In rural America, especially where no Instant Care is available, public health is the first step for vaccinations, for helping young mothers and their babies, for questions like “Is it a break or a sprain” and patching up of wounds.
This article linked to an outdated video, which made a serious mistake about fluoride science, and should be corrected.
The speaker in the video claims a Harvard University meta-analysis of 27 fluoride/IQ studies reported an average difference of 0.45 IQ points. In reality, the Harvard researchers reported a loss of 0.45 of *a standard deviation*, which amounts to a loss of 7 IQ points.
A loss of 7 IQ points would more than halve the number of very bright children (IQ greater than 130) and increase by at least 50% the number of mentally handicapped (IQ less than 70).
A good journalist checks their facts. Carroll and Frakt, do your job! The Harvard study is here: https://dash.harvard.edu/bitstream/handle/1/10579664/3491930.pdf?sequence=1
Look at the bottom of figure 2 - the 0.45 number is SMD, not IQ points!
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@David W
Not only was the video unbelieveably outdated and erroneous --- but the two replies I made to it underneath were completely and eviserated by some kind of automatic editing --(no, no bad words, etc) Very weird.
1
One area was left out. It's not traditional public health but if we don't fix it, we are all responsible.
It's access. Yes, finding someone with the time to see you to explain allof the things noted to you. To talk about smoking or obesity or hypertension.
PAs and NPs are one huge answer.
We are still largely handcuffed in many states.
1
I'd say the answer is simple; being the last industrialized country in the world, we've had the opportunity to observe all the socialized medicine solutions developed and deployed by the United Kingdom, the Commonwealth of Great Britain, and the sort of unique solutions attempted by the EU. They've been tested, measured and found wanting.
None of us are attracted to the myriad problems those systems have and we haven't yet bred and educated a genius who can improve them.
I think that's it in a nutshell. There aren't any truly successful examples of socialized medicine our society wants to emulate and we don't have a better idea.
I don’t think the people of the UK would exchange their socialized medical system for our for profit model.
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@Sgt. Pepper You forgot to tell us who tested them and therefore how they were found wanting. I realize this article is old but we were led here from today's anti vaxxing editorial - today = 20 January 2019.
I have spent 22 years in Sweden and because I retired here during those 22 I also I have Medicare + supplemental Aetna insurance when in the USA. So I in a sense experience something resembling SE Universal Health Care when I am in the USA.
But ordinary Americans, millions have absolutely nothing to match that care, either as measured by cost or by results. The easy example is by comparing pre, peri, and post natal for ALL pregnant women in the USA and ALL pregnant women in SE.
No contest, pregnant women have it better in what you call a socialized medicine country¨
Only-NeverInSweden.blogspot.com
Drs. Carroll and Frakt,
The next time you feel like asking the question - "Why aren't we spending more on things that can save both money and lives", here's what I sugggest -
Close your eyes tight and try and put yourself inside the head of our greedy and vapid President. Then ask, what he would ask, OK, what's in it for ME, Mr. moneybags, who doesn't really feel like he should be penalized for his success by being taxed to pay for other people's problems? Our nanny state is WAAAY too big and I am being taxed to death.
This sentiment is shared by MANY of Trump's supporters. Even the ones who would benefit from public health initiatives don't want to see the gov't do anything. They want good paying middle class jobs and they think that if gov't gets out of the way, that is what will happen.
Congress is in the hands of a party who doesn't believe in the Federal gov't doing much, even if, perhaps especially if it might be useful and effective.
2
The American health care system has devolved into a system where we wait until people are sick, then we apply bandaids and pills. Preventive health measures cost up front but unfortunately, time must pass before the public can see how great are the benefits in terms of longevity, health outcomes and net cost. We only think short term.
The best public health program that the U.S. could adopt at this moment would be to house all its population. We hear a lot about socialized medicine, but those Northern European countries which do have such systems also make sure that their citizens are housed, warm, and adequately fed. That solves many basic medical problems right there.
Thank you for your comment. I believe we are facing more concerning epidemics such as diabetes, which goes under non-communicable diseases. This could be attributed to the increasing incidence and prevalence of obesity in adults and the youth.
Providing housing is a great idea, but I would not consider it a priority at the moments, looking at the other diseases burden. Your suggestion would be more applicable in other developing countries where cholera, Tuberculosis, and other infectious diseases are on top of the list.
Public health starts with the public.The gains in longevity in the past 50 years have been behavioral, not government programs.
All health is divided into three: genetics, life style, and luck. You can't change the first and the last. All you can do is see that your lifestyle is a healthy one. Public health is about you and you have to do it. Throwing more money at it will have negligible effect.
We spend 18% 0f GDP on health, 4% on Defense. The ROI probably favors the latter. Europe spends about 12% on health and they live longer.
Throwing more money at "public health" is a waste.
2
Re from the article --
"Why Is Funding So Low?
For all its benefits, spending on public health is surprisingly low. The private sector can’t make money on it. That leaves the public sector, which is subject to political forces on spending and taxes.."
Just so. Or, as Rep. Alan Grayson (D-FL) summed it up in 2009 --
https://www.politico.com/story/2009/09/grayson-gop-wants-you-to-die-027726
The success of the food industry bears a large part of the blame. Low fiber, high sugar/fructose, high salt, high fat, chemical laden foods are pushed by Madison Avenue. They know what they’re doing and they don’t care. Profits rule. They’re making everyone sick, burdening the health care system.
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Louisa, I don't think you can lay this all at the feet of the food industry because, in truth, it's cheaper to buy healthy food if you have available labor to prepare it yourself. Buying prepared foods is an "industrial disease" in the words of Dire Straights.
In the 50's and 60's, when Mom worked at home and did the shopping and cooking, Americans ate better. Plain and simple. We have two income families as the norm now and Mom is the Sr. VP of Marketing. She's not cooking.
My wife and I were a professional couple through the 80's, 90's and the Naughties. We had to divide things up and we had to hire a live in Nanny for the kids. I learned to cook because I enjoyed it. She learned to garden because she enjoyed it. We always made a good team and had a healthy family, but lots of families either can't or won't do that nowadays.
The food industry doesn't do a good job of providing healthy prepared food, but that's mostly due to lack of experience. They're honestly trying. I don't expect them to ever reach the quality levels Mom would have accepted, but they are trying.
The real problem is societal. We no longer have the free time (labor) to take care of our own nutritional needs and the sub-contractors just aren't cutting it.
1
What a very odd question.... most of know exactly why not - why would you even ask? Just to provoke us to reply? Health care is not what we have in the US.... we have sick people who need care but who cannot afford it.
I'm wondering - is that annual visit from UK's medical plane still coming to bring help to America's poor? You know the one - that parks on a tarmac for 4 days in some western state whose residents have infected teeth, and who need glasses, and who haven't had any vaccinations, and who have skin conditions, and broken thisses and thats that they don't have the money to have fixed in their own country....they drive there and sit in their cars for four days just waiting to be seen by medics.....
Deeply shaming!.. as is everything to do with helping the poor in America.
I ask you....How can you pull yourself up by your bootstraps if you cannot afford boots - only flip-flops?
They are the true Good Samaritans and I never heard that those docs and nurses are 'religious', in the US meaning of the word.
5
Why you ask?
Because the GOP made sure that the Congress has the best healthcare the US tax payers can buy for them and they don’t need to make it better.
3
I'm looking forward to seeing how the authors dive more deeply into this concept, and would love for them to highlight dietary counseling (provided by experts and often covered by insurance!) as an important and emerging public health intervention. Many insurance companies now offer preventive benefits to their members that enable members to have access to an in-network dietitian for covered nutritional counseling. Members are eager to take preventive measures to safeguard their health or learn how to better manage chronic conditions through diet, and registered dietitians are trained to provide expert nutritional counseling.
If the authors are interested in exploring this further, I can be reached at [email protected].
2
I've been wondering about Hepatitis A vaccines. This vaccine is not covered by my insurance unless I am traveling to a third world country. Yet, Hepatitis A is common among the homeless in this country.
Why isn't there a vaccine for Hepatitis C?
2
There is only one public health campaign we need to focus on right now and it is on LIMITING ACCESS TO GUNS. Every single day that every public health practitioner does not speak out about the problem of gun violence in America (and I want to emphasize that this very much includes suicide, the rate of which is increasing at alarming rates in the American population) is a day lost. Please, NYT, Please use your platform to feature an in-depth discussion with a PH expert on the epidemic of gun violence in America, a situation that has such a straightforward solution. I recommend Dr. Michael Webster from JHSPH's Center for Gun Policy and Research (https://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-cent....
Here is a radical idea:
The more money people are paid so that they can be financially secure, provided free health care for treatment as well as maintaining health, protected by preventative measures taken and given to all (vaccines, education, clean water, various drug regimes ) supported by community care services and national networks (Suicide prevention, Addiction services, Mental health support, Loneliness Initiatives etc) and the provision of a societal safety nets (paid Maternity leave, paid sick leave, paid holiday leave).
These Initiatives and investments that a country can make...on all the people that need the help and support that can be utilised to better , help, save ,improve and pre-empt those things that now trap, catch and afflict far too many people...Men, women and children...will produce benefits and positive outcomes in myriad ways that will resonate through society producing benefits for everyone making for a far more happier, safe, prosperous, confident, productive and successful Nation and the people who make it up and make it be what it can become to all.
It is already happens in many countries far less prosperous than the U.S so it is NOT a pipedream, more a question of those who have the influence, power and ability to change their attitudes and personal desires and see the worth, value and overall advantages of a country that works together for The Greater Good and decide to work in a Common cause to make it happen.
Are they up to the task?
1
I don't know we have enough tax money to give an additional 30 billion in farm welfare to American Farmers this year. I guess in the GOP 2 million farmers trump 320 million Americans. The GOP who gave the additional 30 billion in Farm Welfare to well off American Farmers, took money put of public health and children's health programs.
1
How to get the greatest return on the investment in public health? How about the approach proposed by Dan Buettner in The Blue Zones Solution? The results described (including stories in NYTimes as far back as 2012) are compelling, and nobody is forced to change anything they don't want to change. The methods include diet and lifestyle changes that people willingly choose in order to live healthier and longer lives. The budget investment is trivial, but requires low-level sustained effort over an extended period (not something we seem to be very good at in the US).
The main themes include healthy food choices, easy access to healthy food choices, regular exercise, and (perhaps most importantly) good social/community relationships on a person-to-person direct level. So it really is about changing how we live, on a personal level at one's own pace, supported by others who also want to change their lives. Buettner's book is excellent reading and suggests a sane approach to making major improvements to health and life. I suggest you explore his Blue Zones further if trying to figure out how to get the biggest return for public health dollars spent.
Carroll and Frakt claim they are shocked! Shocked! to discover that for-profit health insurers won't spend money on public health projects because they can't make a buck out of it. Then they express surprise that the British system's heavy spending on public health yields excellent results in improved health outcomes.
The British system, also called a "Beveridge System" of health insurance after Malcom Beveridge who proposed the system after WW II, is truly socialized medicine: all health care providers are government employees, and the British people pay for medical care through their taxes. And yes, the system works beautifully.
Instead of Carroll and Frakt "consulting" with American health care experts and constraining the entire discussion by claiming "limited resources," let's see them ask health care experts in Germany, Taiwan, Britain and Canada about the American health care system, and have them explain how adopting their systems can dramatically improve our health care.
It appears the party in power has no will to invest in public anything, including our crumbling infrastructure. They are completely ignorant of the massive public investments from the Civil War to the Cold War that delivered the world they take for granted. Sad.
Recall, when Public Health initiatives fail, they can fail in spectacular fashion.
—low fat diet & obesity crisis
—chronic pain Rx & opioid crisis
—#EHR, metrics & MD burnout
Central health planners need #skininthegame @nntaleb
1
Counterpoint: a toxic combination of american beauty ideals and capitalism created the obesity crisis through the mass promotion and consumption of foods loaded with ingredients that activate the brain's dopamine receptors in a way similar to drug use; the opioid crisis was created by pharmaceutical companies aggressively marketing and peddling their highly addictive drugs for all different 'kinds' of pain; MD burnout with EHR is not a result of a public health campaign, but a shortcoming of the imperfect but only way we have to keep patients healthy and clinicians accountable
Many Americans prefer 'alternative facts' to science and reality.
