Health Organization defines health as "a state of complete physical, mental and social well-being". [1] Average life expectancy at birth was 78.7 in 2017. [2] Heart diseases are responsible for the greatest number of deaths in the United States. [2]
All 50 states in the U.S. require immunization for children in order to enroll in public school, but various exemptions are available by state (such as for religious reasons). [3] Immunizations are often compulsory for military enlistment in the United States. [4]
It is estimated that one in five adults in the US lives with a mental health disorder, with 50% receiving treatment for their condition. [5] Sexually transmitted infections impact the health of approximately 19 million yearly. [6] The two most commonly reported infections include chlamydia and gonorrhea. [6]
In the context of ensuring the continuation of medical services, concerns of a current and future shortage of medical doctors due to the supply and demand for physicians in the United States have come from multiple entities including professional bodies such as the American Medical Association (AMA), [7] with the subject being analyzed as well by the American news media in publications such as Forbes , [8] The Nation , [9] and Newsweek . [10] In the 2010s, a study released by the Association of American Medical Colleges (AAMC) titled The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 specifically projected a shortage of between 37,800 and 124,000 individuals within the following two decades, approximately. [7]
As of 2003, there are a few programs which aim to gain more knowledge on the epidemiology of chronic disease using data collection. The hope of these programs is to gather epidemiological data on various chronic diseases across the United States and demonstrate how this knowledge can be valuable in addressing chronic disease. [11]
In the United States, as of 2004 nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64. [12] The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. [12] The most common chronic conditions are high blood pressure, arthritis, respiratory diseases like emphysema, and high cholesterol.[ citation needed ]
Based on data from 2014 Medical Expenditure Panel Survey (MEPS), about 60% of adult Americans were estimated to have one chronic illness, with about 40% having more than one; this rate appears to be mostly unchanged from 2008. [13] MEPS data from 1998 showed 45% of adult Americans had at least one chronic illness, and 21% had more than one. [14]
According to research by the CDC, chronic disease is also especially a concern in the elderly population in America. Chronic diseases like stroke, heart disease, and cancer were among the leading causes of death among Americans aged 65 or older in 2002, accounting for 61% of all deaths among this subset of the population. [15] It is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions. [15] The two most common chronic conditions in the elderly are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported among the elder population. [16]
In examining the statistics of chronic disease among the living elderly, it is also important to make note of the statistics pertaining to fatalities as a result of chronic disease. Heart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer's disease. [15] Though the rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among elderly are nearly identical across racial/ethnic groups. [15]
Chronic illnesses cause about 70% of deaths in the US and in 2002 chronic conditions (heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer's disease, mental illness and kidney diseases) were six of the top ten causes of mortality in the general US population. [17]Sexually transmitted infections (STIs) remain a major public health challenge in the United States. CDC estimates that there are approximately 19 million new STIs yearly. The country experienced a reduction in reported STIs early in the COVID-19 pandemic, likely due to reduction in care devoted to them, but rates have rebounded in ensuing years. [18] The two most commonly reported infections 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. [6]
Chlamydia remains the most commonly reported infection 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. [6] The rate reached 1.6 million cases in 2020, which was actually a decrease from 2016. [18]
There were 301,174 reported cases of gonorrhea in 2009 (10 percent less than in 2008), making gonorrhea the second most commonly reported infection in the U.S. In 2009, the gonorrhea rate for women was slightly higher than for men. [6] By 2020, there were more than twice as many cases reported, about 678,000, a 45% increase from 2016. [18]
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). [6] The number of cases was ten times the 2009 figure by 2020, about 134,000, more than a 50% increase from 2016. [18] According to a report from the Centers for Disease Control and Prevention on April 11, 2023, syphilis is now at a rate not seen since the 1950s, increasing by about 30 percent between 2020 and 2021, a big jump from syphilis rates recorded in the early 2000s, where only about 30,000 cases were recorded each year. [19]
This section duplicates the scope of other articles, specifically Vaccination policy in the United States.(December 2020) |
The Advisory Committee on Immunization Practices makes scientific recommendations which are generally followed by the federal government, state governments, and private health insurance companies.[ citation needed ]
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, [20] while sixteen states allow parents to cite personal, conscientious, philosophical, or other objections. [21] 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. [22] [23]
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. [24]
See Vaccination schedule for the vaccination schedule used in the United States.
