June 23, 2003

Health was emphasized at the opening plenary luncheon, with speakers addressing three critical areas: cancer in the United States; HIV/AIDS in Africa; and SARS worldwide.

Promoting Cancer Awareness to the Underserved

Virginia Beach Mayor Meyera Oberndorf described the role that mayors play in promoting the health of the nation, citing the leadership that they have displayed by taking on cancer as a public health issue, a recommendation that she made to her fellow mayors more than six years ago. Starting with the Mayors' Campaign Against Breast Cancer, followed by the Mayors' Coalition for Prostate Cancer Awareness and Education, and now an umbrella Cancer Awareness Program, close to 300 mayors promote the importance of early detection, particularly to the underserved.

Speaking as one of 9 million cancer survivors in the US, Oberdorf noted that the next challenge is to help individuals to "live with, through, and beyond cancer," a task that must address medical and public health services as well as re-employment and health insurance issues.

Boston Mayor Conference President Thomas M. Menino, who has a citywide Crusade Against Cancer, underscored Oberndorf's remarks, and commented on the economic impact of the Boston's recent ban on smoking in pubs and restaurants. Not only are patrons and employees now protected from secondhand smoke, but, contrary to expectations, establishment owners report an increase in business since the ban went into effect.

African Mayors Respond to HIV/AIDS

Mayor David Wakudumira of Jinga, Uganda said that with 30 million persons living with HIV/AIDS in Africa, African mayors knew that they had to take action. They recognized that local government represents the closest link between national government, its citizens, and civil society.

With that in mind, they formed the Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa that has nine chapters on the continent and is concentrating on vocational and technical training for orphans and vulnerable youth. These mayors are also speaking out to address the fear and stigma associated with HIV/AIDS.

Wakudumira, a businessman with a commitment to public service, went on to describe the conditions that led him and his fellow mayors to form the Alliance:

• HIV/AIDS is putting entire economies at risk, with the hardest hit African countries losing up to 1.2 percent GDP;
• 11 million African children have lost one or both parents to AIDS, with an estimated 2 million orphans in Uganda;
• Teachers are falling ill and dying, an alarming situation because education is crucial to national development;
• Children, especially young girls, are having their education disrupted because they must leave school to care for sick relatives and support their families;
• Health and social services are over'stretched; and
• Food security is being threatened because of loss of income due to illness.

Despite these grim statistics, Wakudumira said, "Éthere are glimmers of hope."

He explained by saying that Uganda is among a small but growing number of countries — others being Senegal, Thailand and Brazil — that has seen a small but consistent decline in HIV prevalence. Noting that there is evidence that prevention works, he credited progress to the collective responsibility of individuals, community groups, non-profits, and various levels of government.

But, he stressed that these efforts must not only be maintained but also expanded because "Africa is stretched beyond its capacity to cope with these multiple crises." To this end, he commended President George W. Bush and the U.S. Congress for making available $15 billion to combat AIDS in Africa and the Caribbean.

Responding to SARS

Severe Acute Respiratory Sybdrine (SARS) is unlike anything the medical community has ever handled, the mayors were told by Ed Thompson, MD, MPH, Deputy Director for Public Health Services of the U.S. Centers for Disease Control and Prevention (CDC).

Anthrax can be treated with anti-biotics, West Nile Virus can be diminished by controlling the mosquito population, smallpox has a vaccine, but there is no specific medication or prevention for SARS.

Tools for Containing SARS

Thompson said that there are two important tools for containing SARS: quarantine and travel.

Quarantine involves restricting the activity/separation of well persons exposed to contagious disease, generally done at home. It can be taken a step further through isolation, which is the restriction of sick, infected persons with contagious disease, done in a hospital setting.

Quarantine and isolation can be voluntary or mandatory, and quarantine authority covers both actions. Individual states are responsible for intrastate public health control measures using their laws, but there is significant variation among states. State/local health officers have experience with individual control measures, e.g., tuberculosis, school immunizations.

The federal law gives the federal government concurrent power to apprehend, detain or conditionally release individuals to prevent the interstate spread or international importation of certain diseases. Such diseases must first be listed in an Executive Order signed by the President.

Thompson said that it is possible for federal, state, and local laws to all come into play in a particular situation. For example, coordination would be crucial in the case of arriving aircraft at a large city airport.

Travel measures include: travel alerts and travel advisories. In the case of a travel alert, Thompson said that CDC notifies travelers and resident expatriates that outbreak of a disease is occurring in a geographic area, giving information about risk and response if infected. A travel advisory from CDC provides the same information as an alert, but advises against nonessential travel.

Thompson also spoke about HealthierUS, a five-year program to promote prevention of chronic diseases. For more information go to: www.HealthierUS.Gov.