I strongly believe vaccinations are a major intervention needed during this time, more than ever. You always hear in the news and through people talking about how vaccinations are not important anymore because of how many diseases are not common now. This intervention requires a huge amount of education on how vaccines work, what different vaccines there are, and possible diseases that will result in refusing to vaccinate. Education is key in implementing vaccine importance!
As a public health professional, it is truly disheartening to see not a single one of these addresses the persistent health disparities in this country, which continue to affect the poor and people in marginalized communities. Until we address the deep rooted systemic and interpersonal racism and discrimination that plagues our society, we will never achieve optimal health. If you want to be involved check out the work that is being done in your areas. Public Health departments are in need of community collaborations and input to make their programs serve all of us better. And to learn more, check out the American Public Health Association's "Generation Public Health:" https://www.apha.org/what-is-public-health/generation-public-health
1
CFR: I am also a public health professional, & I about to air some dirty laundry. Hands down, public health activities are one of the best investments of our tax dollars. Unfortunately, public health practitioners have done a dreadful job of making that common knowledge. Moreover, we've done a dreadful job of clearly defining public health health activities. That said, it is a lot to expect the public to be familiar with health disparities. We might as well expect them to understand quantum mechanics.
The field has to do a much better job. We could start by informing people that all types of medical care are not public health. The video link you provide is a good start, but we need the equivalent of an ad during the Super Bowl to capture the public's attention to begin elevating the value of taking steps to prevent illness & injury from afflicting entire populations.
I would like to see a focus on reducing maternal deaths among black women which goes hand-in-hand with improving prenatal & postnatal care. The AMA reports that black are 2 to 6 times more likely than white women to die from complications of pregnancy. While there are initiatives underway, maternal death rates for black women are the same as some third-world countries.
Ironic and telling that in two recent NYT articles focusing on public health, neither piece explicitly recognizes and acknowledges that the opioid crisis is the #1 public health issue facing America. This is understandable given that most people see addiction as a criminal justice issue or worse still, as a matter of choice.
Vaccinate your kids. Pay to have others' kids vaccinated.
Last thing we need is a public health threat that should have been long ago solved.
1
Alzheimers. If it truly is type three diabetes, there is much that we could and should be doing. The same measures would also impact diabetes and heart disease.
Texting while driving ... and cycling and scootering and walking down the street and ...
1
Improving education/awareness of what support resources, events and programmes are happening in your communities will help individuals seek help, find help, and get the help they need. We need technology as an enabler to this.
In NZ we have created just that with a simple free community app called MYRIVR...
MYRIVR is now NZ’s largest in-app directory of community services, enabling visibility and instant access to more than 20,000 professionals from over 7,000 health and social services around the country.
Consumers can rate and comment on their experience with the services so that others can make informed decisions on what is working and opportunities for improvements. This will better inform policy and strategy of where they need is and what needs to be supported/funded.
There are so many awesome programmes, community events and services in the community that people are not aware of but through technology we can see and use it if we choose.
We are excited that we have teamed up with Stop the Silence from America to deliver a joint project here in NZ to deliver Child Sexual Abuse prevention, intervention and mitigation training in this field. Using MYRIVR app we can provide realtime data that can support our staff and its clients get sustainable better outcomes.
http://mpp.govt.nz/news-and-stories/myrivr-your-one-stop-app-about-nz/
2
"Lunch was Sun chips, another bag of Sun Chips, a bag of Doritos (bought from our privatized school lunch provider), snack was a granola bar, a Capri Sun, another Capri Sun; dinner was a peanut butter hamburger (PB on a white hamburger bun) and a bowl of Fruity Pebbles times 3 (3 servings of each); breakfast this morning was another bowl of Fruity Pebbles and milk at home, then a couple doughnuts when I got school breakfast". 24 hour food diary of a third grader complaining to the school nurse of not feeling well. Teacher reports this is pretty much his standard daily diet. He's really smart but he can't focus or attend or bear to be in class long enough to learn anything. 75% or more of our students are eating pre-packaged "food" at every "meal" every day according to this nurse's observations. Parents don't seem to know or care that real food is medicine. In addition, the trash we're creating with all this packaged food is overwhelming. A very sad, costly problem but the processed food corporations and health insurance companies are raking in the profits while we go bankrupt trying to pay our medical bills.