Immunizations are often compulsory for military enlistment in the U.S. [4]
All vaccines recommended by the U.S. government for its citizens are required for green card applicants. [25] 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. [26] In November 2009, this requirement was canceled. [27]
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. [28] 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. [29] 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. [29]
These school vaccination resulted in political debates throughout the United States, as those opposed to vaccination sought to overturn local policies and state laws. [30] 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. [29] 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. [31] 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.[ citation needed ]
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. [31] 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. [31]
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. [20] [32] 18 states allow personal or philosophical opposition to vaccination. [21]
Over the last decade[ when? ] 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. [33] The outbreaks have significant correlations with unvaccinated children, and state policy exemption processes. California, which is currently[ when? ] 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. [34]
In 1790, people over the age of 65 were less than 2% of the American population. In 2017, they were about 14%. [35]
Climate change continues to affect every country in the world and the United States is no exception. In the U.S. the average temperature has increased between 1.3°F - 1.9°F since record keeping began in 1895, with most of the increase having occurred since about 1970. [36] Additionally, hurricanes and winter storms have increased in both intensity and frequency and the length of the frost-free season has been increasing nationally since the 1980s, affecting ecosystems and agriculture. Climate change and climate variability has many potential effects on the health of Americans. It can exacerbate existing health threats or create new public health challenges through a variety of pathways. Although all Americans will face some health effect from climate change, certain individuals are more vulnerable than others due to levels of exposure, sensitivity, and ability to adapt (See Table). [37]
Determinant | Definition | Example |
---|---|---|
Exposure | The degree to which an individual is susceptible to contact with a stressor induced by climate change. | A family in a low-income NYC neighborhood may not be able to afford air conditioning and therefore be more likely to die of heat stroke. |
Sensitivity | The degree to which the individual could be harmed by the exposure. | A child with asthma is more susceptible to negative health effects from poor air quality than his classmates. |
Ability to Adapt | The degree to which the individual can adjust and respond to a harmful situation caused by the exposure. | Someone with a physical disability may have a tougher time evacuating during a storm warning. |
The Center for Disease Control (CDC) has identified nine national health topics relating to climate change. [38]
Ground-level ozone (a key component of smog) is associated with multiple health problems. Examples include diminished lung function, increased hospital admissions and emergency room visits for asthma, and increases in premature deaths. Health-related costs of the current effects of ozone air pollution exceeding national standards have been estimated at $6.5 billion (in 2008 U.S. dollars) nationwide, based on a U.S. assessment of health impacts from ozone levels during 2000–2002. [39]
Climate change will potentially lead to shifts in precipitation patterns, more frost-free days, warmer seasonal air temperatures, and more carbon dioxide (CO2) in the atmosphere. These occurrences will lead to both higher pollen concentrations and longer pollen seasons, causing more people to suffer more health effects from pollen and other allergens. In a recent study looking at pollen metrics from 60 metric stations in North America between 1990 and 2018 scientists found that pollen seasons were starting up to 20 days earlier and lasting for up to eight days longer. [40]
Within the United States the impact of climate change from domestically acquiring diseases is uncertain due to vector-control efforts and lifestyle factors, such as time spent indoors, that reduce human-insect contact. However, the impact on the geographical distribution and incidence of vector-borne diseases in other countries where these diseases are already found can still impact Americans, especially due to travel and trade. [41]
Diarrheal diseases are more common when temperatures are higher, although location and pathogen can also affect the pattern. Extremely high and low precipitation has also been linked to an increased frequency in the occurrence of diarrheal diseases. Additionally, sporadic increases in stream flow rates, often followed by rapid snowmelt and changes in water treatment, have also been linked outbreaks. Risks of waterborne illness and beach closures resulting from changes in the magnitude of recent precipitation (within the previous 24 hours) and in lake temperature, are expected to increase in the Great Lakes region because of climate change. In the United States, those who are exposed to inadequately or untreated groundwater are most likely to be affected. Additionally, children and the elderly are most vulnerable to serious outcomes. [42]
Food production, quality, distribution, and prices can all be affected by climate change. Not only are crops affected by changes in rainfall and extreme weather, but livestock and fish are also being impacted. The related health effects will vary. Due to rising prices, poor persons will turn to “nutrient-poor but calorie-rich foods and/or they endure hunger, with consequences ranging from micronutrient malnutrition to obesity.” Additionally, nutritional quality will be impacted because “elevated atmospheric CO2 is associated with decreased plant nitrogen concentration, and therefore decreased protein, in many crops, such as barley, sorghum, and soy. The nutrient content of crops is also projected to decline if soil nitrogen levels are suboptimal, with reduced levels of nutrients such as calcium, iron, zinc, vitamins, and sugars. This effect can be alleviated if sufficient nitrogen is supplied.” [43]