Perhaps if they had to pay themselves for medical care of an unvaccinated child, public health might be given its due.
You want to know who's spending more on public health? The smart, alruistic young people who see its value and are entering the field. I am an early-career public health professional who recently earned her MPH from a top-10 school (with a scholarship), and the principal on my graduate school loans is double my annual take-home pay. We entered the PH workforce under Trump amid hiring freezes and massive funding uncertainty and many are un- or underemployed as a result. This crucial, life-saving field is crippled by our toxic, selfish political climate at every turn.
7
(1) Our market based economy isn't much concerned for public goods... it's too enticing to turn health problems into business opportunities.
(2) Health interventions focused at the population level often impinge on our great american right to be left alone.
(3) The successes of public health are invisible. While doctors can point to real people as evidence of their life-saving abilities, public health has no way of knowing who would have become sick. Statistical lives aren't as moving as real ones.
(4) Investing in our hard earned money now in order to enjoy some abstract health benefit later is a hard sell, even when it means saving a lot of money in the long term.
5
We don’t spend more on public health because conservatives claim they never took a handout and so you aren’t getting one either. They simply don’t remember most of their immunizations and they were to young to know who paid for them. They are eager to destroy every aspect of today’s social safety net because they don’t want anyone to be “lazy” or have anyhting different from what they had and you know they had to walk five miles in the snow to get to school...yadayadayada
5
Problems addressing the public's health relate to our dysfunctional nation, to the problems our legislators have with getting much of anything done in our polarized environs.
If you think this isn't a problem, just read the opening chapter of Steven Brill's recent book, “Tailspin: The People and Forces Behind America's Fifty-Year Fall — and Those Fighting to Reverse It," reviewed here: https://www.salon.com/2018/05/27/americas-tailspin-and-the-rise-of-oliga... .
There's another stark problem not mentioned in this column--guns: "Private Guns, Public Health, New Ed.," 2017 by David Hemenway ( https://www.press.umich.edu/9737711/private_guns_public_health_new_ed ).
Our own Bill of Rights gets in our way--not that there is any easy way out of any of this. The first and second amendments are interpreted at such extremes we can't handle public health, infrastructure, economic inequality (to include wage stagnation) and any number of other major concerns.
And yes, our US health system is the most overpriced in the world. Brill has written about that as well. As has Dr. Elizabeth Rosenthal ( https://www.nytimes.com/by/elisabeth-rosenthal ).
2
Per above: "Health protection interventions, which would include vaccinations, have saved $34 for every $1 spent on them, according to the review. But not every vaccine has a positive return. For example, in years for which the flu vaccine is a poor match for the actual influenza types that are circulating, the return on investment can be as low as -21, meaning that it costs $21 to save $1." And, for the 2017-2018 flu season, it was a poor match.
Via a CDC pamphlet (Sept. 14, 2017): "There are a number of reasons why flu vaccine effectiveness against influenza A(H3N2) viruses may be lower:" including:
1. For A(H3N2), the mutations and changes in "A(H3N2) viruses have more frequently resulted in differences between the virus components of the flu vaccine and circulating influenza viruses (i.e. antigenic change) compared with influenza A(H1N1) and influenza B viruses." Simply meaning that a shorter lead time exists to maintain the effectiveness of A(H3N2) vaccines between their dates of manufacture and use.
2. Also, per the CDC analysis: "Growth in eggs is part of the production process for most seasonal flu vaccines," and changes in the influenza A(H3N2) viruses in egg-grown vaccines and the circulating A(H3N2) viruses limit the vaccine's effectiveness. Again, a la the CDC: "Newer cell-based vaccine production or recombinant flu vaccines, could circumvent this shortcoming...."
But these newer methods of vaccine manufacture would require new investment dollars.
5/30 9:10a
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The problem is that we actively pursue feeding our population with the cheapest possible food that science can produce with little of any regards for the consequences.
How do you really test food additives for a 20 year exposures? Why did the approval process for artificial sweeteners never consider the effects on the microbiome?... and how much damage has it caused?
Why does the press consistently ignore the results of our use of HFCS and it's effect on the brain to reduce our feelings of fullness and thus make us eat more.
We do not need to increase spending to regain health. We need the government to stop destroying people's health.
3
We need to get people in to primary care. So much of the rest in preventive medicine to avoid expensive chronic conditions can flow from a patient having regular visits with a primary care provider. It would not take much money to aggressively promote all patients establish a primary care physician. My organization is pursuing a local health literacy campaign to get those on all types of insurance to use it for primary care to boost their health.
Eventually more resources are going to have to be spent on care coordination to further reduce hospital readmissions, manage complex patients, reduce disparities, and improve population health including through screening and referral of patients for shortcomings in social determinants of health. Interventions and hand holding by home health workers, community health workers, nurse practitioners, nurses, and doctors depending on the complexity of the case within the important home care setting for people of all ages including seniors will be key to improving outcomes and reducing costs. A huge field army of caregivers will be required in a short term expenditure for long term gains. Otherwise our population will remain sick and expensive. Sending an asthma patient home to moldy housing is just one example of the ongoing price we all pay in the US. That needs to change.
So, absent tons of resources, health literacy and primary care promotion and resources put toward care in the home are the two areas I would like to see pursued.
1
The fact that Medicare does not cover shingles vaccines under Part B coverage (like flu vaccines) and instead either might cover it under Part D (Zostavax with expensive copays) or doesn't cover it at all (Shingrex, which is not on the approved list) says a lot about how we handle non-legacy (like polio and DPT) vaccines.
Even though PH would agree that a vaccine is not only cheaper, but so much kinder to potential shingles suffers, CMS is still not placing the vaccine coverage under the appropriate Medicare coverage tent.
For people with Part C, they can only hope their Advantage plan will cover it the way other vaccines are covered, but it isn't likely that will be happening in many cases.
the only surprise here is that the NYT is surprised.
Remember the GOP congressmen that questioned why their wealthy backers have any responsibility for taxes to pay for the health care of the poor?
We have a whole party that has been convinced that taxes are evil -- even if they benefit from the spending!! Out here in CA the roads are pitiful. They finally passes a measly 12 cents a gallon tax to improve the roads, the first tax increase in years. The cost per car at 12K miles per year in a 20mpg car is about $60. Yet, predictably, the GOP has put a ballot measure to cancel the increase.
6
For economic background to this discussion; consider:
In a recent Sunday NY Times ( April 22,2018), Christopher Preble states: "By some estimates, the United States accounted for roughly 50 percent of global output at the end of World War II. By 1985, its share stood at 22.5 percent. It has fallen to 15.1 percent today, and the International Monetary Fund projects that it will slip to 13.7 percent by 2023."
Per the Tuesday, April 10, 2018, NY Tiimes, Thomas Kaplan reports: "The federal government's annual budget deficit is set to widen significantly in the next few years, and is expected to top $1 trillion in 2020 despite healthy economic growth, according to new projections from the nonpartisan Congressional Budget Office ...."
Mr. Kaplan continues: "The $804 billion projected deficit for the current fiscal year is $242 billion larger than what the budget office had expected in June." Per the CBO: by 2023, "interest costs are projected to exceed what the government spends on the military."
In addition to a decreasing share of global output, Americans are also saddled with high levels of income and wealth inequalities that compound problems from the shrinking US share of global GDP.
Not only do these financial constraints limit budgeting alternatives for public health; but they actually contribute to the opioid crisis itself per Dr Angus Deaton, and other economists, as the shrinking US GDP share means a loss of factory jobs with the associated problems.
5/29 Tu 3:40p
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Given limited resources I would like to see a health campaign to discourage consumption of animal-based protein, especially in light of the overlapping epidemiological and experimental evidence demonstrating improved health outcomes from reduced animal-based protein consumption, the WHO's classification of red and processed meat as highly probable carcinogens, and the theoretical yet strongly supported mechanisms through which animal protein could either cause or help in the proliferation of many types of cancer. None of this is to exclude the research linking animal protein consumption and chronic inflammation, heart disease, diabetes, and obesity. Many hospitals are already recognizing these relationships and taking steps to reduce their patients' exposure. Additionally, depending on how widely you define public health, the environmental impact of reduced animal protein consumption could have significant effects on housing (especially via land use) and pollution in many parts of the country/world.
Why is suicide and suicide prevention seldom if ever discussed when it comes to public health funding. 60% of all gun deaths nationwide are due to suicide. In the state of Oregon 82% of all gun deaths are due to suicide.
2
We are not allowed to use government funds to research gun deaths/violence. Which makes it very difficult to do gun research, especially into suicide.
That being said, there is other funding that could be used towards research/programs on suicide, but anything around gun violence is hard to get funding for.
1
It depends on how receptive people are to a particular intervention.
Medicare Advantage.
It's finally a business model where the private sector can make money on preventive care and good public health campaigns. About a third of seniors today are in Medicare Advantage plans, and many of those plans have demonstrated success in saving costs and keeping patients healthy.
3
That really depends on how one does the accounting. Medicare Advantage programs target the “new” old as they are healthier overall and consume less resources. Wait 10 years to see how this grand experiment plays out. Risk pool management would be easier with EVERYONE in the same bucket, Medicare for all.
3
Why are cigarettes legal? Why are antibiotics used in the agricultural industry(gov't now says it must be prescribed by a vet but they can be corrupt to make the money). Antibiotic resistance is a major national hazard as a result! Why are we surrounded by so many chemicals in the agricultural industry when organic farming should be nationwide except under extreme conditions. Why aren't healthy life style choices taught and emphasized in school, media, etc. instead of all the drug commercials we see regularly. In 'health care' everything is given a pill when so many conditions can be managed without it. Etc. etc. There are so many solutions to so many of the problems we have but lobbied interest groups have a greater impact on our elected officials than good policy. The SCOTUS ruled in 2014 that money was the equivalent of free speech in the election process. I don't know what they were smoking when they made this decision but that nailed the coffin shut as far as our future goes.
4
Take a look at federal paid parental leave. While we know that leave for parents whether they've given birth, adopted, or are the secondary caretaker has tangible value, it's inhumane that we currently have no national paid program for birth or adoptive parents.
We know that for women, especially, without the means for health and childcare, the additional costs of dropping out of the workforce, wage stagnation due to various factors, have additional societal costs (externalities) that are also a concern to the future health and well-being of their children.
By supporting women's physical and mental well-being, we regain the full economic value of a woman contributing and working.
2
Why not label and address it as caregiving leave rather than parental leave? That way, all categories are covered: "maternity" leave leaves out -pun intended - caring for sick/ disabled pets, parents, siblings, friends, other extended family. I never used maternity leave since I am and will be childless but I have cared for numerous family members, fortunately with a flex schedule. On the other side, as a physician, I see a lot of different configurations of caregiver and recipient. Do it this way and not only it is practical, it is also politically likely to gain support across groups.
5
America is a meritocracy. Tragically, part of our population believes that some people don't deserve to live because they don't earn enough money or have made "poor choices." When members of this meritocracy become less healthy with age, may they be subject to their own criteria for value.
5
The reason we don't spend enough money on Public Health is the same reason we don't spend enough money on other government investments - consumption expenditures eat up an increasing proportion of tax revenues. Beneficiaries of Social Security, Medicare, farm and other subsidies, and defense spending will complain about cuts in their favorite programs, but not about cuts to programs they don't see a direct benefit from. Even Ohio's liberal senator - Sherrod Brown - opposed a proposal to cut defense spending that might have adversely affected employment in Ohio. (Since when did we decide National Defense was a jobs program?)
3
As a Doctor of Public Health, who worked and taught for 30 years in America, Netherlands, England, Germany and other nations, here are my explanations:
The profit margins from public health are smaller than in other sectors of the health care system.
Salaries in public health are lower than in other medical, nursing and health management fields.
