What the Experts Want Us to Know About Public Health

Things like clean water, immunization and mosquito control are crucial, yet easily
overlooked or taken for granted.

The United States receives tremendous benefits from public health spending — with
far more value per dollar than with most other types of health care spending.

We reviewed those benefits in a recent article, suggesting that more such spending
should be considered. Then Upshot readers weighed in with their choices of what
public health campaigns they’d like to see. Those included more help for mothers
and babies (the Nurse-Family Partnership), and a greater focus on diabetes,
nutrition, gun deaths (including suicide), loneliness and the harms of sharing
hypodermic needles.

We asked some experts — officials who run public health departments, academics
and leaders of funding organizations — what they think we should be doing in
public health, and a few themes emerged.

Overrating doctors and hospitals

Although we spend huge sums on health care, it’s not always on the right things.

“The key to better health isn’t always to build more hospitals and train more
specialists,” said Vivek Murthy, the former surgeon general. “In fact, it usually is
not.”

That’s where public health comes in. Consider antismoking commercials late in the
last century, for example. Or as Richard Besser, the president and chief executive of
the Robert Wood Johnson Foundation, put it, public health has kept us safe “from
infectious diseases through immunizations, information, mosquito control and food
safety.”

“It ensures that our water is safe to drink and our pools and lakes are safe for
swimming,” he added. “It provides screening for cancer and works to prevent
injuries.”

Karen DeSalvo, a former New Orleans health commissioner, said: “Of the $1
trillion in federal spending, only 1 percent is on public health — an infrastructure
that saves lives” and that can “reduce suffering and improve community well-being
and vitality.”

We could do a better job at providing access to the things we know that already
work. Ursula Bauer, who manages the nation’s chronic disease prevention portfolio
at the Centers for Disease Control and Prevention, said, “Not all adults have access
to appropriate cancer screenings, and we don’t do a good job of managing high
blood pressure.” She added: “It’s very difficult for most Americans to integrate
 routine physical activity into our lives. We don’t have destinations within walking
distance or sidewalks to get there. We can’t find the stairs to use in most buildings.”

Thomas Farley, the health commissioner for Philadelphia, said, “There’s a lot of
money to be made selling products that, over the long term, kill people.” These
include tobacco, alcohol, unhealthy food, addictive drugs (legal and illegal) and
guns.

Dr. Bauer said policies could do better at using carrots and sticks, including taxes
and subsidies, in these cases: “There are more incentives and opportunities for
people to consume unhealthy foods and beverages than there are for them to make
healthy food and beverage choices.”

‘Deep divides of race and income’

Another theme that emerged was that we could do a lot more in addressing
disparities across race and class.

“Public health needs to take a leadership role in confronting and influencing the
social, political and economic factors that determine population health,” said Sandro
Galea, the Robert A. Knox professor and dean of Boston University’s School of
Public Health.

“The patterns of disease and death track along this nation’s deep divides of race and
income,” said Mary Travis Bassett, the former New York City health commissioner,
who recently took a position at Harvard. She said America needed to divest in
prisons and “put that funding toward new systems of justice, better housing or
universal child care.”

The opioid crisis is one of America’s most urgent problems. Rhode Island has
shown promise in being able to reduce overdose deaths by offering prisoners
medications to treat addiction while they’re incarcerated and after they’re released.

Other initiatives can be tailored to meet the needs of various populations. Older and
low-income residents of Boston have benefited from the receipt of specially
formulated meals — such as those with soft food or with low cholesterol. According
to a study in Health Affairs, those receiving such meals had fewer hospital
admissions than those who didn’t.

For others, housing assistance may be the most direct way to improve health. That’s
why the Boston Medical Center — the city’s principal hospital for low-income and
underinsured residents — is investing in affordable housing and referring patients to
community housing programs.

Such efforts aren’t unique to Boston. A project in California is providing meals to

Medicaid-enrolled cancer patients. In Ohio, a program backed by Nationwide
Children’s Hospital, which serves low-income children, is helping finance its
affordable housing initiatives, including rehabilitating run-down housing units.
Public health needs better public relations
We could also do a better job addressing things we know that kill. Gun safety and
education could decrease accidents and deaths, Monica Bharel, commissioner of the
Massachusetts Department of Public Health, told us.

She also pointed out likely problem areas in the future, including e-cigarettes and
vaping; the consequences of marijuana legalization; and social isolation.

Dr. Murthy said a shift toward school- and community-based programs to

strengthen emotional health would be worthwhile. “Such programs have been
shown to reduce violence, smoking, alcohol and drug addiction and mental illness,”
he said.

The 2016 Surgeon General’s Report by Dr. Murthy lists several evidence-based
school and community programs to address these issues. They include, for example,
The Fast Track Program, which identifies children with high rates of aggression and
aims to improve their social and educational skills.

Dr. Murthy also argued that “the way the Congressional Budget Office scores health
legislation does not recognize much of the cost savings from prevention, which
creates a further disincentive for legislators to pursue prevention-oriented
legislation.”

Perhaps the biggest change needed is for public health to do a better job at
trumpeting its success. Too often, it seems to be the unsung hero. “It can be difficult
to maintain support for public health systems when they are so often invisible,” Dr.
Besser said.

Few public health initiatives will make anyone wealthy. In the American political
environment, that makes it difficult to organize a winning coalition for any specific
policy.

But that outlook misses a crucial fact about public health: Many campaigns have
achieved a rare double victory: They have lengthened and improved lives, and they
have also saved more money than they’ve cost.
Summary

The United states receives tremendous benefits from public health spending. There should be more
spending’s like this be considered. Although they spend huge sums on health care, it’s not always on
the right things. They spend it mainly on more hospitals and specialists, but often is the quality more
important as the quantity.
According to Karen DeSalvo they could be a better job at providing access to the things they know
already works. In addition, said Ursula Bauer: “It’s very difficult for most Americans to integrate
routine physical activity into our lives. We don’t have destinations within walking distance or
sidewalks to get there. We can’t find the stairs to use in most buildings. ” Finally, they would need to
improve policy. There’s a lot of money to be made selling products that, over the long term, kill
people. Also are there more incentives and opportunities for people to consume unhealthy foods
and beverages than there are for them to make healthy food and beverage choices
In addition to all these areas of improvement with regard to health, they should reduce disparities
across race and class. Sandro Galea said: “Public health needs to take a leadership role in
confronting and influencing the social, political and economic factors that determine population
health.”
They could also do a better job addressing things they know that kill. Gun safety and education could
decrease accidents and deaths. A shift toward school- and community-based programs to
strengthen emotional health would be worthwhile. Such programs have been shown to reduce
violence, smoking, alcohol and drug addiction and mental illness.
Few public health initiatives will make anyone wealthy. In the American political environment, that
makes it difficult to organize a winning coalition for any specific policy.
But that outlook misses a crucial fact about public health: Many campaigns have achieved a rare
double victory: They have lengthened and improved lives, and they have also saved more money
than they’ve cost.