Our guest blogger is Aysha Akhtar MD, MPH, a fellow for the Oxford Center for Animal Ethics and a neurologist and public health specialist at the Food and Drug Administration.

In order to better avert the threat of swine flu epidemics like the one currently spreading around the globe, public health efforts must address the conditions that allow pigs to become breeding grounds for infectious disease. As the number of confirmed cases of swine flu around the globe increases, we grow closer and closer to having a pandemic on our hands. Surprisingly, however, there is very little discussion about how swine flu got started in the first place.

The primary reservoir for influenza viruses is aquatic birds, but humans are not readily directly infected by the strains from those animals. Pigs, however, are highly susceptible to both avian and human influenza A viruses. In pigs, viruses swap genes, and new influenza strains emerge with the potential to infect humans. The current swine influenza A, called H1N1, is a triple hybrid avian/pig/human virus, “definitely” of swine origin.

More focus needs to be placed on preventing pathogens from getting into the human population in the first place, and that means starting at the farm. The source of the current epidemic has not yet been identified, but the first confirmed case of swine flu occurred in La Gloria, Mexico, a town surrounded by industrial pig farms, partly owned by Smithfields Foods. Even if these particular farms are not confirmed as the primary source, based on research into the previous outbreaks of swine flu, it makes sense to consider factory farms as very likely potential sites for the development of these pathogens.

In recent years the influenza virus has undergone an “evolutionary surge,” with new variants emerging rapidly. According to the World Health Organization, we are seeing more new infectious diseases and epidemics than ever before, and they are appearing at an alarming rate. Increased human travel is certainly a factor, but perhaps the most significant variable is the change in animal agricultural practices that have occurred in the last few decades:

– By 2020, world meat production is expected to double.

– In the U.S. alone, approximately 1 million land animals are slaughtered for food every hour.

– The percentage of operations in North America with 5,000 or more animals expanded from 18 percent in 1993 to 53 percent in 2002.

As a result of the rise in animal product demand, traditional farming practices have been mostly replaced in developed countries by immense intensive animal operations, and developing countries are rapidly catching up. Read more

Under the ‘what should I do if I get sick‘ section of the CDC’s ‘Swine Flu and You’ page, the agency writes that “if you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms…you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.”

But for the millions of Americans who can’t afford to purchase health insurance, a visit to a “health care provider” is an expensive proposition. We know that the 45.7 million Americans without insurance are less likely to visit a doctor and receive needed care, but the the economic crisis, the erosion of employer-based benefits and the skyrocketing costs of health insurance are now causing an increasing number of insured Americans to avoid their “health care provider.” According to the latest Kaiser Poll, 60 percent of Americans say that “they or a member of their household have delayed or skipped health care in the past year” and many are “substituting home remedies or over the counter drugs for doctors visits.”

Unsustainable health care prices are already threatening the nation’s economic prosperity, but in the midst of a possible flu epidemic, the consequences of a large number of Americans forgoing care because it’s too costly become all the more frighting.

This isn’t to say that health care reform will end epidemics. Providing everyone with affordable access to basic medical benefits can only contain health emergencies, but it’s now difficult to argue that extending coverage to all Americans is a wasteful entitlement, or that the insured have little to gain from bringing everyone into the system.

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