Public health is seen as part of government, and "government isn't the solution, it's the problem". It is seen as collectivist, socialist, anti-libertarian and removes responsibility from individuals to take care of themselves.
7
Why aren't we spending more? 'cause those who actually pay taxes need some evidence that whatever program you are proposing actually would improve our lives from survival to thrive. No point in stalling death if we are going to have no quality of life from expensive intervention.
Secondly, the elitism. The Diane Sawyer analysis and commentary on breast cancer screening at 40 vs 50 (that was aired in 2011) was stunning in how one group's lives weren't valued at all -- not enough younger were found with cancer, so better not to screen them until they are 50 and in stage 3 or 4. Those younger have genetic issues have been totally written off by the Public Health folks. Imagine what the world would be like if people who are Vitamin D deficient because of genetic reasons found out and were treated before their cancers developed and progressed. The CDC knows 28% of the population is deficient in D, and hasn't done squat about it. Similar story for B12. Then there is the folic acid question...the food supply now has enough folic acid to negatively affect the health of the roughly 1/3 of the population with genetic issues, and they weren't even told about it in advance so they could avoid it. You want their money? They spent it on the treatment for the diseases you knowingly inflicted. And now you want more?
2
The bottom line imo is that you can abuse the system from both ends.
On one side, we have a de facto criminal health care system, where at any one time (pre ACA) you can have up to 50 million uninsured people that basically do not get any medical care.
On the other end, you have the insured who are bombarded with unneeded procedures, operations, drugs etc., that are of little or no use other then to make big HMO and Big Phrama execs billionaires.
The answer is to address both issues.
14
Correct billing fraud must be addressed. Medicare has become an ATM for the billing community.
1
Thank you for your reply SW. You are correct and the Medicare system has to defend itself against abuse on all sides.
However, it doesn't mean it is not a lifeline for seniors.
I never met a conservative Republican who wants to do away with it, although they will rail against ACA.
A simple observation: In a day when science is denigrated and "freedom" can mean doing whatever you want regardless of the public consequences, public health programs have lost their oomph. Hence, anti-vaxxers, slow responses to hurricane-induced releases of sewage and toxic chemicals, slow or non-existent responses to chemicals disposed of in soils decades ago. Can't see and immediate problem, therefore a problem must not exist.
21
Freedom to drop dead. Conservatives are darwinian in their economics, but not their schools, only the richest will survive,
Maybe here's why - many of those with money resent our tax dollars going to pay for people who have made poor choices. But there's a lot of code bundled up on those words. "With money" overwhelmingly tends to mean white and privileged. "People who have made poor choices" overwhelmingly tends to mean non-white and dealing with the day to day realities of structural racism and poverty. Same arguments re why we don't fund decent public education and health care.
3
As a PhD student in Public Health, I take great exception to your accusation. The majority of programs and policies are focused on helping or supporting disadvantaged populations, NOT privileged ones. However, there must some understanding that it is very difficult for a person who is struggling to put food on the table and keep their children on the straight and narrow, to spare the time it takes to shop and cook thoughtfully, or work out regularly, let alone to afford it. Rather than creating a false narrative of social and economic elitism, how about extending some sympathy and help to those in need? Not to dismiss the problem of structural racism and poverty, but blaming Public Health efforts for them is, frankly, nonsensical.
3
I apologize because I seem to have miscommunicated my point, which is very much what you are saying. I am not blaming public health but in fact suggesting that racism is a key underlying reason why public health isn't better funded. What you say is correct and to that, I was trying to add that so often we denigrate "poor" people (so often code for non-white) and try to suggest that their social and economic circumstances are because of choices they made. Which as you point out (and I was trying to, above) is simply not the case.
"Fluoridation (still controversial in some circles), has greatly improved the condition of our teeth." 97% of Western Europe does not fluoridate the drinking water and their teeth are no worse than ours. Dental decay is epidemic in the US where 75% of municipal water supplies are fluoridated. Only 5% of the world's population drinks artificially fluoridated water. The NY Times is outside the loop when it comes to water fluoridation. See the statements below from European countries on why they don't fluoridate.
http://fluoridealert.org/content/europe-statements/
6
Given limited resources, which health campaign would you like to see started?
Eating better - calories on restaurant menus - home cooking
1
This is easy. Because providing for the common good is "socialist." It's better for the poor to die.
4
I can't see any change for the better until the medical industry is rewarded for health outcome, not how much money it can make by excessive treatment and prescription. Chances of that happening whilst I am alive (I'm 80) is about zero.
2
The crux of the matter to me is how people think of “health”, in the absence of a single, standard definition.
In my experience, to most people it is NOT a “quality” life, but rather about our level of symptoms, the diseases we have been diagnosed with and a sense of how long we have left to live.
It has been pointed out that the 1948 World Health Organization definition of health in broad domains (physical, emotional, social) was basically co-opted by the medical industry to focus on disease. I think that is still the case.
I think people and our society would be much better off if we could focus on a positive concept of health in nonmedical terms, including our physical fitness, relations with others, access to clean air, water, decent food, access to educational and vocational opportunities, and very importantly adequate support for parents and their children. And of course universal coverage of essential disease care.
These are very hard to promote in a society brainwashed to idolize greed, competitiveness and “freedom”, such as that of the U.S.
Stephen Rinsler, MD
7
Bravo! I would add the as long as medicine is based on profit rather than outcomes, this completely rational and evidence-based approach will not occur. Capitalism is great in certain arenas, but healthcare is not one of them. Unless you can monetize the lack of disease, our current system will continue to fall far short of it primary purpose--creating, enhancing and maintaining the best health possible for the greatest number of people possible.
2
It's shocking that we spend 15% of GDP trying to cure diseases that people can largely avoid through basic, simple lifestyle changes. Public health programs help. Unfortunately, no regiments of lobbyists are there to advocate for them. If more health care were public, maybe public health would get more attention.
4
The overall improvement in mankind’s heath and lifespan has mainly been due to public health measures like clean water and air.
The problem is that government is the only body with any incentive to pay for public health and each initiative usually conflicts with some part of the private sector.
1
Why would the fact that public health care saves money in the long run change anyone's mind about paying for it? The what's in it for me crowd can't understand the benefits.
3
Until we get 100% un-flawed people having 100% un-flawed children and so on, face it: Humans are vulnerable and need help -- and to help each other. Of course, we are also mean and greedy and sadistic and self destructive. So into the void of care and support comes The Government, which I view as not some "other" but as "us" -- as in each of us is The Government.
How did we get so mean? Anywho...
I'd like to see public health messages about
1) increasing physical activity, namely walking
2) the impacts of our car-mad culture (lower speeds, better air quality, less noise impacts)
3) the impact to water quality from smokers' littering cigarette butts (which are plastic)
3
Public health is, at its core, about a sense of community and collective identity. Sadly, those are values which are being trashed on the Right and the Left, pious rhetoric to the contrary notwithstanding. They are challenged from the Right by a belief in hyper-individualism and the projection of a false narrative saying America has achieved a meritocracy. They are challenged from the Left by identity politics, which takes a nation of hyphenated Americans and establishes one's primary identity as the adjective preceding the hyphen, rather than the collective noun, American. Meanwhile, we have become a very mobile country geographically as traditional jobs disappear ripping communities asunder.
A reality often ignored by those advocating for more "progressive" attitudes toward health care is that a significant number of Americans actually want a system that gives them the freedom to choose care they cannot afford. That may seem like a "stupid" or self-defeating attitude, but those people cannot be, nor should they be, ignored.
It also is not irrelevant that to a large extent the zip codes with the lowest rates of childhood vaccinations are zip codes with the highest degree of education and income, zip codes, I would hazard a guess, where the belief in serious anthropogenic global warming is pervasive, even while the science behind the virtues of vaccination for the community is more solid than for the climate issue. Across the spectrum it's "I know, but you only believe."
2
The key factors in this question are the cult of the individual and the demonisation of taxes. Everybody is supposed to pay their own way, according to some, and those who can't should be allowed to perish. Public Health is viewed by them as creeping socialism that weakens the moral fibre of the nation. To exacerbate the situation politicians have gone out of their way to demonise taxes as an instrument of the devil when used for the common good yet have no difficulty in spending tax money to stage parades and rallies to glorify themselves.
2
Half of US cancer deaths are preventable by proven methods - ie public health measures. But a drug to keep people with advanced cancer alive for a few additional months is worth $$$billions/year. Is it surprising that cancer kills 1 in 4 Americans?
America has lost its way. Greed, selfishness, and dishonesty have run rampant. From the White House to the health care industry. Very very very discouraging.
11
I pay enough taxes. I would like to keep some money that I earn instead of subsidizing more health programs
1
Think about the contagion effect, as only one example, and the benefit to yourself. Public Health is not for somebody else. It's for all of us.
8
Then you'll love public health. Every dollar spent there typically saves dozens of dollars. When was the last time you or the Government had to spend money treating a case of polio - a disease once so common it afflicted a President.
7
Boo to you because we are all in this together.
3
Read Poor Economics and skip to the three "i's"--inertia, ideology, and inertia. These are powerful predictors of the current state of health care spending.
In future articles on this topic, I hope the authors will highlight the critical importance of applying a public health lens to the prevention of gun violence in America. Over 33,000 people are killed by guns in this country yearly and over twice as many are wounded. It’s been estimated that we spend $229 billion per year on this epidemic that devastates individuals, families, and communities. There is much that can and should be done to prevent these senseless deaths and injuries, and I hope that the authors will use this platform to shine a bright light on the role that public health/preventive strategies can play in curbing this crisis in their next installment.
16
Much of the money going into "health care" goes for sickness care, repair, not prevention and not for wellness. Why? In part because the private sector doctors and hospitals created per payment plans to finance the services...Blue Cross/Blue Shield grew out of that. Medicare copied the models...demanded discounts and effectively ruined these not for profits who priced on a community rating scale and that led to many companies going to commercial insurance to get out of the system which loaded their payments to cover government shortfalls.
Public health grew out of taking care of sailers infectious disease works. The private sector became very strong and has never been challenge effectively by any public health agency.
The agencies managing the Medicare and Medicaid and Food stamps programs are all in a position to do "public health" and they do but that isn't the areas where funding is lacking. CDC gets a lions share of money to prevent epidemics. National Institutes of Health are tied more to research at Universities and they get tons of money.
So it isn't that there is no public health money. There is a ton of it, just not in some the areas mentioned in this article. Even the military supports a lot of health research and services. And think of the VA. No money for public health, Wake up, look around. There is a huge flow of funds through public agencies in positions to change health outcomes... do they do it/ That is another question.
3
We must improve the way we nurture small children if we actually want to improve public health.
Kaiser's Adverse Childhood Experiences (ACEs) study by Dr Vincent Felitti showed us some 20 years ago that adversities in childhood seed both physical and mental illnesses. Kids who experience traumas have more cancer, heart disease, diabetes, depression, suicide, and addiction as adults. And there is a dose response effect: the more adversity, the worse the health outcomes.
Programs that address the mother baby dyad, like the Nurse Family Partnership, pay for themselves very rapidly by inculcating attachment and parenting skills, supporting breastfeeding, etc.
4
Here's what I've never understood: Why do we spend $20 billion a year subsidizing farm businesses growing corn, soybeans, wheat, cotton and rice and not subsidizing farm businesses raising fruits, nuts, and vegetables? This could have enormous benefits to public health.
31
A good example of increasing lack of public health support is: the new Shinglex vaccine which has been shown to be over 95% effective against shingles and has recently been recommended by the CDC for people over 50. The retail cost for that vaccine is $280 for two doses, yet it is even more expensive under the AARP Medicare Part D AARP Hartford plans because it has been classified as tier 3 plus pharmacies and other health care providers are charging added administering fees so I recently paid Walgreens a $20 administering fee for the first of two doses so will end up paying $320.00 for the vaccine. It would cost more in administrative fees through Sutter health and not have any Medicare coverage there either. While flu shots are covered for Seniors under Part B, these new vaccines are supposed to be covered under Part D plans but not AARP sponsored Part D health plans apparently, probably not any better under medicare or for those under private plans.