2
Right. Bring food, how it's grown, when to plant, how to prepare it, how much to put on one's plate with the traditions of civil culture & discourse into the schools. Then there will be more whole, more well, more fulfilled children, which is where we might begin.
Hi Beth B.,
I'm very familiar with the scenario you've presented. I've seen it in several areas of the U.S.
I'm a public health practitioner and we like to look 'upstream' to figure out how to solve population-wide health challenges. The kids who eat the kind of 'meals' you've described above live in poverty, and poor families tend to live in what are called 'food deserts.' That means there aren't a lot of healthy offerings from their local supermarkets, if they even have a supermarket located close by.
Also, food stamps (the SNAP program) have been cut significantly, so some families supplement food stamps with the cheapest food they can afford such as fast food, cheap packaged food, and canned food.
Lastly, families living in poverty have a lot of additional stressors beyond their inability to access healthy food such as intergenerational trauma, substance abuse, mental health challenges, lack of education, and the list goes on. These everyday challenges sometimes make it difficult for parents or other caregivers to ensure children receive healthy meals.
Looking at a child's food diary out of context does not help to solve this disadvantage. First we have to look 'upstream' to see how poverty affects families in a variety of ways, including their ability to provide healthy food to their children.
Only upstream interventions will address the nationwide problem of families lacking access to healthy food. And when I say upstream I mean at the policy level.
1
Profits over people is the American Way. Don't agree, just look at Tobacco control. It's still legal to smoke if you are over 21, yet it kills not only the smoker, the smokers family and friends, their pets, but possibly even the person who buys their house after they die.
https://www.washingtonpost.com/news/to-your-health/wp/2018/05/09/third-h...
Obesity, obesity, obesity. it is the current national health crisis. it affects young and old, and the outcome on society is.. well... heavy...
1
In 2015, Bill Gates said: “if anything kills over 10 million people in the next few decades, it’s likely to be a highly infectious virus.”
Not ISIS or MS-13 coming through our southern border, horrendous fear tactic by Trump. We have an $800 BILLION budget for defense with aircraft, ships, tanks and infantry units...to fight what exactly?
Gates met w Trump in Dec. 2016 at Trump Tower. Trump said he wanted to form a commission to study the bad effects of vaccines! Gates told the president-elect--“Waste of time. Vaccines work.” But TWICE Trump asked Gates if there was any difference between HIV and HPV.
Gates: ’It would take a heck of a meteor or volcano or earthquake to get you to 10 million. Even a nuclear weapon going off in New York City wouldn’t be 10 million.’"
By contrast, in 1918, when an H1N1 flu virus swept the world, it killed between 50 and 100 million people, and slashed U.S. life expectancy by 12 years.
PLUS The world is far more populated than in 1918—7.6 billion people today versus around 2 billion then—as well as more densely populated.
Based on that, the Institute for Disease Modeling predicts that a severe flu pandemic could kill more than 33 million people in just 250 days.
https://www.theatlantic.com/science/archive/2018/04/what-bill-gates-fear...
Take half that Pentagon budget, allow CDC/WHO to come up with a universal vaccine! No military parades--we need thousands more anti-viral scientists!
Solution? VoteBlue 2018 & 2020.
1
Although tragic on anindividual basis, anything that will reduce the world's population, short of nuclear war, would be helpful.
We need to stop treating microbial contamination of fresh produce as a product liability issue and instead start looking it at the same we would do other disease outbreaks.
E. Coli and Salmonella are naturally occurring bacteria that exist throughout the world. They are never going to be eliminated from food unless it is all sterilized before eating. We need to work on a vaccine that renders us immune to their worst effects.
Until that happens, people are going to keep getting sick. No amount of regulation is going to cure this problem.
Bottom line: we need to start with prenatal care and continue through old age, with thorough preventative medicine and follow-up for all chronic illnesses. We also need to insist on vaccinations for all children and follow-up with boosters for older children and adults.
