Sometimes we don’t value what we can’t see. It’s why I have to remind patients to keep taking their blood pressure medication even through they “don’t feel a difference.” Trust me, you will if you don’t keep it under control. Public health is much like continuing to take your medication; the work it does is often unseen because it prevents bad outcomes and therefore, doesn’t get the value or appreciation it deserves.
While many Americans likely believe that we are the healthiest nation in the world, we actually have the lowest life expectancy at birth among comparable countries – 78.6 years vs. 82.3 years. And compared to other high-income countries, we trail in nearly all health metrics. Nearly 50% of Americans have a preventable, chronic medical condition yet we only 3% of our health care spending is on prevention and public health programs.
What is the mission of our public health system? The Institute of Medicine articulated it as the, “fulfillment of society’s interests in assuring the conditions in which people can be healthy.” This is a broad, sweeping statement but one that we should have be a strong interest in achieving – and that can only happen when we have both an understanding of what public health is (and isn’t) and adequately fund that work. Because we know that access to health care services isn’t enough.
Let’s start out by dispelling the misconception that physicians are trained in public health and therefore should be consulted as experts during public health crises. For the most part, this is NOT TRUE. Physicians are trained to provide medical care – to diagnose, treat, and manage individual health problems. While some medical schools do teach epidemiology (the science of public health), it is not enough to head out into the world as a public health professional. If you’re a physician with a Master of Public Health (like I will be!), then you certainly have more credibility to speak on matters of public health as a physician. And the reverse is true as well – experts in public health who did not go to medical school are not doctors! The medical and public health professions need to work together beyond times of crisis and both need to be consulted by policy makers. Doctors alone should not be asked how to contain a pandemic – simply put, we are not trained to give that advice.
So, let’s get into it. What exactly is public health?
We’re well into the 2020 presidential election cycle and there are a lot of health care proposals floating around. Most of them want to increase access to insurance and some have a plan to reduce the cost of care. But unfortunately, universal access to health insurance does not equate to health equity or better health outcomes. Health care systems are designed to handle individual medical needs, not the most critical causes of poor health – socioeconomic factors. In the United States, the development and provision of health care has fundamentally misunderstood what health is and what it requires.
A 2017 study in Health Affairs conveyed that the U.S. has one of the largest income-based health disparities in the world. Among the poorest third of Americans in the study, 38.2 percent reported being in “fair or poor health,” compared with 12.3 percent of the richest third. Most of the nations studied had an income-based health disparity, with the exception of Japan and Switzerland.
Nutrition education is lacking in most health professions education — either isn’t incorporated, exists in the context of specific disease-related diets, or glosses over the concept of nutrition and diet. Honestly, it’s understandable considering how much knowledge needs to be conveyed and learned — especially in medical school, the only health profession I can speak to personally. But, just as I’ve written before about the need to incorporate more health policy education, it’s time to also offer more discussions about nutrition and the vast impact of society and policy on the “what” and “where” people eat. [Also just as important is proper education on eating disorders. This post from my friend Clare of Fitting it All In is a great overview about caring for individuals with eating disorders.]
Obesity is common, costly, and poses serious health risks. So let’s start with some numbers to get our bearings about why this topic warrants our attention:
Hurricane Florence is poised to make landfall on the Carolina coast tonight, marking the first landfall on the U.S. mainland this hurricane season. Secretary of HHS Alex Azar declared a public health emergency for North Carolina and South Carolina to provide Medicare and Medicaid beneficiaries and health care providers greater flexibility in meeting emergency health needs, as well as readying personnel from the National Disaster Medical System. As we all watch Florence and her impact on millions of Americans, we thought it would be a good to take a quick look at the inexorable connection between emergency preparedness, weather, and medical care. [No discussion of hurricanes and health would be complete without addressing Hurricane Maria and the devastation it wrought on Puerto Rico, but that is a longer post for another day.]
I’ve probably seen every episode of Law & Order: SVU at least twice. Those marathons on USA draw me in every time. Police procedurals on television have familiarized a generation to the reading of Miranda Rights, but did you know there’s another type of police power? Let’s pull out our handy dandy pocket U.S. Constitution and take a look at the 10th Amendment. [You think I’m kidding? I’m not, I actually have a well-worn copy that I purchased at the National Archives as an incredibly nerdy 16 year old.]
The 10th Amendment defines the division of authority between the federal government and state governments: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.”