6
Because people getting sick in America is hugely profitable for those who matter most here, why else do both Parties want us all in hospital, regardless of what it takes and whatever way it takes.
6
Public health is, at its core, about a sense of community and collective identity. Sadly, those are values which are being trashed on the Right and the Left, pious rhetoric to the contrary notwithstanding. They are challenged from the Right by a belief in hyper-individualism and the projection of a false narrative saying America has achieved a meritocracy. They are challenged from the Left by identity politics, which takes a nation of hyphenated Americans and establishes one's primary identity as the adjective preceding the hyphen, rather than the collective noun, American. Meanwhile, we have become a very mobile country geographically as traditional jobs disappear ripping communities asunder.
A reality often ignored by those advocating for more "progressive" attitudes toward health care is that a significant number of Americans actually want a system that gives them the freedom to choose care they cannot afford. That may seem like a "stupid" or self-defeating attitude, but those people cannot be, nor should they be, ignored.
It also is not irrelevant that to a large extent the zip codes with the lowest rates of childhood vaccinations are zip codes with the highest degree of education and income, zip codes, I would hazard a guess, where the belief in serious anthropogenic global warming is pervasive, even while the science behind the virtues of vaccination for the community is more solid than for the climate issue. Across the spectrum it's "I know, but you only believe."
3
Because the wealthy people who own the government already have the health care they need.
11
The headline answers its own question: Public Health saves lives and saves money. Where's the profit in that?
16
There’s more of a financial incentive in using medicine to cure than there is in using it to prevent, and in too many cases doctors are either not allowed or not interested in doing anything to mitigate this motivational error.
6
Ah! The pro-life agenda!
Protecting embryos and forcing women to give birth to children the mothers cannot take care of.
And murdering born children by denying them health care.
But then again, to the pro-life movement, children of color, and not just immigrants, are the products of "breeding animals."
9
We don't spend money on public health because black people might benefit, in just the same way we don't provide fair pay, excellent schooling for all, adequate housing, and labor protections.
20
I can only imagine the campaigns progressives might find "critical to our very survival." They make this claim about pretty much everything whenever a republican is in the Oval Office.
1
Why would you want to spend money on public health and well being when you could built more cruise missiles and aircraft carriers
6
Yes, why indeed aren’t we spending more on public health issues like the epidemic of gun violence?
9
If you’re dumb enough to eat fast food and not read up on what you’re eating, why on earth should people who do make this stupendous leap of logic be forced to subsidize you?
No assistance for those who did it to themselves.
2
This may come as a shock to you, but not everyone is perfect. It's not a leap of logic, it's an investment in caring for others.
At one time, the USDA Food Pyramid provided much more nutritional information than it does today. In essence, someone could go to the USDA website, log in what they were eating and see what vitamins and minerals were in their diets, how much sugar and fat they were consuming as well as calories and what the recommended guidelines were. What happened? The Government decided that nutritional information given for free, and it was Government information collected using our taxpayer monies, should be withheld from us and instead sold to online nutrition websites that could then sell that information to anyone who had the money for a nutrition website subscription. The result has been more people lacking necessary nutritional and dietary information. That information would have been a great addition to public health, especially for those who cannot afford to subscribe to online dietary and nutritional websites and our taxes had already paid for it.
3
The problem is that after initial improvements in health, nothing happens — until you stop the public health campaign.
1
I would like to see a public health campaign advocating walking at least 1 mile a day. You have to start somewhere and exercise prevents or controls a variety of chronic conditions.
5
The program that most touches my heart and mind is the Nurse Family Partnership. It seeks to educate and assist low income pregnant women to assure the delivery of a healthy child, and maintain the health of both Mother and child thereafter. It makes a big difference to get a child off on the right foot and this program has many subsequent benefits to all of society.
17
Planned Parenthood is a public health organization. It’s been used as a political rallying point by Republicans who don’t get the value for the buck PP provides. Teaching universities are part of the public health network. These institutions continue to have their funding cut. Americans need to get their priorities straight.
19
I read all of the 124 comments so far. The column and the comments are all rational.
Unfortunately people like Franklin Graham, highlighted by NYT today, and others like him, have forgotten that the first order of business for his people is supposed to be the social gospel. The meek and needy are supposed to inherit the earth.
Every time some Bible thumper is interviewed, stick out a mike and ask about it.
10
These proponents of the “prosperity gospel” blame the sick and poor for these own problems. I would love to hear their response on how this squares with the teachings of Jesus.
"Given limited resources, which health campaign would you like to see started?"
I'd like to see an *Expand Resources* health campaign. It would rescind Trump's very special tax breaks for billionaires and corporations. Step two? Raise their taxes, for crying out loud.
America must not passively accept the incalculable damage that right-wing greed is inflicting on our country.
11
Public Health, like national parks, public infrastructure, clean water and air, consumer protection, have been forsaken in the name of small government and deregulation. Americans can’t waste money on the benefits improving our lives and environment, as outlined in this article any more. We need those tax dollars to buy plastic trinkets from China to add to the flotsam in our ever rising oceans. Who needs the nanny state? We want to feel fat (obese may be a better word) and rich with all those tax dollars. The less we spend on taxes the more our kids have to buy fentanyl from China.
9
Because the powers that be, would rather have us unhealthy, unhealthy serfs that most of have become can't revolt....
6
The Public Health Argument — making prevention and coordination of care possible, increasing overalll wellness and reducing overall costs — is just one of the principal compelling arguments for "Improved Medicare for All” — in New York, its known as The New York Health Act,
Consider two others —
The Moral Argument — that New Yorker’s shouldn’t die early because they can’t afford essential healthcare — and thousands do each year. Millions (insured and uninsured) avoid healthcare expense for financial reasons.
The Economic Argument: Saving $45B/year within NYS will dramatically increase purchasing power within the state — creating an estimated 200,000 new jobs and $200M/year more spent on goods and services; NY businesses will become more competitive when the hidden tax (healthcare burden) is lifted.
Healthcare is a moral good, not a business commodity.
NYHealth is the right thing to do — now! Find out more at www.NYHCampaign.org
8
Because, according to the ruling elite only sick people get sick and it was their fault in the first place, and America needs to cull the herd of sick, vulnerable and weak people.
15
It’s not strictly true that the private sector can’t make money on public health interventions, given that the private sector produces the means for many of them — e.g., vaccines, diagnostics, medicines. More importantly, poor population health is a drag on productivity, so employers benefit when their workers are healthier, which public health isn’t usually credited for. Think about obesity and its sequelae, for example. We all pay more in insurance premiums, whether as fellow private insureds or as taxpayers, when people are overweight and suffer from a variety of ailments, and employers’ obesity-associated productivity losses are well documented. Same with under/no vaccination for highly infectious diseases like measles. The ROI for public health should captures these gains and losses, not just averted health spending, to be more accurately assessed.
1
One thing I keep thinking about is mandatory course in Nutrition with classes to teach cooking of low cost, nutritionally sound meals to anyone who is on SNAP etc. And, I know it's for "controversial" that SNAP not be used for soda and junk food but I strongly believe that it should not be allowed. It's just common sense. It is not that hard or expensive or time consuming to cook with real food given the knowledge and training. That would go a long way to help all kinds of people, young and old.
4
People receiving SNAP benefits often do not have kitchen utensils and ranges appropriate to prepare nutricious meals. Further, they often live in "food deserts" where full-service food markets are not available.
6
We used to teach those subjects in school: it's called Home Economics. I think there's a correlation between cutting that course from the curriculum and the increasing obesity/poor nutrition in many communities.
Commercials that promote restaurants and "meal prep" services go on and on about how "hard" it is to cook and how "time-consuming" it is. It isn't really, but a lot of people generally believe the ads and not their own common sense.
8
If soda and junk food is bad for poor people's health then it is also bad for rich people's health. Perhaps no soda or junk food should be allowed on store shelves.
Also, SNAP does not give as much as people think it does. I get a whopping $83 per month which is about $20 per week. That does not go very far. When I was homeless, I got a whopping $16 per month because the state decided that since I did not have a kitchen, I did not need as much food. That was what they told me, a veteran.
On top of all of that, my neurologists have all told me NOT to turn on the stove but to only use a microwave because of my epilepsy.
All of this makes healthy eating a challenge but fortunately, I am quite the Martha Stewart cook and talked the landlady into letting me take over the backyard and turn it into a community garden. But most folks can not cook like I do. And that makes healthy eating a LOT harder for people.
6
I would like to see huge increased investments in diet (a plant based vegan diet, or whole foods high in fruits and vegetables), regular daily exercise, and stress management techniques.
Those are proven means to reduce heart disease, stroke, obesity, diabetes and other chronic diseases associated with inflammation and metabolic syndrome.
3
Some of these investments you mention just are beyond practical scope. However, on thing that can be focused on that everyone can understand is reduction of sugar in the diet. However, the sugar industry has a phenomenal lobby and propaganda machine. Reduction of sugar in the diet is going to take a long time, but its something everyone can understand and it has to start someone.
5
So you want to force people to eat vegan. Or force them to give up sugar -- the one taste nearly all humans adore. GOOD LUCK, FOLKS! but expect a whole heck of a lot of pushback -- not from the food industry -- but from ordinary folks.
1
Because Republicans think public health is something for poor people. Wait until we have a formidable flu epidemic and they will squeal about not being ready for it. As the planet warms communicable diseases from Mexico to the equator are coming to America already. Will we be ready? Not
a chance!
14
The authors did not do a good job of specifying exactly what was in “public health” not being covered. To my knowledge, most vaccination programs have low cost or free components. They mention more public ads, but be honest. Don’t we already see a ton of these ads? Doesn’t Medicaid cover diabetes and cholesterol checks? Maybe the real story is the items that do not require Americans to change behavior, e.g., besides getting a shot or drinking fluoridated water, are done. People are not interested in their government hectoring them about drinking sodas or eating cheeseburgers. We have transportation programs in most cities building sidewalks.
Of course, the typical NY Times commenter wants nothing less than a complete revamping of the US Health System. They are even more confused about the definition of public health, after reading this article.
5
I agree with you, the health items other than vaccination and some infectious disease screening like for hepatitis that have been shown to be really effective are few. However there are two things everyone can agree on. Prevention of smoking and smoking cessation, maintaining a waist circumference less than 40 inches. The US doesn't even follow WHO recommendations for discouraging smoking. I went to Costa Rica and all tobacco products have to have 70%of the packaging containing warnings and autosopy/ chemotherapy pictures. Their smoking rate is 5%, unfortunately we have a very corrupt government that lets criminals like the tobacco companies run things.
4
We should have a public campaign to promote personal responsibility. Imagine how much more effective all the other campaigns might be? This might not be a bad time to start holding people -- versus organizations, political parties, etc. -- responsible for their actions.
2
Really? You want to spend public money for a campaign on personal responsibility? Can I recommend that we spend public money on a program to explain irony and hypocrisy to libertarians?
In my local corner of the healthcare industry, the healthcare systems believe that "social isolation," ask "loneliness" is the nex frontier for public health and traditional healthcare.
2
because its more important to sent tens of billions of tax payer dollars to Israel - give away tax breaks to the 1% so they can get that all importans second yact - feed the bloated military budget - give tax breaks to corporations with no strings attached - like bringing jobs back from overseas - in case you missed it this country has become one big SCAM.
16
Yeah, we have a cure for hepatitis C so instead of eradicating it, we make sure there is sustainable demand so Gilead Sciences Mergers and Acquisitions can enrich Bay Area Democrats while buying off AIDS activists so they can retire on their Teflon patents blessed by the FDA’s nonscientific findings.
1
I wish you would provide some substantiation for your claims.
3
Speaking of smoking, it's tough to find a movie where there's not chain smoking in every scene. Unless, of course, you're watching cartoons.
1
Smoking in movies could be outlawed unless the movie writers and producers provide justifications that it is essential to the plot and character development. This wouldn't require policing, just require a summary of the analysis along with the movie credits in the movie and trailer. I think this would stop a lot of it and start to make people opposed to smoking in tv and movies.
