Hope, and Health | SPH This Week

Vice President Joe Biden has won the 2020 US presidential election. There remains much to be resolved, not least of which will be President Trump’s concession. One can only hope that President Trump respects the outcome of the electoral process, avoiding the challenges that arise if the election’s resolution remains unsettled for some time.

As the political circumstances resolve, it seems reasonable to pause for a moment to reflect on the hope that comes with political renewal, and the inflection point a new administration offers towards creating a better, healthier world.

Learning From November 3: A Wake Up Call | The Milbank Quarterly

This was supposed to be an election about health. For the first three years of his presidency, Donald Trump presided over what appeared to be a robust economy, which he made the foundation of his re-election campaign. Polls last year suggested economic gains that could place Trump in a favorable position for re-election. Then, in 2020, there came a novel coronavirus, which became known as COVID-19. As of now, more than nine million Americans have been infected with COVID-19, and over 233,000 have died, a story that rightly has dominated the national conversation.

In response to this crisis, the president acted in direct opposition to public health and medical advice, sometimes seeming to reject the very existence of COVID-19, and making this outlook central to his re-election platform. This seemed at dramatic odds with how the country felt about COVID-19. Polls suggest that Americans consider COVID-19 to be an important threat—in June, 66% of Americans said they were worried about exposure to the disease. This concern is, of course, consistent with reality, with hundreds of thousands of Americans dying and many more becoming

infected with the virus.

Moving Forward, Together | SPH Today

As I write this Note, it is 11 pm on Election Night. Some of what I write may reflect a reality which has changed by the time you read this in the morning. As of this writing, it remains unclear who has won the presidential race.

This uncertainty comes on the heels of a challenging four years in many ways, not least for health. I have often written about how the Trump administration has embraced, in its rhetoric and its policies, a counterproductive approach to many of the factors that shape health. From its efforts to undermine the Affordable Care Act, to its withdrawal from the Paris Climate Agreement, to its targeting of immigrants and LGBT Americans, to its attempts to further fray our country’s social safety net, to its economic policies which deepen the inequalities that inform health divides, the administration has consistently deprioritized health. This is to say nothing of its mismanagement of the Covid-19 pandemic, where the administration’s willingness to downplay the virus and dismiss public health best practices has placed lives at risk. In falling short, the administration has—however inadvertently—reminded the country of how important issues like climate change, inequality, social justice, and investment in public health infrastructure are shaping a context that generates health.

And yet, despite this, this moment finds us with an election that is currently undecided, even as we have broad national acknowledgement that this election truly matters for much—and particularly for health.

US Election Result Must Not Obscure Need for Higher Education Reform | Times Higher Education

Authored by Sandro Galea and Nason Maani.

Whoever prevails in tomorrow’s presidential election, America’s universities face a period of immense challenge likely to test the most resilient of institutions.

Not only does the shadow of Covid-19 still loom large, along with the ensuing economic crisis that has raised the threat of staff redundancies even while universities consider the complexities of hybrid or online-only teaching, but other pressing issues also remain unresolved. Indeed, the pandemic has exposed a number of broader social crises and longer-term structural challenges for US higher education that can no longer be ignored. A major one is how to handle the ongoing calls to address structural racism; universities are grappling with their own role in perpetuating disparities, with recent campaigns such as #BlackInTheIvory highlighting the barriers faced by many academics of colour. Beyond this, higher education institutions must confront how racial disparities are exacerbated by admissions processes, fee structures, student debt and the final marks and degrees awarded to ethnic minority students. In parallel, universities must also strike the right balance between ensuring students feel welcome and safe on campus, yet are exposed to a diversity of speech and opinion.

The Election and After | Boston University School of Public Health

Few events have been more written about, talked about, and thought about than this week’s election. It has been a national preoccupation, arguably, since the day President Trump won his first term. We are approaching the moment where all that can be said about it likely has been said, where there is nothing left to do but vote. Many, of course, have voted early, not waiting longer than necessary to engage with the political process which has such a profound effect on our lives.