Extreme weather and high temperatures can affect mental health in a variety of ways for both individuals with, and without preexisting mental health conditions. Additionally, the symptoms can be short-term or long lasting. [44] For example, studies done after Hurricane Katrina hit the United States Gulf Coast showed that children affected by the hurricane have found high rates of depression, anxiety, behavioral problems and post- traumatic stress disorder (PTSD). [45]
The United States has seen an increase in the frequency of heavy precipitation events, and the upward trend is supposed to continue throughout the different regions of the country. These events such as floods and droughts present immediate risks to the health of Americans during the occurrence but can also affect health in the period following the catastrophe. For example, flooding can cause water damage to buildings leading to mold or need for demolition. These events can necessitate the forceful relocation of an entire family which may be distancing them from schools, primary doctors and other resources that they may have gotten used to. [46]
Increasing concentrations of greenhouse gases lead to an increase of both average and extreme temperatures. This is expected to lead to an increase in deaths and illness from heat and a potential decrease in deaths from cold. Days that are hotter than the average seasonal temperature in the summer or colder than the average seasonal temperature in the winter cause increased levels of illness and death by compromising the body’s ability to regulate its temperature or by inducing direct or indirect health complications. Loss of internal temperature control can result in a cascade of illnesses, including heat cramps, heat exhaustion, heatstroke, and hyperthermia in the presence of extreme heat, and hypothermia and frostbite in the presence of extreme cold. Temperature extremes can also worsen chronic conditions such as cardiovascular disease, respiratory disease, cerebrovascular disease, and diabetes-related conditions. Prolonged exposure to high temperatures is associated with increased hospital admissions for cardiovascular, kidney, and respiratory disorders. [47]
In 2021 we have seen an increase in the news and social media coverage about wildfires spreading throughout California as shown in the image at the end of the section. No doubt, one of the many effects of climate change, these wildfires have many harmful (short and long term) effects on the health of Americans. Not only do many people lose their homes, livelihoods and even lives in these fires, but smoke exposure has many negative effects on physical health as well. It increases respiratory and cardiovascular hospitalizations; emergency department visits; medication dispensations for asthma, bronchitis, chest pain, chronic obstructive pulmonary disease, and respiratory infections; and medical visits for lung illnesses. [48]
Poverty and health are intertwined in the United States. [49] As of 2019, 10.5% of Americans were considered in poverty, according to the U.S. Government's official poverty measure. People who are beneath and at the poverty line have different health risks than citizens above it, as well as different health outcomes. The impoverished population grapples with a plethora of challenges in physical health, mental health, and access to healthcare. These challenges are often due to the population's geographic location and negative environmental effects. Examining the divergences in health between the impoverished and their non-impoverished counterparts provides insight into the living conditions of those who live in poverty.
A 2023 study published in The Journal of the American Medical Association found that cumulative poverty of 10+ years is the fourth leading risk factor for mortality in the United States, associated with almost 300,000 deaths per year. A single year of poverty was associated with 183,000 deaths in 2019, making it the seventh leading risk factor for mortality that year. [50] [51] [52] [53] [54]Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.
Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.
Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Most infections are asymptomatic or have a mild clinical course, but in some outbreaks, the mortality rate approaches 10%. Signs and symptoms may vary from mild to severe, and usually start two to five days after exposure. Symptoms often develop gradually, beginning with a sore throat and fever. In severe cases, a grey or white patch develops in the throat, which can block the airway, and create a barking cough similar to what is observed in croup. The neck may also swell, in part due to the enlargement of the facial lymph nodes. Diphtheria can also involve the skin, eyes, or genitals, and can cause complications, including myocarditis, inflammation of nerves, kidney problems, and bleeding problems due to low levels of platelets.
The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.
Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious, vaccine-preventable bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or three months of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person breathes in. The violent coughing may last for 10 or more weeks, hence the phrase "100-day cough". The cough may be so hard that it causes vomiting, rib fractures, and fatigue. Children less than one year old may have little or no cough and instead have periods when they cannot breathe. The incubation period is usually seven to ten days. Disease may occur in those who have been vaccinated, but symptoms are typically milder.
Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. Although adverse effects associated with vaccines are occasionally observed, the scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.
Flu season is an annually recurring time period characterized by the prevalence of an outbreak of influenza (flu). The season occurs during the cold half of the year in each hemisphere. It takes approximately two days to show symptoms. Influenza activity can sometimes be predicted and even tracked geographically. While the beginning of major flu activity in each season varies by location, in any specific location these minor epidemics usually take about three weeks to reach its pinnacle, and another three weeks to significantly diminish.
The schedule for childhood immunizations in the United States is published by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood immunizations are key in preventing diseases with epidemic potential.
Meningococcal disease describes infections caused by the bacterium Neisseria meningitidis. It has a high mortality rate if untreated but is vaccine-preventable. While best known as a cause of meningitis, it can also result in sepsis, which is an even more damaging and dangerous condition. Meningitis and meningococcemia are major causes of illness, death, and disability in both developed and under-developed countries.
The National Center for Immunization and Respiratory Diseases (NCIRD), formerly known as the National Immunization Program until April 2006, is charged with responsibility for the planning, coordination, and conduct of immunization activities in the United States. NCIRD is a part of the Centers for Disease Control and Prevention, located in Atlanta, Georgia, and housed in the CDC's Coordinating Center for Infectious Diseases (CCID). The National Center for Immunization provides consultation, training, statistical, promotional, educational, epidemiological, and technical services to assist state and local health departments across the US in planning, developing, contracting and implementing immunization programs.
A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by state or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available.
Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decreases. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.
Yellow fever vaccine is a vaccine that protects against yellow fever. Yellow fever is a viral infection that occurs in Africa and South America. Most people begin to develop immunity within ten days of vaccination and 99% are protected within one month, and this appears to be lifelong. The vaccine can be used to control outbreaks of disease. It is given either by injection into a muscle or just under the skin.
In 1976, an outbreak of the swine flu, influenza A virus subtype H1N1 at Fort Dix, New Jersey caused one death, hospitalized 13, and led to a mass immunization program. After the program began, the vaccine was associated with an increase in reports of Guillain–Barré syndrome (GBS), which can cause paralysis, respiratory arrest, and death. The immunization program was ended after approximately 43 million United States citizens had been administered the vaccine.
The Vaccines for Children Program (VFC) is a federally funded program in the United States providing no-cost vaccines to children who lack health insurance or who otherwise cannot afford the cost of the vaccination. The VFC program was created by the Omnibus Budget Reconciliation Act of 1993 and is required to be a new entitlement of each state's Medicaid plan under section 1928 of the Social Security Act. The program was officially implemented in October 1994 and serves eligible children in all U.S. states, as well as the Commonwealth of Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands.
Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.
California Senate Bill 277 (SB277) is a California law that removed personal belief as a reason for an exemption from the vaccination requirements for entry to private or public elementary or secondary schools in California, as well as day care centers. The final version of the bill was enacted by the California Legislature in 2015 and was signed into law by Governor Jerry Brown on June 30, 2015.
In early months of 2019, a measles outbreak occurred in the Portland metropolitan area, including the Clark County, Washington suburbs, in the United States. At the time, the outbreak was the largest outbreak in more than two decades; outbreaks in 2019 in areas including Brooklyn and Rockland County, New York have since seen far greater numbers of cases.
Measles was declared eliminated from the United States in 2000 by the World Health Organization due to the success of vaccination efforts. However, it continues to be reintroduced by international travelers, and in recent years, anti-vaccination sentiment has allowed for the reemergence of measles outbreaks.
Vaccination policy of the United States is the subset of U.S. federal health policy that deals with immunization against infectious disease. It is decided at various levels of the government, including the individual states. This policy has been developed over the approximately two centuries since the invention of vaccination with the purpose of eradicating disease from the U.S. population, or creating a herd immunity. Policies intended to encourage vaccination impact numerous areas of law, including regulation of vaccine safety, funding of vaccination programs, vaccine mandates, adverse event reporting requirements, and compensation for injuries asserted to be associated with vaccination.
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(help)A single year of poverty, defined relatively in the study as having less than 50 percent of the US median household income, is associated with 183,000 American deaths per year. Being in 'cumulative poverty,' or 10 years or more of uninterrupted poverty, is associated with 295,000 annual deaths.