Once there was public health clinics through out Los Angeles County providing Well Baby exams and vaccinations. For adults periodic check ups and education.
Vaccinations were given at school, and each one had a nurse on duty. I went to a doctor's office only when ill, about a half a dozen times except for the removal of an oral tumor, which was caught in a school exam.
The cost of prenatal care, delivery, and hospital for the birth of my first child totaled $300.00. When first insured by my husband's company I remember a feeling of unease sensing this was the beginning of something, maybe healthcare losing its humanity. The cost for our last child, only ten years later, was $3,000. Healthcare was better as well as cheaper when healthcare was the goal.
Everything, beyond health care, is driven by the bottom line: what's the cash return. The cost to our society is too high.
5
A local columnist wrote about an Arkansas law that punishes anyone caught with "drug paraphernalia".
Some drug addicts maintain their own needles in order not to catch and spread HIV, and Hepatitis which happens when sharing needles. For this good practice ( public health ) , they are punished. The idea of offering free needles to addicts is still regarded as somehow "not right " . Yet we have opioid crisis and this will be followed by HIV and Hepatitis crisis. This is not something you can hide from in your gated community, your kids are dating kids who have used needles ( sadly I know a lot about this subject )
3
You're correct in your comment regarding providing needles for drug users. Simplest and least expensive way to stop diseases from spreading. Certainly, it would be wiser to provide rehabilitative and social services for these individuals. This type of beneficial thinking isn't mainstream. There are certain people that believe that that abortion is murder. Some people believe that Jesus will return, too. Problem with those people is that it's not enough to for them to practice what they preach. They wish to force their will on other people regardless of what they believe. There will always be those people who place themselves on a higher plane and believe that their way is only right path. Democracy was supposed to circumvent that type of thinking and allow people to live in communities that allow them life, liberty and the pursuit of happiness. We've a lot of work to do before people open their minds and their hearts to allow social progress to occur. We'd also need politicians who actually cared about protecting democracy rather than lobbyists.
6
A major problem with needle exchange programs is this, do you want one not he street where you live or work, most don't. So these are often located in the worst areas which is a problem in and of itself.
1
Needles are freely passed out here in the Northwest and there are even needle exchange programs. Sounds great, doesn't it?
Except that the junkies do not give a rip about public health and are literally throwing their dirty needles wherever just like smokers throw their butts anywhere.
Local news just reported about a toddler getting poked by a used needle at the park.
My landlady has found two used syringes tossed over the fence into our yard. I do the yardwork and am very careful when I am pulling weeds. Between the blackberries and the syringes, its delicate work:)
2
The GOP don't believe in supplying an affordable health plan for all American so why should they spend more on Public health that could find cures for people to live longer. If there is a fake war to get involved with their is plenty of money available . We need a big change in mid terms.
4
"The private sector can’t make money on it."
Right, and the private sector foundations, like the Gates foundation, are too busy improving public health outside our country, as American lives are not deemed as valuable as others.
5
National Mandatory childhood immunization
Funding for blanket anti-smoking ads aimed toward youth.
Higher taxes on cigarettes, marijuana, alcohol, and vaping supplies and equipment.
Mandatory sentencing for first and every DUI.
Taxes on sugar and high-fructose corn syrup.
Mandatory helmet laws for motorcyclists and bicyclists.
More, much more federal spending on meat and vegetable grower and supplier, and food and restaurant inspections.
5
Ah yes, we, the richest nation on Earth, have decided that we don't care about the public good and count the $$$$$. Health outcomes in this country are highly dependent on income and overall are going south, while costs are going north.
With the GOP reveling in Trump's desperate need to destroy Obamacare, the hybrid attempt at fixing our problem, forget the public good. $$$ and insurance companies reign as usual.
Single payer puts everyone under one umbrella and many of the public health issues would be dealt with. Not gonna happen in MAGA world.
16
We choose competition over collaboration: we'd rather be better off than the other guy.
8
Boy, that’s a simple answer to the question in the headline. Republicans must destroy anything that proves that government can be successful in order to satisfy their warped ideology. Obamacare is one obvious example. They obsess over cutting Medicare and Social Security, but they know it’s too popular. Also, the GOP exists only to cut taxes for the rich and they don’t want to pay for your health care. The only way they’ve been able to convince the public that health care spending is just a giveaway to Those People is through a massive disinformation campaign that media elites don’t challenge.
13
Because it's cheap, and because the recognized needs have been met. Once everyone has been immunized, immunizing them again serves no purpose.
1
Absolutely wrong! Many immunizations last for only one year (e.g. influenza, since the virus' evolve), or require boosters (e.g. hepatitis B). And here are improvements that increase the number of forms of an infectious agent the immunization is against (e.g. pneumonia vaccines; original one was against 12-15 bacterial strains, the new one more than 25). And new people are born or emigrate or become residents to this country. So there is always a population to vaccinate.
1
We spend trillions on the threat of terrorism that kills a few dozen people a year but can't spend money on public health or infrastructure that saves tens of thousands and billions of dollars - let's face it, as a country we are full of idiots easily manipulated by oligarchs - you have to acknowledge the truth before you can change anything
32
Tragically, people are naturally drawn to demagogs.
Healthcare is a major business activity. Who invest where, in what, is based on ROI. If there is any breakthrough, then the battle lines are drawn between Drug companies , Insurance companies, the AMA , and for profit Hospital corporations. If there is no forecast for the bottom line, there is scant research . For what is currently available, if you can't pay, you don't participate as a patient. New Cancer blockbuster drugs are extremely expensive few can participate.
4
We don't spend on pubic health for a few reasons, but the chief two are: 1) we don't like to spend on people whom we don't know personally 2) we don't like to spend on things that don't have immediate or visible results.
So we don't spend on "public health" because it helps THEM but we don't see it helping US; and we don't spend because we don't believe we will benefit. We know we benefit from our own insurance paying out. We don't think we benefit from someone else being healthy.
In short, we don't fund it because it is socialism, or needs tax money, or is big government or whatever. We will get pretty nasty of Zika or Ebola comes to our neighborhood, though. because somebody ought to have done something.
13
This country has prioritized business over human beings since day one.
And people in power do not want this to change.
44
Healthcare got worse when it became inbestment driven. It became worse in 1980 with Reagan.
4
Having lived in Bolivia, the value of Public Health, of preventive measures to avoid disease and accident and premature death, corporal and mental, is very much appreciated in theory...but neglected in practice. In these United States, we have become complacent and taken our health for granted, reason that any epidemic is told in detail and late measures taken, expensive and limited. How about preventing the totally idiotic license to sell, and use, weapons of mass destruction, thus far a republican feat in allegiance to the N.R.A., drenched in the blood of innocent victims? And further, how about some action in Public Health to minimize the deleterious effects of man-made climate change (already biting us, even killing us, by the increased frequency and severity of droughts, floods and fire)? And political health by educating ourselves in civics, and preventing demagogues 'a la Trump' from causing awful sickness in this country's standing? I could go on, but you get the jest.
7
Because public health campaigns do not create profits for Big Pharma, the insurance companies, or for-profit hospital chains.
27
As long as our for-profit health industry donates large amounts of money to Congress, we will never put the public health ahead of re-election.
Our most urgent need -- apart from dumping Trump -- is mandatory public campaign financing for all elections.
If we took the money out of politics, all the charlatans and grifters would become international real estate developers like Donald and our representatives in government would work for the people.
21
"It Saves Lives. It Can Save Money. So Why Aren’t We Spending More on Public Health?"
Because conservatives feel, quite erroneously so, that the federal government is always the problem, and they are in charge right now. Under Trump, it is increasingly becoming the problem because of its ineffectiveness and incompetence that he is delivering from the top.
Trump is ensuring that the people hurt and blame the government, so he can dismantle it to advantage himself and others of his ilk.
The name Custer mean anything to you. As fewer and fewer people have the money or resources to barely get by in the richest country in the world, there will be a day of reckoning. The elections this fall come to mind.
8
Public health is, at its core, about a sense of community and collective identity. Sadly, those are values which are being trashed on the Right and the Left, pious rhetoric to the contrary notwithstanding. They are challenged from the Right by a belief in hyper-individualism and the projection of a false narrative saying America has achieved a meritocracy. They are challenged from the Left by identity politics, which takes a nation of hyphenated Americans and establishes one's primary identity as the adjective preceding the hyphen, rather than the collective noun, American. Meanwhile, we have become a very mobile country geographically as traditional jobs disappear ripping communities asunder.
A reality often ignored by those advocating for more "progressive" attitudes toward health care is that a significant number of Americans actually want a system that gives them the freedom to choose care they cannot afford. That may seem like a "stupid" or self-defeating attitude, but those people cannot be, nor should they be, ignored.
It also is not irrelevant that to a large extent the zip codes with the lowest rates of childhood vaccinations are zip codes with the highest degree of education and income, zip codes, I would hazard a guess, where the belief in serious anthropogenic global warming is pervasive, even while the science behind the virtues of vaccination for the community is more solid than for the climate issue. Across the spectrum it's "I know, but you only believe."
5
Forget any thoughts about public health and the best interest of the public. In the age of Mr. Trump who only cares about himself. Trump is breaking the Emoluments Clause and no one wants to enforce it. Trump and his allies are basically pay to play and sucking up as much money from their positions as they can (aka Pruitt) Trump won't even follow through on safe drinking water for Flint, we have an EPA head who is a pro-toxic waste, anti-regulation, let business run free head.
In the age of Trump it is survival of the fittest for individuals because the Democrats have no voting power, Trump ignores any rules and the GOP have been pacified with money so they enable Trump and are mute. Public health, forget about it.
8
I would love for the US to concentrate on two areas of public health: maternal child health, and expanding our diabetes prevention efforts. Both have high returns on investment as published by the CDC and other entities. Medicaid has been essential in helping women obtain early prenatal care and preventing premature births. This along with basic family planning goes a long way to save tax dollars. Both are under attack politically. Regarding diabetes prevention, nationally only around 6% of adults know if they are pre-diabetic. In Hawaii this rate is 14%, making us the highest ranking state in testing, yet this is insufficient. Effective help such as the YMCAs Diabetes Prevention Program go a long way in helping support people to change behaviors that delay and prevent diabetes, a very costly disease indeed.
10
Unfortunately, the savings from public health initiatives accrue to the public. There is no capitalistic profit motive to drive the investment. Additionally, in the current political climate who do the benefits most directly affect - the people who can least afford healthcare when public health measures have failed. Review the spending on public health for the other countries in the OECD. Then look at the relative quality of care in those countries. More spending on public health and societal support early and less spending on healthcare later -can, t attribute causality, but there is certainly an interesting relationship that bears further research.
1
I can remember getting my first polio shot. It was a hot summer night in the mid 1950s. The town health dept. decided it was so important to get everyone inoculated that they just told everyone to go to the town green and line up and they would give the shots there, instead of, say, making people get appointments with doctors.
17
I also remember lining up en masse down a street in Galveston in the 50s to get a polio shot. It was a welcome invitation. I had just seen a close friend in an iron lung in a hospital.
21
I remember lining up in the basement at school in Grade 3 for the polio vaccine. My mother could not sign that consent for vaccination fast enough. She was terrified we would get polio. I remember the pools being closed. One of my besties survived paralytic polio at age 5 in the Phillipines. She has bilateral foot drop and post polio syndrome.
1
Ask Big Pharma whether it makes more money from healthy people or sick people. Also ask Congress and state legislatures whether they would rather receive lots of money from lobbyists or have healthy constituents.
26
Easy answer, wealthy republicans can afford health care but for some reason they think they cannot afford to pay taxes.
25
America's leaders and financiers: "Let the poor and sick die. If they were smarter, more deserving, or had whiter DNA, they wouldn't be sick in the first place. There are plenty of grunts whose labor can support us. The ones who can't work for us – why bother about them at all?" Ours is no longer a civil society; it's a money-making machine for those in control.