The stakes of the election have been underlined by the ongoing COVID-19 pandemic, which has highlighted both the critical role of federal leadership in navigating a health crisis and the link between political policies and the conditions that shape health. Many members of our school community and the broader public health community have engaged with the politics of this moment, towards the goal of ending the pandemic and building a healthier world. This has unfolded in the context of the movement for racial justice which came to new prominence last summer after the killing of George Floyd. This movement, too, reinforced the stakes of the moment for health, by helping the country to see the disproportionate burden of COVID-19 infections borne by communities of color and the systemic roots of this inequity.

How American Health Was Broken Before COVID-19 | Psychology Today

Authored by Sandro Galea and Nason Maani.

In recent weeks, there has been an increasing conversation, including in prominent medical journals, about the failure of current U.S. political leadership during the COVID-19 pandemic, the preventable deaths it has caused, and that it is time for a change. These contributions reflect the fact that, as Virchow famously said, “Politics is nothing else but medicine on a large scale.”

Building on the challenges posed by this failure for the COVID-19 moment, we suggest that a fuller assessment of the role of leadership must also include an honest and unflinching assessment of longstanding shortcomings in our country’s health, which also contributed enormously to the challenges of the moment, and in which we all have a hand.

Before the pandemic, U.S life expectancy was lagging behind peer countries, and, uniquely, was declining. It suffered from double the chronic disease burden of the OECD average. It lacked universal health coverage. While some have wondered how the US fared so poorly considering its vaunted biomedical industry, world-leading hospitals, and history of medical innovations, the overall population health of the U.S before COVID-19 was far from the envy of its peers. Why?

COVID-19 Has Deepened America’s Depression | Psychology Today

Authored by Sandro Galea and Catherine Ettman.

“Since the earliest days of the Covid-19 pandemic, this crisis has posed challenges for mental health. As of April, 2020, stay-at-home advisories or shelter-in-place policies affected no less than 316 million people in the US—about 96 percent of the population—making sustained social isolation, for perhaps the first time in the country’s history, a ubiquitous experience. We have for months been physically cut off from family and friends. We have had to learn new ways of interacting, new practices for safeguarding health. Many of us now have had personal experience with the virus, either by contracting it ourselves, or knowing someone who has. Some mourn the loss of loved ones, and we all mourn the thousands who have died from this disease in the US and around the world.
These challenges—the virus itself and the policies we have adopted to contain it—have created a perfect storm for poor mental health. This was reflected by a recent report from the Centers for Disease Control and Prevention, which found during June of 2020 adults in the US reported considerably elevated adverse mental health conditions linked with the pandemic. In particular, racial/ethnic minorities, essential workers, unpaid adult caregivers, and younger adults reported disproportionately poorer mental health outcomes, including elevated levels of substance use and suicidal ideation.”

A national mandatory order to wear a mask would keep people from becoming ‘walking weapons’ | STAT News

Authored by: Amy Lauren Fairchild, Cheryl Healton, and Sandro Galea.

Although we don’t yet know what proportion of new infections are the result of transmission from people who are asymptomatic or pre-symptomatic, we know enough to require everyone, unless they have a medical condition like severe asthma that would make mask a health hazard, to wear a mask anytime they are in indoor public spaces or crowded outdoor spaces.
People infected with SARS-CoV-2, the virus that causes Covid-19, most actively shed the virus at the time symptoms begin. Individuals without symptoms who test positive for Covid-19 show viral loads as high as those with symptoms. Individuals who are infected with the virus can feel fine but still transmit virus for days before they develop any symptoms.
A national mask order can be nuanced. Evidence continues to suggest that indoor aerosol or droplet transmission is key to the spread of the epidemic. A mask probably doesn’t need to be worn while jogging or strolling through a park or lightly populated outdoor area if you won’t be close to other people. But they should be worn in urban areas with heavy pedestrian traffic, during protests, or at political rallies.

This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.