We need to continue anti-smoking and anti-drug campaigns, and they need to be real. Kids are vaping and then "graduating" to cigarettes. They are too immature to understand the addiction they will surely develop. Tobacco is one of the most addictive substances on earth.
We can get a lot more quality for our healthcare dollars, but only if we start with prevention and follow that up with medical care as needed--for everyone.
2
Traffic calming double down - narrow the streets for cars so that they slow down, are channelized and less able to make dangerous and sudden lane changes and accelerations and at the same time give that space over to wide bike lanes, class 1 bike lanes, pedestrian wide walkways with green space buffering that can double to absorb water to prevent run off . At the same time, add roundabouts in the intersections so the vehicle traffic can move steadily and not start and stop.
Plan these walkways and bikeways so that people can walk and bike everywhere in their cities from their homes without needing to get in a car and not just a decoration at the edge that requires you to drive there to use it.
4
Excellent idea. This would go a long way toward helping people get more exercise throughout the day, as well!
Stop eating animal products. Exercise more. In his best-selling book, "How Not to Die," Dr. Michael Greger explains how almost all the major health problems we now face can be avoided or overcome by a plant-based diet heavy in fruits and vegetables. A healthy diet should be combined with plenty of exercise. Heart disease, cancer, diabetes, obesity, dementia -- these and many more have strong connections to a diet based heavily on animal products. People think the diet problem is all about sugar. Yes, too much sugar is not good for you, but people often overlook the fact that too much food derived from animals may be just as bad, or maybe worse, than a diet heavy in sugar.
5
I suspect my my post yesterday wasn't published due to cultural bias by the editor. I'll try again. Eliminate elective cosmetic sexual surgery on male infants. (circumcision) .
It is the most common surgery in the US. Foreskin is not a birth defect. Every year infants die from circumcision and the cause is camouflaged as exsanguination (without saying that the cause of exsanguination was a botched circumcision). The dollars wasted on this elective surgery could be better spent elsewhere. Circumcision performed on unconsenting pateints a violation of everyone'sright to an intact body. If you think the victims are all happy with their altered state look at the bloodstained men on facebook; check intactamerica.org and doctors opposing circumcision. A good start would be for insurance to stop paying for it.
6
What about the caregiver shortage that threatens the health and safety of our most vulnerable?
1
At the top of my list would be a campaign that would address child sexual abuse. The estimates of child sexual abuse (CSA) around the world are staggering. In the U.S. alone, more than one out of four girls and at least one out of six boys are sexually molested by the time they are 18 years old (Centers for Disease Control and Prevention, 2014).
CSA constitutes a broad range of behaviors and occurs in epidemic proportions across the globe resulting in a host of poor outcomes for children, the adults they become, and society at large. CSA severely affects a broad spectrum of mental and physical health outcomes, life expectancy, and the monetary cost to nations.
Other childhood traumas (e.g., physical and psychological abuse, neglect, parent incarcerated, parental substance abuse – a part of the spectrum of Adverse Childhood Experiences, or ACEs, research and identification by Fellitti and Alda, see www.ACEsTooHigh.com) are also extremely damaging as well as multiplicative in terms of negative impact. In comparison to the problem, little is being done – but needs to be, could be, and must be.
Funders of public health programs need to learn more about evidence-based programs to prevent, treat, and mitigate CSA and why investing in CSA prevention is critical to preventing so many negative health conditions.
2
"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."
In effect we are destroying the lives of the children we seize from immigrants who are seeking asylum and those children whose parents are killed in a police stop where the only guns are held by the police. These children now understand that they truly have nothing more to lose. It should be a national priority to first and foremost provide a safe environment for children across the board.
1
I think its vital we invest more money and research into tick-related diseases. The northeast is seeing an alarming increase in ticks and lyme disease and the other illnesses that ticks can spread, and yet not enough is known about how to identify these illnesses and manage them and its scary! As a new mother, who in my childhood I spent every day running in the woods, I hate that I have to worry about my son and ticks. We must do more and better on this issue!
I'm surprised there's no mention on mental health, in general. Things like depression, suicide and addiction are tied to mental health. I think mental health is one of the least understood health problems that impacts a large swath of our population. We need to raise awareness and increase access to services. Starting in the 60s many mental institutions began closing and large portions of the homeless population in the US have mental health problems.
