The Public's Health: We Cannot Have it All | Public Health Post

Imagine for a minute that you are the health commissioner responsible for a town of 100,000 people. The mayor calls you into her office and reminds you that one of her campaign promises was to improve the flu vaccination rate in the town. The previous season, 45% of the town’s residents received the vaccine. This season she wants the vaccination rate to hit 65%. That all sounds reasonable, and with your team you develop a strategy that communicates primarily through doctors’ offices the importance of flu vaccinations. You develop written material and some videos and you make sure that all patients see them prominently displayed. The strategy works. At the end of this year’s flu season, you have vaccinated 65% of everyone in town.  
 
An enterprising analyst in the health department then looks at the data a bit more carefully. She notes that the town really is divided into two groups. Half the town, in its north end, is rich and there the flu vaccination rate was already 60% when you started. It rose to 90% at the end of the campaign. The southern, poorer half of town had a vaccination rate of 30% when you started; it rose to 40% by the end of the campaign. Therefore, you increased the vaccination rate by 30% among the rich, and by 10% among the poor, many of whom do not get to doctors’ offices and as such did not benefit as much from your campaign. Your rich-poor gap in vaccination was 30% when you started; it was 50% when you finished.
 
So, was your campaign a success?
 
At the level of what the mayor promised in her campaign—that more residents would be vaccinated—it was. In fact, you increased rates overall by 20%, which is impressive. And you can point to the fact that the rates of vaccination improved among everyone. Yes, they increased less in the poor parts of town, but they did increase.
 
But the health gaps in town between the rich and the poor residents also increased, and they did so substantially. This is an illustration of what economists call an equity/efficiency trade-off. In other words: we cannot have it all. As long as we design interventions that are going to privilege the rich, even if we improve overall health, we will be widening the gaps between health haves and health have nots.
 
Recognizing that we cannot have it all, is this trade-off acceptable to us? At heart this comes down to our values. Do we simply care about average health, even at the expense of one group?  
 
We suggest that inequities should matter. Inequities are the result of systematic injustice—in this case of unequal access to healthcare settings where marketing and vaccine delivery occurred; either way, some are left behind. Public health must not allow lopsided interventions and approaches to happen—even if it comes at the expense of better overall health. 
 
Warmly,
Michael Stein & Sandro Galea 

We Need a Health New Deal | Dean's Note

In recent weeks, the political conversation has been animated by talk of a Green New Deal (GND). The idea behind the GND, unveiled last month as a Congressional resolution by Senator Ed Markey and Representative Alexandria Ocasio-Cortez, is to tackle the threat of climate change through a series of wide-ranging reforms. The goals of the GND address not just the challenge of reducing carbon emissions, but the underlying socioeconomic inequities that gave rise to climate change. These goals include overhauling the country’s transportation system, providing universal health care, creating a federal jobs guarantee, and investing in infrastructure. They reflect the plan’s broader call for social and economic justice, workers’ rights, and greater investment in public goods. Through these aspirations, the GND acknowledges that carbon emissions are just the tip of the (rapidly melting) climate change iceberg, that the problem is the sum of deeper, structural challenges, and that solving climate change means using public policy to tackle the problem at every level of society, addressing not just the science of climate change, but the injustice that created the crisis in the first place.

The Public's Health: Mental Health and Mortality | Public Health Post

Mental illness contributes more todisability adjusted life yearsthan any other condition worldwide, with unipolar depression leading the way. And yet, prioritizing mental health among the assortment of concerns and actions of population health thinking remains a distant hope. There are many reasons for this, starting with the historical stigma around mental illness and continuing with our lack of understanding of brain processes—and therefore behaviors—at the cellular or molecular level. But perhaps one of the core reasons is that we do not keep in mind the extraordinary burden of death associated with mental health disorders. 

We Need a Health New Deal | U.S. News

During the Great Depression, President Franklin Roosevelt and his allies instituted a sweeping program of reforms to address the crisis. These reforms, known collectively as the New Deal, went beyond economic recovery, to reimagine the role of government in American life.

Today, our political debate is animated by talk of a Green New Deal. Like its namesake, the Green New Deal is a response to a crisis: climate change. It calls for a transformation of the American economy and social contract on a scale not seen since the days of FDR. Its suggested reforms include providing universal healthcare, creating a federal jobs guarantee and securing broader investment public goods. These measures tackle the core socio-economic injustices that underlie climate change.

The Case for a 'Health New Deal' | Fortune

In recent weeks, talk of a Green New Deal has moved to the center of our political debate. The Green New Deal aims to address climate change by tackling the underlying socioeconomic inequities that gave rise to the crisis. It calls for overhauling the country’s transportation system, providing universal healthcare, creating a federal jobs guarantee, investing in infrastructure, and other goals.

This ambition echoes the scope of the original New Deal, another wide-ranging political program that was born out of crisis. In the 1930s, President Roosevelt and his allies used the shock of the Great Depression to transform the relationship between government and citizen through a series of reforms addressing the injustices at the heart of the economic crisis.

The Public's Health: Zero Tolerance for Preventable Deaths | Public Health Post

Of the approximately 150,000 daily deaths around the world, about a third, or 50,000 or so, are preventable (the rest are age-related, hence non-preventable). In the United States more than 400,000 people die annually due to smoking and more than 300,000 due to poor diet, the leading causes of preventable deaths.
 
The good news is that the number of preventable causes of death is improving in the US. Preventable deaths from cancer, injuries, stroke, and heart disease decreased by 25, 23, 11, and 4 percent respectively in the first five years of this decade. We also know that we can reduce the number of deaths from preventable causes further. An analysis conducted by the Centers for Disease Control and Prevention (CDC), found that if we were to reduce the number of deaths across all states to the levels found in the best three states we would save 91,891 deaths from diseases of the heart, 84,539 from cancer, 37,016 from unintentional injuries, 28,853 from chronic lower respiratory diseases, and 17,062 from stroke for a total of more than 250,000 deaths annually, or nearly 10% of annual deaths in the US.

The Mental and Physical Health of Caregivers | Psychology Today

In a 2017 Health Affairs piece, Peter Buerhaus, David Auerbach, and Douglas Staiger discussed an approaching healthcare challenge—the reality that many nurses of the Baby Boomer generation will soon retire, creating a shortage of experience among the remaining RN workforce. The article caused me to reflect on the broader condition of caregivers in the US, particularly that of non-professional caregivers, who face many of the same scenarios that confront professional nurses but must do so without the training and expertise of the experienced RNs who will soon leave the healthcare field. As these caregivers play an ever-greater role in safeguarding the health of our aging population, a note on the physical and mental health of caregivers, and how public health can best support these individuals, and, by extension, the populations they care for.

The Public's Health: Food Justice | Public Health Post

One in six of our citizens experiences food insecurity. Forty-two million low income and working-class Americans—most of whom are elderly, disabled, or children—use Supplemental Nutrition Assistance Program (SNAP) benefits to buy groceries. That is, they don’t earn enough to feed themselves consistently. Food insecurity has dramatic effects on the health of children and the elderly in particular, influencing educational progress, family stress, and nutritional deficiencies. 

At the same time we throw away 40% of our food every day. That’s 400 pounds per person per year.