26
Chemical water fluoridation is and always has been a major public health blunder. The upshot is that ingesting fluoride has not been proven safe or effective. Even main stream dental journals are reporting on the harmful effects of over exposure to fluoride. It's time for journalists at the NY Times to do your homework.
https://www.prnewswire.com/news-releases/childrens-fluoride-exposures-li...
7
You need to identify yourself and your credentials if you are going to make specific recommendations regarding public health that have major national health implications.
14
Labeling neither establishes the credibility of the person nor the validity of the argument. However, for the record, I am an analyst. I believed CWF was safe and effective, and started my research with the CDC & ADA pro-fluoride material. As an analyst, I became quite alarmed at what was obviously a put-up job. As someone who suffered for decades with chronic illness that went away in less than 2 weeks of assiduous avoidance of fluoride, I am became motivated to use my skills to make this material more accessible to the public.
Check out this short 2017 article for a short synopsis. Follow the links to both science and other aggregations in the references for more detail: http://www.greenmedinfo.com/blog/science-and-alternative-facts-about-flu...
1
Again, anecdotal evidence is not science. I'm glad you're feeling better, but your improvement is not a statistically significant finding for anyone except you.
I respectfully disagree that the private sector believes that they can't make money in public health. As the co-founder and managing partner of P2Health Ventures (http://www.p2health.vc), I look to invest in early-stage tech startups that address preventive health, medically underserved populations and the social determinants of health - the core aims of public health. We are excited to accelerate inclusive health innovation that addresses health disparities, improves health outcomes and reduces down costs.
4
To spend more in many instances would mean helping the poor whose self-indulgent lifestyle is a major cause of their illnesses. We don't want to encourage shiftless behaviors.
Further, any health measures attack business ventures in fast foods, soft drinks, and unsafe cars which are essential for American jobs and our #1 World Status. There are a lot of other practical reasons, which ultimately will prove compassionate for the unhealthy, poor, and lazy - types not present in Scandinavia where they like to boast of their tax creating social programs.
Finally we must remember that our military has been cruelly deprived of the tools necessary to keep us and the world safe. Sacrifice is necessary.
Granted, this is not politically correct.
In fact it is pathologically self-serving and transparently false in every particular. But few arguments have so much partisan and industry money behind them, so they must be at least truthy.
7
What about the non-poor whose lifestyles are self-indulgent? What about those who have diseases due to their parents' DNA, not due to lifestyle choices? Finally, a healthier USA population will keep America far safer than maintaining, or increasing, military spending. In my opinion, your statements are not only not politically correct, they are not correct in any sense.
3
Christopher, did you read the last paragraph?
"In fact it is pathologically self-serving and transparently false in every particular. But few arguments have so much partisan and industry money behind them, so they must be at least truthy."
Take yes for an answer and look up "irony"
1
Modern science indicates that ingesting fluoride, neither a nutrient nor essential for healthy teeth, is ineffective at reducing tooth decay and harmful to health. An International Dentist Group urges fluoridation be stopped country wide. Here's its position paper https://iaomt.org/iaomt-position-fluoridation/ 4800 professionals signed a statement opposing fluoridation as scientifically undefensible http://fluorideaction.net/researchers/professionals-statement
4
Anti-vaxxers and anti-fluoride people need to identify themselves and their credentials if they are going to make specific claims about important and public health issues. You can't just cite a couple of articles for such an important topic, you need to cite the consensus of professional societies.
14
Endorsements based on lobbying efforts by well-funded, industry-backed, special interest groups are not science. More revealing is the large number of organizations which have been removed from the list of groups supporting fluoridation and those which never appeared. Most recently, the National Kidney Foundation asked to be removed. An objective individual would be concerned that fluoride gets into the brain where it was never intended to go whether you want to believe the 300+ studies showing a link between fluoride and brain damage or not
Biased much? Telling people to avoid too much sugar is too bossy but mandating consumption of a drug via municipal water supply is fine?
Fluoridation policy is politics pretending to be science. Over half of American teens have the visible evidence of too much fluoride consumption during early childhood on their mottled teeth. One in five teens have brown stains and perhaps pitting on at least two brittle teeth which will require costly veneers and crowns in adulthood. (Wiener et al. 2018; McDonagh et al. 2000)
Millions with thyroid, kidney, inflammatory & immune system disease have their health worsened by exposure to fluoride - even by ‘optimal’ concentrations. Moreover, there is no dose control once you add this FDA 'unapproved drug' to the water supplies. Fluoridation is an immoral medical mandate that profits vested interests - a public harm policy.
6
We went through all this with the anti-vaxxer crowd, who didn't know what they were talking about. Cite the recommendations of professional societies in the world of dentistry, not a couple of articles which have very limited implications.
10
Glad you asked. The implications range from thousands in veneers & crowns due to fluoride damaged teeth, to decades of misery from IBS & arthritis, to kidney disease & premature death.
A few recent items:
IAOMT 2017 Position Paper with 500 references opposing fluoride use: https://iaomt.org/iaomt-fluoride-position-paper-2/
From 2018:
- in Journal of Dental Hygiene. Dental Fluorosis over Time… (31% increase of dental defects in ten years due to fluoride poisoning) http://jdh.adha.org/content/92/1/23
- in Biological Trace Element Research. Mitochondria-Mediated Pathway Regulates C2C12 Cell Apoptosis Induced by Fluoride… (cell function & survival compromised by fluoride doses the equivalent of ‘optimal’) https://www.ncbi.nlm.nih.gov/pubmed/29594946
- in Biomedical Informatics. Screening of Human Proteins for Fluoride and Aluminum Binding... (F and AL increase neurological disease) http://www.bioinformation.net/014/97320630014068.pdf
Space doesn't permit be posting much more, but this should be enough to get started on FLUORIDATION science.
How about the American Dental Association, then you can get back to us. Thanks.
The defining characteristic and guiding principle of the modern of the GOP is "man's inhumanity to man", because the greater one man's poverty and misery, the richer and more well off another man becomes.
Take any policy issue, determine the most morally bankrupt approach, and there you will find the GOP.
In short, the modern GOP is nothing more than one massive misery machine. The promotion of vast income inequality, the gutting of all social programs, trillion dollar tax giveaways to the 1%, the decimation of the health care system, the embrace of racism, ensuring the rights of corporations supersede those of individual human beings, engaging in wars of choice like the Iraq War, etc, etc, etc, etc.
There are 6,000,000 homeless children in this country right now. And the GOP wants to insure that every fetus is carried to term, as they cut funding for education and every single social program that could benefit that child. "Life is precious", but, they have absolutely no problem leaving these same children in live and die in abject poverty and misery.
This is the essence of the modern GOP's concept of "caring".
If you're not rich, you're a nobody, and when a nobody dies, the GOP not only couldn't care less, but, they'll insist you pay to dig you own grave.
29
This is an article written by folks who believe that there’s enough for everyone. Most folks out here in the Real America know that there isn’t enough. Out here, “public health” and “common good” are liberal code words for taking money away from worthy folks (rural) and giving it to the unworthy (cities). It’s anti-liberty and anti-freedom. What I see as a moral issue they see as a partisan issue.
2
What makes rural dwellers worthy, and city dwellers unworthy?
2
A significant percentage of the US population religiously believes that "government" is bad and nothing is going to change minds. This same significant percentage of the US population is over-represented in government due to gerrymandering and the Electoral College. They get what they vote for.
Regrettably, so do many others...
5
Money reigns over health in a capitalist society, especially when it comes to caring about others. Americans are clueless as to "the common good." It's every man for themselves in the good ole' USA. "You can't afford health insurance?" "Oh, too bad. get a job. I'm not paying one more cent in taxes so you can be healthy."
9
Another example of our devolving Libertarian Nightmare. The power of the people is a collective power. Through vaccines, collective cooperation protects all.
Reagan and his ilk have so frightened this country about communism, that anything done collectively is considered bad and destructive of freedom. Nothing could be further from the truth in the case of public health.
Reagan followed by George W. and Paul Ryan have made individual freedoms paramount above all, reduced federal power so corporations could call all the shots and turned worker against worker, thereby separating and weakening all of us so we have no recourse against the inhumanities of the private sector and its almighty fortune of dollars.
9
A fit, healthy, and educated populace is required for the defense of a country. Public Health is most correctly seen as a national security imperative.
15
One reality often ignored by those advocating for more "progressive" attitudes toward health care is that a significant number of Americans actually want a system that gives them the freedom to choose care they cannot afford. That may seem like a silly or, at least, a self-defeating attitude, but those people cannot, nor should they be, ignored.
It also is not irrelevant that to a large extent the zip codes with the lowest rates of childhood vaccinations are zip codes with the highest degree of education and income, zip codes, I would hazard a guess, where the belief in serious anthropogenic global warming is pervasive, even while the science behind the virtues of vaccination for the community is more solid than for the climate issue.
Public health is, at its core, about a sense of community and collective identity. Sadly, those are values which for quite some time have been trashed on the Right and the Left, pious rhetoric to the contrary notwithstanding. They are challenged from the Right by a belief in hyper-individualism and a false narrative that we have achieved a meritocracy. They are challenged from the Left by identity politics, which takes a nation of hyphenated Americans and establishes one's primary identity as the adjective preceding the hyphen, rather than the collective noun, American.
The Right, too, is now adopting identity politics, moreso in Europe than the U.S., though clearly with different categories of identity.
1
'Public Goods' -- services that benefit not just individuals but society at large -- including public health, child care and education -- are underfunded (using cost/benefit analysis) to accommodate tax cuts to fund stock 'by-backs' that further the economic divide and provide the means and incentive for those few beneficiaries to sustain the politics of hate and paranoia. And so it goes.
2
Greed Over People
Greed Over Principle
Grand Old Poverty
Grand Old Profit
We are not spending money on public health because the greatest healthcare rip-off in the modern world is a privatized, vulture capitalist sewer of Greed Over People 17% of GDP healthcare nightmare owned and operated by America's rapacious Republican right-wing that respects profit, not people.
Civilized countries regulate healthcare and blood money.
America is not a civilized country, thanks to the amorality and immorality of the Republican political party.
America is neither a Christian nor a healthy nation.
It is a nation run by right-wing capitalist zealots largely unconcerned with the health of humanity.
57
Why so little spending on public health? Public health is an obvious example where government and community efforts are very effective. However many don't want to see that working together is actually good for the country.
7
Politicians would rather show you how they cut your taxes then show you how you benefit from the taxes you paid. And most voters would rather vote for something they can see than for services they don't see, even when those services make us all better off.
We can look to developing countries for ideas on how to make progress affordable and tangible. According the Economist April 28, 2018:
Chile and Costa Rica spend about an eighth of what America does per person on health and have similar life expectancies. Thailand spends $220 per person a year on health, and yet has outcomes nearly as good as in the OECD. Its rate of deaths related to pregnancy, for example, is just over half that of African-American mothers. Rwanda has introduced ultrabasic health insurance for more than 90% of its people; infant mortality has fallen from 120 per 1,000 live births in 2000 to under 30 last year.
8
Because hospitals and drug companies consume all of the funding that could otherwise go to public health and they are not going to give that revenue up without a fight.
8
Not fair to lump in all hospitals with the pharmaceutical industry.
3
Why aren't we embracing public health like we used to?
Because we've allowed our health care sector and all of it's privatized tentacles to become the millionaire class's wheel of fortune stock market investment house that let's them all live
like kings, at the expense and off the backs of 'little people'.
Sorry, but it's an honest but been-there-seen-it answer.
14
Part of the issue is the reduced emphasis on financial aspects of public health in public health curriculum. If public health officials cannot articulate the financial benefits of public health, we will continue to have problems attaining funding in a period of reduced funds. If demands on social security continue, national debt payments increase, and health care costs continue to rise, public health officials will need to have the ability to illustrate the benefits of public health in a manner similar to what is included in this article. Public health academia can lead the way by increasing our emphasis on financial aspects.
1
It has been done over and over. See the Economist on the affordability of public health care. It sums up the arguments that have been available and advocated for years. You might find the section on America's profile in spending of interest. WHO has rated the USA as number 37 in the world on the quality of health care. Here is the link for the https://www.economist.com/leaders/2018/04/26/universal-health-care-world...