Excellent article. It's hard to think about the most successful public health initiative. However, I was a small part of the indoor smoke places movement, so I'm biased towards that. The tobacco control movement pushed smoking out of indoor spaces, which massively alleviated asthma and second-hand smoke illnesses (strokes, cancers). Not all states put health funding to good use but overall, smoking indoors is a thing of the past.
Lyme Disease and other tick born illnesses.
3
Pretty much the most serious health problem we have is poverty and inequality. Fix poverty and an awful lot of health problems will disappear.
7
Echoing others already commenting, one of the most important "public health crusades" needed is teaching/convincing votes at all levels exactly what "my taxes" actually pay for. "Civilized life" requires driveable roads and effective water systems and sewers and non-crumbling bridges and enlightened, effective police forces and fire departments and on and on... Too many uninformed/oblivious/stubborn people blindly voting "against taxes" in many instances has gotten us where we are now in many parts of the country.
2
First we need to elect politicians who see improving public health as a goal. Today's Republicans/conservatives couldn't care less about public health. (Then can we talk about unintended pregnancies?)
4
Persuading conservatives that public health is important is step #1.
If they keep fighting against "My Tax Dollars" being spent to help "Losers Who Should Have Taken Personal Responsibility," and ridicule public health as a form of "EEK! Socialism!" all other efforts will fail.
4
Guns. People think they're buying a gun to protect their family and they don't realize that statistically speaking, the biggest danger is that one of their family members will shoot themselves with it. That needs to really be pushed hard, that you think a gun will make you safer when really it's so much more likely that you or a family member will shoot yourself with it accidentally or on purpose, or that someone will shoot someone else in the household accidentally or on purpose, than that someone in the household will successfully use it against a strange intruder. Also, tackling the toxic masculinity problem in gun culture, quote people saying it's "not good or bad, it's just a tool," and then show people taking social media profile pictures with their hammer, rapping about their screwdriver, reading magazines about chainsaws, etc. to show that people don't treat guns the same way they do other tools.
2
How about a We Need Universal Healthcare! campaign. Separate from blabbering politicians. Just we ALL need healthcare.
7
A vaccine for Herpes simplex virus. Cold sores and genital herpes could be eliminated.
Sleep - nothing beats its healing and restorative powers. And more and more of us are struggling with getting enough of the good kind.
3
I couldn't agree more with sleep as a public health issue! We need people (myself, sadly, included) to recognize the need to detach from screens at least an hour before bed. Not getting enough rest has so many negative knock on effects.
1
The mental health of the US worker can't be left behind. Although we're light years of controlling the amount of hours one could work (France/Germany), we need to start looking into the issue of only having 2 weeks of vacations (some companies don't even have that) and the fact that many US workers simply don't take them. And stress brings along quite a number of health issues.
4
I think the best public health campaigns for Americans are to restrict business from polluting our bodies more strict way so that we can lower number of obese/over-weight people, currently two thirds of Americans. Scientists nowadays point out that causes of obese/overweight are" obesogens", chemical compounds that disrupt normal development and balance of lipid metabolism, not nutrients like carbohydrates.
Secondly medical schools need to teach students how to remove these toxic chemicals safely from our bodies. Medicare/medical insurances and FDA need to work together in order to make these medical procedures being paid by medical insurance.
1
Treating every person in this country like a human being no matter what their income is. We tend to value the moneyed class too much and short change everyone else.
Create friendlier neighborhoods and foster more of a sense of community, trust, and responsibility. People have so little control over things nowadays and are very unfriendly. I think it's because we're all afraid of each other. The fault for that lies with social media and the news. Every little thing is portrayed as a major development/horror story.
Create a real health care system instead of the wealth care system we have currently. Make it simpler for us to get care when and where we need it. All our current system does is add to our stress and expenses.
Last of all, start to hold businesses accountable for their working conditions. Emphasize decency towards employees instead of shareholder benefits. Those employees that businesses use and abuse are part of the community. We keep your business going so you have a product to sell. If you continue to abuse us, fire us at will, force us to work 24/7, and give us no choices in any area of the job how do you expect us to stay healthy, care about work, and do a good job?
