Public Health Post

The Public's Health: The New Elderly Surveillance State | Public Health Post

Millions of older adults will develop dementia over the coming decades. The middle-agers who assume responsibility for this older generation face a looming concern: how can we keep our parents safe and at home? Can technology help make this possible?
If we read the popular press on this, the Internet of Things will carry part of the load of caring for our elders. New, in-home smart systems will reduce caregiver stress through electronic surveillance, allow doctors to get real-time insights into the health of our loved ones, and improve their quality of life. 
Teams of clinical, economic, security, and technical experts are now at work on a new form of “assisted living.” The model patient in her home will have passive environmental sensors (the stove turns itself off), medical devices, wearable technologies, and interactive apps connected to her body and bed, floor and door frames, collecting a fast-moving stream of data, a “velocity challenge.”
Such “living labs” are already deployed and being evaluated. These new “trusted patient homes” will require a new kind of workforce of healthcare practitioners, not only persons who can read the new dashboards but also technicians who can maintain the sensors. But will these new, technologically sophisticated homes really tackle the core problem? At the moment these homes feel, to us, like new sites of isolation. They remind us of a surveillance state, albeit one that aims to preserve health.
Yes, we will all have more data. Yes, we might better understand the physiological patterns of persons living with dementia at scale. But can we really improve the quality of lives of our elders with dementia and their families with easy-to-follow audio instructions piped in over speakers? Will a daughter feel safe leaving her mother alone at home in this surveilled new world?
The world of continuous monitoring will bring new challenges. And the technology by itself will not be the full solution. Somewhere we have to figure out the role that old-fashioned social networks, humans checking in on humans, will play, and how technology can help augment, not replace, the role that caregivers play in maximizing quality of life for those who can no longer look after themselves. That will require a serious examination of the role of work and obligation, borne by those in middle age, and how this can fit in with the increasing responsibilities that they will inevitably bear as the population ages.
We need space in the public conversation for this too.

Michael Stein & Sandro Galea 

The Public's Health: As Midterm Elections Approach, Three Steps to Creating a Healthier World | Public Health Post

We have argued often in this column that health is the product of the social, economic, and political forces around us, frequently invisible unless we pay close attention to how they influence health. The challenge of addressing these forces is one of abstraction. We realize that it is more tangible to say “we need to build more hospitals to make our health better” than to say “we need to ensure that the political environment creates more health.” And yet, the latter is critical and as we head to the midterms we offer a simple three-part prescription for how we can improve health that is so inextricably linked to the world around us.

The Public's Health: Three Notes on the Opioid Crisis | Public Health Post

We are in the midst of the greatest American health crisis of this young century, an opioid epidemic that has now led to an astounding 500,000 deaths in the past two decades. There has been substantial ink—appropriately—devoted to this issue, we think there are three areas that receive far less attention than they should. One relates to the silent, concurrent increase in other substance use that is happening, the second relates to who we believe is affected by opioids, and the third to our best hope of stemming this crisis.

The Public's Health: Good App Hunting | Public Health Post

Public health and medicine are in a moment of digital euphoria. We have convinced ourselves that mhealth (mobile phone) technologies will improve the health of millions. After all, there are 6 billion smartphones out there and more than 300,000 stand-alone health apps on the market ready to be uploaded. Suddenly, the promises of behavior change to improve the care of highly prevalent conditions (obesity, diabetes, anxiety, insomnia) are scalable. But as behavioral health facilitators, will phone apps work and how will we know if they do?

The Public's Health: Mental Health on Campus | Public Health Post

College students experience highs and lows. But with more than 10% of today’s students reporting suicidal thoughts, the highest rate since the first widespread surveying on campuses, the lows appear to have deepened. College counselors point to growing stress and distress among students, with more than a third reporting that they have been diagnosed with a mental health condition, most often anxiety or depression, but also increasingly with eating disorders and forms of self-harm. There is considerable variation across schools, not explained by school size or competitiveness, but there remains a consistently higher prevalence of all mental health problems among students from lower socioeconomic backgrounds (financial stress is the most common risk factor) and among students with minority gender and sexual orientations.

The Public's Health: The Promise of Palliative Care | Public Health Post

As the population ages, patients seeking care for multiple chronic conditions has become the norm. Sixty percent of Americans die following a prolonged illness; the “compression of morbidity”—the burden of disease and disability limited to a brief time before death—has not yet become a reality in the United States. The care of persons with serious chronic illnesses like cancer and heart disease then often falls to families whose members absorb the burden of a loved one’s needs, with negative effects on their work, finances, relationships, and community engagement.  

The Public's Health: Denying Climate Change is Denying Health | Public Health Post

In recent years a few sentinel issues have become third rails in American culture, dividing us along political lines and becoming touchstones for particular parties. One of these issues is global environmental climate change. The current executive branch embodies the Republican party’s general feeling about climate change, espousing a range of positions from the extreme—the earth is not getting warmer—to one of agency—i.e., even if it is, humans have nothing to do with it.

The Public's Health: Toward a Muscular Public Health | Public Health Post

Public health often offers directives. You should wear seat belts. You should get vaccinated. You shouldn’t smoke. This command language, with its moral tinge, is at odds with the language of shared decision-making that has become central in the medical world and in some ways may marginalize the message of public health.

Why does public health seem to revel in an approach that is at odds both with notions of individual freedom and with norms in medicine? In the shared decision-making world of modern medicine, doctors are meant to discuss options with patients, the final health decision is made by the patient, who may in the end, make an unhealthy choice. But public health persists in suggesting courses of actions for the entire population.
Why? And is this ok?