5
Why aren't we spending more? Because too many of us feel that we don't have to, right NOW. Of course we should because it is the right and moral thing to do, but it is also right because we will eventually have to make up for the neglect we've chosen.
The UK is discovering now what we learned long ago, if you spend too little on social programs (including public health), then the general health of your population declines. Your economy declines. Your country declines and becomes a populist bastion filled with underachieving, resentful people.
12
The answer is simple and contained in the article. We have gotten most of the low hanging fruit, and it is foolish to think that spending more automatically gets more benefits. I see plenty of public health information, nobody today should be ignorant on the benefits of various actions including not being obese. Perhaps a better question is how we could improve our spending rather than spending more.
3
"Perhaps a better question is how we could improve our spending rather than spending more."
**********************
Yes, in New York State we have some of the highest Medicaid costs and worst outcomes. There are programs underway to reverse this trend. Democrats complain that we are "hurting" people with spending cuts. They never seem to notice how we're hurting people with ineffective programs.
Public Health should take a broader role in the dismantling of structural racism in America. Our dismal health outcomes relative to the rest of the world are driven by our racial disparities - for example, in many states the black infant mortality rate is three times that of white infants.
Expanding investment in our communities so that everyone has adequate clean water to drink and bathe, clean air to breathe, and access to quality nutrition and green spaces should be viewed as both a public health and a civil rights imperative.
Nowhere is our country’s racist history more apparent than in how it is imprinted on black and brown bodies in the health outcomes - deep racial disparities persist in life expectancy, infant mortality, maternal mortality, and most other key measures of public health, across the country.
Public health at the federal, state and local levels can and should be setting the targets, metrics and program and policy levers that will guide us in the work of undoing those racist legacies in America.
Because healthier futures for all Americans is something I think we can all agree we should be aiming towards.
13
In an age of austerity, many politicians (and the voters that elect them) have cried about foreign aid and other investments. These typically occupy a tiny portion of our budget and the benefits for public health projects here and abroad are so visible. With so much anger at government, these projects have the ability to tangibly improve people's lives and improve trust in government. Vaccination, anti-smoking campaigns, and epidemiologic surveillance have all been useful in improving our economy and saving lives here at home. The money we appropriate for global health projects is also extremely important. Most importantly, it helps save and improve lives around the world. These projects also have great returns on investment and create goodwill around the world towards the US, especially in a time where we could really use it. The GW Bush-era AIDS in Africa campaign is a perfect example of it. Something such as providing nets for malaria prevention could be relatively inexpensive, save millions of lives, and create goodwill toward our country.
5
I would like to see more funding for telemedicine and medical housecalls for selected groups. In many cases, older or disabled people cannot make it easily to the doctor's office and so put off clinic visits until they are so sick, they end up in the ER and then, somtimes, in the ICU. Catching them before they get seriously ill and treating them early avoids such situations and can save a significant amount of $. I used to do housecalls for a large healthcare system.
As a public health researcher, I think public health is also underfunded because it is often not glamorous (the most effective measures do not rely on whiz-bang technology), serves the disadvantaged (no movie star endorsements), and when effective, it prevents problems, so the public never sees the disasters averted. It is a gratifying field to work in though: I rarely feel the sense of puposelessness other friends feel about their work.
9
The answer to "Why aren't we spending more on public health?" is very simple. The CEOs and boards of directors for insurance companies all need new Bentleys.
13
Many people resent that Those People would derive some benefit from government spending.
They would rather die young themselves.
7
On a similar note, the Age of Antibiotics is coming to an end, after less than a century (Penicillin didn't become available to the public until 1943), as American capitalists invest less and less in developing new antibiotics to treat resistant bacteria, because there is much more money to be made in selling people chemicals to treat their self-inflicted diseases, like Type II Diabetes.
And above the so-called "pro-life" crowd, protecting embryos from death is a holy passion. But helping born children live healthy and productive lives? The pro-life crowd doesn't want to pay taxes to help these children.
In fact, to pro-life conservatives, foreign women are "breeding animals" who need to go back to their own countries to die in misery.
Funny how the media NEVER discusses all the pro-death positions of the so-called "pro-life" movement.
34
Why do we value the rights of gun owners, which implies a de facto right to kill with a gun, more than we value of the lives of own children?
Because we are collectively insane as a society.
And health care in Capitalist America is almost exclusively about making money. Public health entities save a lot of money. But they make no money.
You're welcome. Glad I could help answer your answer.
12
Jay David: read the US Constitution. Gun rights were so important to our Founding Fathers, that they made it THE SECOND Amendment -- right after Freedom of Speech.
2
Tax tobacco and alcohol to completely cover their contributions to health care costs.
8
The Trump administration doesn't believe in science and has cut funds for public health in the US and abroad. They will only act with funds when Ebola or some other pandemic threatens them personally.
4
Sugar. Addictive and manipulative (sound familiar). Cost to those manipulated, and the tax payer are all immense.
3
Public health is part of commonwealth. Commonwealth has been under attack since the 50's by the GOP and the 1% that don't want to pay a dime for commonwealth. Thus, public health is under attack.
Another form of commonwealth abandoned by the 1% is education. Just look a the teacher strikes in the k-12 arena and the exploding cost of college education.
Pick up an economics text book and you won't find a reference to commonwealth. Even our Universities are abandoning commonwealth.
So, the public wonders, what happened to public health!!!
9
I think this is a no-brainer. We don't spend enough on public health because in our selfish, trumpian world, of which trump is both a symptom and a result, the rich can buy what they need for themselves and then circle their wagons, closing out those who can't. The relentless privatization of what were once public goods has resulted in increasing poverty, segregation and worsening health outcomes for all those who cannot buy it for themselves. We as a nation are failing our citizens by allowing this. By privatizing schools, medical care, parks, pools, and so on, we cut off those who cannot afford them. Public health means the "browning" of America and white America is not having it. We need to raise taxes, spread the wealth and remember that a rising tide lifts all boats.
9
Are you suggesting that the US does not have public schools? In every city, every state? because that is 100% false. (BTW: Charter schools ARE public schools.)
1
The authors define public health broadly, to include behavior altering programs such as taxes on beverages with sugar to lower consumption and building sidewalks to encourage walking. They would probably also include NYC's 25 mile per hour speed limit, which was adopted in an effort to reduce fatal traffic accidents.
Most of the electorate doesn't view these as health measures; they are policy issues to be resolved through the political process. Just because one choice on such a policy issue may result in improved health or reduced mortality doesn't exempt it from legitimate debate or dissent.
2
We aren't spending more because we don't have the necessary champions in elected government. Previous champions of public health spending like Sen. Ted Kennedy, Sen. Tom Harkin, and Rep. Henry Waxman have left office and new champions have not stepped forward.
7
Two thoughts:
The anti-vaxxer movement is perhaps made possible by the success of vaccines. Protected by herd immunity, some people now don't see vaccines as necessary and rebel against the government telling them what to do.
Politicians may lack enthusiasm for public health campaigns because they generally don't get credit for problems avoided.
13
Public health pays for itself, but the media calls it expenditure or cost. When we collectively buy health at a bargain price, we are getting more value than it costs. That is the essence of this article, but so many people imagine all government programs to be wasteful. They don't see the profits to us all. BTW, private businesses DO make more money with PH, through a healthy workforce for example. The one industry that loses, of course, is personal healthcare -- doctors, hospitals.
5
I don't think many appreciate that increased life expectancy has largely been a matter of public health measures, especially cutting mortality among babies and children. The US is still not nearly as good as it could be in having healthy children.
10
We don't spend more on public health because we don't see the need to spend more. Ratios of savings to expenditures are abstract concepts. We spend on public health when diseases threaten our families and friends and, of course, ourselves.
In the US, we picked much of the low-hanging public-health fruit with gains in public sanitation in the 1800s and early 1900s when we implemented sanitary sewer systems, public water supplies, and, later, various means to protect our surface and ground water, such as landfill and mining water standards and stormwater standards.
Maybe the last disease to threaten all of us, of all socio-economic groups, was polio, altho, as we learn more of cardiovascular disease and cancer, we may identify new risk factors for these diseases. Since defeating polio in this country, we have epidemics of AIDs, mosquito-borne disease such as Zika, hepatitis, and the like, but the universal threat posed by polio was raised only by the Ebola/hemorrhagic fever outbreak four yrs ago.
Dr. Carroll is off the mark if he thinks that public health initiatives will succeed based on bang-for-the-buck arguments. People and their elected reps will respond to fear, as they may experience in a few months if the current outbreak of Ebola spreads from the Congo, which few of us could find on an unmarked map, to Texas and NY, as occurred in 2014.
Problem is that Trump's reaction, unlike Obama's, will be to erect a wall. As they say, elections have consequences.
7
We aren't spending more on public health because tRump, and the Republicrooks, are running the country, at the moment. We don't need smaller government, we need bigger, better government. And, maybe some honest, intelligent, humane leaders would help, as well. Health care, and education, are both working better in blue states.
15
But we don't seem to be spending less on public health than we did when Democrats held the Presidency and a Congressional majority.
2
So.....we spent just enough for public health care under Obama from 2009 to 2016 and then SUDDENLY on January 20, 2017....the money dried up?
1
Welcome to capitalism. Like making flu vaccines, if there's no money in it there's no interest in it from healthcare corporations, and no corresponding advertising campaign to take advantage of the program. My guess is that Big Pharma spends more money advertising erectile dysfunction pills than the entire public health budget. That leaves the government to care for the common good and the public generally doesn't want their taxes raised no matter how essential the spending is to the common good. It's also true that large sectors of the public don't want to see their tax dollars going to people they don't think deserve any help. This antipathy for our neighbor, especially those with black and brown bodies, has been the bane of universal healthcare in the U.S. Why should it be any different for public health programs. Welcome to the end-stages of the republic.
41
Selfishness and withdrawal of concern for the common good is a predictable consequence of a shift to multiculturalism. The weakening of fellow feeling isn't limited to any particular group, whether based on race, religion, ethnicity, class or political party but pretty much affects all of us who strongly identify as a member of a subgroup. We propagandize ourselves about the unalloyed benefits of a diverse society that is open to differing values to the point where we can't admit, or even see, its potential downsides. Until we learn to rebuild a sense of shared national identity and common national destiny this tendency won't change, no matter how much we condemn it.
1
That leaves the public sector, which is subject to political forces on spending and taxes, and is more focused on projects that might have more obvious and immediate benefits like, say, job creation through building a highway.
*********
Except we're not doing much about infrastructure either. Both Infrastructure and public health spending benefit the common good. The common good includes everyone. The common good recognizes equality. Equality means everyone.
Conservatives no longer believe in the common good. Spending money on the common good means everyone will benefit, and that offends the conservative christian base of the Republican party. How dare they be asked to help anyone outside their 'chosen' circle? If you're not white, christian, and already successful you are undeserving and don't belong in this country. Their president said so.
45
Would love to see emergency food programs (food banks, etc) that aim to reduce commercial food waste while improving nutritional quality of monthly/weekly food bags. So much food (much of it "ugly" fruits and vegetables) are wasted and could be used to help people eat healthier meals and live healthier lives.
4
I’d like to see a public information campaign to encourage people to take a walk after dinner rather than sitting back and being glued to a screen. When I lived in Europe this was the norm.
35
I agree, but that often requires sidewalks that don't exist.
2
I would like to see serious focus on sugar and unhealthy foods. Driving on the highway, I saw a McDonald’s billboard with a burger out of white bread bun, fries and soda. “Eat affordably”.
This was frustrating. I work in primary care and see daily the results of our cultural priorities on weight leading to diabetes and hypertension. We then complain about the cost of healthcare and hold clinicians accountable for poor outcomes.
We really need to address this from the population perspective. Look at all the profit, who should be responsible for the fix?
55
Every night, I always see lines of vehicles from McDonalds drive-thurs. We need to fix this first.
2
In a way, Memorial Day seems to be a very appropriate day to extoll the virtues of public health. It's about public policy. The loss of life in war provides us with a terribly tragic example of public policy gone wrong. Yet the gains in public health show us how we can improve when we do public policy right, though we have so much more left to do.