8
i support evidence-based home visiting. Nurse-Family Partnership has 40 years of extremely compelling evidence that mothers and their offspring do significantly better with this intervention. $1 spent yields $5.70 in health and societal cost savings. It is designed to align well with Health Care Organizations. I am working with a team to attempt to scale it to the national level
7
I find it stunning that among your published suggestions not one suggests a serious public awareness campaign about drugs. With the number of overdose fatalities now exceeding the number of people killed in drunk driving accidents I would think a campaign similar to the anti-tobacco campaigns of the 80's and onward should be a no-brainer.
4
All good advice for extending and improving individual human health, but what about our survival as a species? After a 41 year medical practice, I have had to conclude that a complex of factors I have assembled into "population density stress" is killing us now and increasing in its impact daily. I have just published my 20 year accumulation of research and clinical observations in "Stress R Us" on Amazon Books. What really drove me to these conclusions was the realization that contemporary traditional living sparsely populated hunter-gatherers and pastoralists have almost NONE of our "diseases of civilization" (heart disease, cancer, lung diseases, accidents including OD's, kidney diseases, obesity and diabetes, etc.). We all have 99.9% of the exact same geneset, so what's going on here? It must be the physical environment that we have created to house a population 1850-2,865 times larger than that of our original hunter-gatherer migratory clan-living ancestors prior to the agricultural revolution 10,000 years ago. We need to begin population pressure reduction through voluntary one-child families, which will take us back to the sustainable 1950 level of 2.5 billion worldwide by 2,100. Otherwise, all the healthcare in the world won't be enough to keep us alive with our increasing population density stress diseases and infertility. Currently, we Americans spend 25% of our GDP on healthcare and it's increasing. Stress R Us
3
Mothers and babies, esp black mothers and infants. Recent research (well summarized in the April NY Times article https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-m... has revealed systematic deficiencies in the treatment of pregnant black women as well as black mothers and newborns. This is 100% preventable and (like anything that gives babies a stronger start in life!) has ripple benefits that far outweigh the costs.
1
Addiction to smart phone and social media are probably THE worst problems facing young people today. Smart phones make people stupider and lazier and, therefore, easy to manipulate and the big tech companies care about one thing only: Profits. And social media, loyal only to the dollar, is being used to convince us to give us our shared values and breaking up the nation into warring tribes. We are becoming Afghanistan.
3
Drinking and driving. SO tired of this one. Throw the book at those who do it over and over again. What gives?
4
Housing.
3
Pertinent to the walking issue is that so much new development, residential and commercial, is created to be unwalkable.
5
I watched Amy Wong's comedy special on Netflix last night, vulgar but brutally honest. She is exactly right, if we don't have longer paternal and maternal pain/unpaid maternity leave like other first world countries do then we are doing the biggest disservice to the next generation. I would like to see my state and federal public health dollars go to public health departments who focus on maternal and child health (FP program). I would also like to see more public health discussion and evidence based interventions surrounding suicide prevention. Lastly, preventing one drug addict from contracting hepatitis pays for the clean needles. The cost of hepatitis, abscess, hospital admissions (ER/ICU) that could be reduced with clean needles is tremendous.
4
It is evident from the comments that we have multiple areas that need attention, and I think I agree with all the comments I've read. However, junk food, meat, dairy, and eggs certainly cause huge chronic health problems and I'm not sure anyone mentioned that. Nutritional education and support for whole plant foods by the feds rather than their support of big ag and processed food producers would make a huge difference in prevention of chronic health problems.
4
Meat, dairy and eggs?? So I should live on tofu and vegetables?
Health care intervention must include genuine discussion and understanding of abortion. Our society is dominated by a single sided perspective of reproduction which is denying and obscuring realization of the decisive and crucial health benefits to personal, family and public health of abortion and birth control.
Healthcare discussion of "Mothers and Babies" cannot be adequate without including birth control and abortion.
Healthcare discussion of "Nutrition" cannot be adequate without including birth control and abortion.
Healthcare discussion of "Use Taxes Wisely" cannot be adequate without including birth control and abortion.