This is a call for citizen action. Although we depend on our leaders to enact and implement beneficial public policies, it is us who must demand what those policies should be. If we lead, the politicians will follow. No more war. Work on the public good.
9
For over a third of a century, I have been a nurse in the local (12-14 counties) home care and hospice agency. We do great work. From my perspective I can often see the sort of public health described in this article, and also see where the public health system does not penetrate because of lack of funding. I can guarantee that if you want to spend public dollars for the public good and for long term savings, there are many good opportunities available in public health.
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Thank you for an excellent article, complete with good references. You say the most cost effective interventions have already been implemented. However, if one studies the true determinants of health, education is a prime predictor - an increase in publicly subsidized post-secondary education would be a highly cost effective investment in our nation's public health - and cost saving.
Peter Muennig, Marianne Fahs,
The Cost-Effectiveness of Public Postsecondary Education Subsidies, Preventive Medicine, Volume 32, Issue 2, 2001,Pages 156-162, ISSN 0091-7435,
https://doi.org/10.1006/pmed.2000.0790.
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We don't spend more on public health because we have been convinced by a right-wing media to not collect taxes to pay for it, or anything else the public might need or want. It is so painfully obvious and simple. This is what oligarchy looks like.
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If we, as a people, had anything approaching good sense, we would would elect people who have a vision for the good of America, and support a government full of smart, competent, honest people who are effective managers, motivated by public service. This would include things like doing regular maintenance on public buildings, making sure pensions are fully funded, building and fixing public roads and bridges on a schedule, and funding family planning and child health and nutrition. It would also include funding public health, scientific research, and full scholarships for promising students. We would support good jobs for our people.
Yes, these are all boring, but effective. That's what good government should be. Instead, we have corrupt, posturing fools at the helm, who are driving good people out of government.
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We spend more than most nations in the world yet rank 800 and something instead of in the top ten. We should nationalize drug companies and healthcare and get rid of Greed Oligarchs and Profit.
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"The private sector can’t make money on it."
That could have been the entire article.
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It's a simple answer -- public heath care means no profits for the health care industry.
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OR ... No simplified income tax mean no profits for CPAs,
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Indeed, it means LESS profits for the health care industry...
Money invested in Public Health is among the best spent in the government. But PH is not sexy and does not feature "lights and sirens" response to threat. PH requires people to both trust in science and have the capability for delayed gratification. PH success is often measured by the counterfactual. Unfortunately, many people in the US today are not equipped to think that way. Sounds elitist, I know, but spend some time in the field. PH is often in a position to advise people on what's best for them and a lot of people simply won't be told. They won't be vaccinated, wear motorcycle helmets, wear condoms or lock up their guns. Because this is America.
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"An obvious success is vaccines."
Pseudoscience and fake news are working to change that.
"Also, some public health investments effectively tell people what to do (avoid sugar, for example). That’s often viewed as paternalistic or bossy."
Yes, under the theory that "my ignorance is just as good as your knowledge."
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I'd like to chime in with a perspective that I think is different in emphasis from the comments already made, and potentially different from the authors (though they allude to it).
There are many public health interventions that could save lives, but that are simply too intrusive to be palatable to most people. As the authors say, these interventions are seen by many people to be paternalistic (although I think the authors' use of "bossy" is a little bit dismissive of the seriousness of the concern). Granted some of these concerns may be overblown, but they don't feel that way to the people who have them. Regardless of whether you agree with those perspectives, they matter. They matter not just because you need buy-in from the public in order to get the public funding this piece calls for, but also because these are the people whose lives public health intervention is seeking to change. Public health intervention isn't going to work unless you get the people whose behavior you want to change to want to change their own behavior, too.
I concede the possibility that there are instances where the "right" or moral thing to do is intervene against the will of (some of) the people for the betterment of everyone (drunk driving laws might be an example), but if we're going to make those kinds of arguments I think there needs to be a much more rigorous, principled defense that is based on something more than just return on investment and other utilitarian arguments.
Thanks
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Of all the things government at all levels should be doing, maintaining and improving the physical and mental health of society one of government's most important functions. The ACA was a step forward in improving the public's health but is seen by many as a move toward the welfare state. There is no perfect way to administer public health policy but we should always make sure that only sound data dictate public health policy. Sadly, that has not been the case.
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This story keeps repeating itself ad nauseum, however, the answer is and has always been obvious. Until Americans start electing representatives whom are committed to actually doing something about it while not being beholden to special interests and lobbyists, these same questions will continue to be asked over and over again with no resolution and they have been for over 70 years!
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They obviously like the representatives they have, because they re-elect them every two years. It's a real upset when an incumbent loses.
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Thanks for this article.
So many policy choices have been choices against public health in favor of corporate interests. See https://www.legalreader.com/republican-racketeers-violent-policies/
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We aren't spending more on public health, or other programs that benefit the vulnerable, and save lives and money in the long run, simply because, no matter how you put it, it's the fault of the vulnerable for being so. And we want to punish them. That's justified with an objectivist philosophy which includes the deservedness of wealth and privilege as being graced by god, as is the deservedness of poverty, ill-heath, and disability.
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A little too cynical... but only a little. Public health initiatives never ask who's "deserving and who isn't. They thus offend people who want to to see the "undeserving" suffer "consequences."
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The philosophy of Ayn Rand and her acolyte, Paul Ryan believe that it is everyone for yourself. As a result of the Republican Party following their lead we have very little public health spending.
Vote all republicans out of office on Nov. 6, 2018.
In Ontario right now that battle is fully engaged in an upcoming provincial election...Conservative ford...mini me trump..will slash public services..cut taxes for the rich. One conservative premier about 20 to 25 years ago closed many hospitals and schools and laid off teachers and health care workers. I remember reading about homeless nurses. Same everywhere. NYT has an article about how the Conservative party in the UK is decimating Great Britain
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No doubt the news media, including The Times, shares a major part of the blame.
If one read the recent coverage of infections related to romaine lettuce, one might easily think this was one of, if not the major public health problem of the past several months. Yet the number of people who developed infections, much less the number who actually died are minute compared to those who suffer and die from flu because of the failure to get the flu vaccine. And anyone who recalls the hysterics over Ebola a few years ago may also be surprised that the number of Americans who developed this including those who were in countries where Ebola outbreaks had occurred is far less than the number of pedestrian killed in NYC each year.
And although, as the authors note, vaccines have been an important change, in fact the greatest advances in public health occurred as a result of public health efforts including destroying the mosquitoes carrying malaria and yellow fever which were both major problems in the south into the 20th century and insuring clean water and food safety measures that essentially eliminated major causes of death in this country such as cholera. If one looks at the decline of deaths due to infectious diseases, it's easy to see that this began long before we had any of the modern vaccines against such killers as measles and polio much less the flu.
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Republicans Greed Oligarchs and Profit to blame! Nationalize Drug companies and Medicare for all now and do away with insurance companies.
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This is an odd response to this article. NYT reporting on the romaine lettuce issue is hardly the reason for a lack of public health spending. Comparing Ebola to pedestrians killed in NYC is comparing apples to oranges - two different problems, both of which are addressed in different ways. And minimizing the impact of vaccines, as well as stating the decline of infectious diseases came about before modern vaccines is not really accurate. The smallpox vaccine was invented in 1798, with Abigail Adams an early adherent. A number of other ones came along in the late 1880s, along with, as well as before, clean water and food safety measures. All combined to help reduce death and disease along the way. And before you start writing off the impact of vaccines, note the following: Just from 1994-2013, the CDC said "Coverage for many childhood vaccine series was near or above 90% for much of the period. Modeling estimated that, among children born during 1994– 2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths over the course of their lifetimes, at a net savings of $295 billion in direct costs and $1.38 trillion in total societal costs." https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm
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Treating the gun epidemic as a public health issue is the obvious choice. The recent tax law allows the CDC to conduct research now, but the Dickey Amendment is in effect, and progress is occurring only slowly.
https://www.npr.org/sections/health-shots/2018/03/23/596413510/proposed-...
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This is not news. Sixty years ago, distinguished economists John Kenneth Galbraith and Francis Bator wrote about the importance of public spending in their books, The Affluent Society and The Question of Government Spending. But since President Lyndon Johnson and the era of the progressive presidents, public spending has been on a downward path, except for the military. And under Trump, it has taken a nose dive. There is scarcely any public spending to combat opioid addiction, to remove lead from air and drinking water, and to promote good health behavior.
For the first time in many years, the average life span of Americans is dropping.
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What? Sixty years ago we spent $0 on Medicare and Medicaid, because those programs had not yet started. Today, we spend $708 billion on Medicare, and $574 billion on Medicaid.
Maybe that's why there's no money left?
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Medicare and Medicaid are health insurance programs, not public health programs. They are important, because the price of medical care has skyrocketed since the 1950s, so even wealthy people must purchase health insurance. Like all insurance programs, people pay a premium each month in case they need surgery, cancer treatments, or hospital care. The government may subsidize or guarantee these insurance programs, but the bulk of the expense is paid by the policy holders.
Public health programs involve treating populations. They include vaccinations to stop the spread of infectious diseases like influenza or whooping cough. They also include campaigns to alert people to the dangers of opioids, smoking, and other harmful habits.
But there was plenty of money to give billionaires and banks a huge tax cut.
With limited resources, we should focus a public health campaign on something fundamental - clean water and safe food.
The first great strides in public health revolved around clean water and safe food. We now know that our food and water have a tremendous impact on our microbiome, which in turn has a tremendous impact on our overall health. A healthy microbiome promotes a strong immune system and reduces inflammation, thus decreasing both infectious and chronic disease incidence.
Years ago, clean water focused just on microorganisms, but we now know the focus needs to widen to include heavy metals and pharmaceuticals, both of which are present in our drinking supply. The public health campaign means dramatically updating our country's water infrastructure.
A health microbiome needs a variety of foods to stay healthy. We need to promote whole foods, with little additives, and this means changing the tax incentive structure so that the price of processed food isn't subsidized to be cheaper than fresh food. To drill down, we also need to remove the use of antibiotics from our food supply, as these greatly perturb the microbiomes of animals and animal-meat consumers.
The obvious problem with my approach is that it is hard to quantify the "rate of return", and therefore no politician can claim success.
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Sorry, incorrect. The biggest causes of death and disease now are chronic disease, i.e. heart disease, cancer, etc. And these have two main causes, both of which are preventable: tobacco and obesity. As someone who works in public health, resources need to be directed toward changing those behaviors and getting people screened. If people really want to save lives and money, they should beg their legislators to institute tobacco and sugar taxes. Smoke-free policies are a next good step.
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@Laura: we already have cigarette taxes, but the greatest success in stopping smoking was PUBLIC EDUCATION. On the other hand....obesity is not as directly linked to disease as smoking is and we have NO cure or treatment for obesity. "Stop smoking" treatments (nicotine patches, smoke-enders etc) are highly effective. But the treatments for obesity have failed at a 98% rate! in fact, you can argue very effectively that all efforts to "cure obesity" have backfired big time, as people are more obese today (and more people ARE obese) than 50 years ago. A treatment has to actually WORK to be effective. There is no proof that punitive taxation ALONE works to modify behavior -- vs. simply pushing people into other equally bad behaviors (using drugs instead of smoking, or eating fatty foods instead of sugary foods) OR creating a black market.
The lack of support for public health is simply emblematic of the US's overwhelming subservience to wealth and corporate profit.
The reason cited, that business can't make money, is likely more a symptom of the problem, the primacy of business over people's lives. It is not just that businesses can't make money, but that our welfare is antagonistic to corporate profit. This covers a broad range of activities, the first that comes to mind being support for foods that are harmful to humans and the planet, denial of climate science, how the government regulates cars and workplace safety.
Although not a professional in the field, I've often lamented how some of the greatest benefits to our society has been through public health. At one time I seriously considered getting a Master of Public Health, an MPH, although to administer hospital systems, but a love of technology lead me to where I am today, in software development.
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