8
The best way to prevent abortions is education & family planning.
Education-Believe it or not we know that reading at grade level is the key graduating from high school & entering the workforce. BTW higher levels of education increase the likelihood of a group to live a healthier lifestyle.
Family planning- Women who are better educated (high school graduation) are more likely to be successful w/ family planning. Successful family planning means following healthy sex behaviors & being able to plan a pregnancy-key to preventing abortions.
3
Along with the excellent ideas already presented: Require all providers to publish their prices and their outcome statistics. Without complete information there cannot be informed consumers and intelligent choices.
3
The article focuses on healthy lifestyle practices not healthcare. Prevention means we avoid having to seek medical care to treat illness or injury.
Healthcare focuses on the individual. Public health focuses on creating conditions/opportunities (water available in school vending machines rather than soft drinks; seat belt laws; bike helmets; inspecting restaurants for safe food prep practices; safe parks in communities where families can walk/play; & age-appropriate reproductive health education in schools)
No medical professionals involved in any of these measures. Your county & state health department are charged with promoting & protecting the public's health. They are poorly funded (3%) because the vast majority of health spending is channeled to medical care. Click on the link to find out how prevention has an excellent return on your tax dollar. The Robert Wood Johnson Foundation funded research showing that $1 spent on prevention can return up to $11 in avoided healthcare expenditures. investment.https://www.preventioninstitute.org/sites/default/files/publications/Pre...
3
Top of my list would be addressing the opioid "epidemic", starting with sentencing reform, mandating treatment for first-time offenders versus imprisonment.
5
why are drug abusers who get caught "offenders"?
in so many ways, they are victims... often long before they abuse drugs.
2
Advance care planning. Too many people say “Do everything” with no concept of what that means. Not only do patients and families suffer unnecessarily physically and emotionally, they suffer unnecessarily financially leaving chaos and financial disruption on top of their emotional losses.
8
I’ll add my soap box here, major funding and focus on c-difficile vaccines, education and treatment. I’ve had c-diff recur at various timesover the past twenty years, and was recently told by the infectious disease clinic that I could only be eligible for a fecal transplant after two prior antibiotics had failed. Bad news! Your article about European study is encouraging but GI clinics in the US know and can’t implement early - it works. It’s the FDA and our complex regularity process that makes this so challenging to offer to sick people much earlier. Yes, there is the yuck factor (but when you can’t get rid of it, nor can you take any antibiotics for other illnesses due to the risk, the yuck factor isn’t there). People DIE from this, and not just the elderly. My last beef - I support scare tactic education similar to the smoking industry “here’s what your lungs look like”. People who push doctors for a z-pack etc. thinking they need it when there is not enough medical evidence to support they need it should be warned graphically of how antibiotic overuse creates superbugs, and if if they are unlucky enough to contract c-diff it means running to the toilet often 20 times in one day with diarrhea, being so weak you are bedridden, and in order to test for it, giving multiple stool samples. And, once you have it, you may never truly be cured. That’s my public health concern. I’m living it.
Poverty leads to so many problems, especially for children. A living wage and a national health care system should be everyone's right. Tax the ultra wealthy more to pay for this-no one needs to be a billionaire.
11
Raise the minimum wage. https://www.kqed.org/stateofhealth/19337/how-an-increase-in-minimum-wage...
3
1. Objective, evidence-based medicine only.
2. Taking all profit out of health care (which can never have anywhere-close-to "efficient" markets in the economic-science sense).
3. Medicare-for-all. (Start by lowering the qualifying age to 55, then to 45, then to 35, etc. to transition the system over a period of years.)
19
Mental health....75% of people in jails and prisons have a serious mental illness...we must get back to treating, not punishing, mentally ill people....and also give us tools for emotional maturity, compassion, and analysis of problems not subjective reaction.
9
Mental health problems often underlie other problems such as obesity, substance abuse, alcoholism, smoking, hypertension, and so on.
Mental health problems are very widespread but nearly invisible in our culture.
1
Legalize all drugs, so we can end organized crime. Spend the money saved on the war on drugs to provide comprehensive programs for addicts (medical, social, job, finance, family, spiritual, etc.), like Portugal does. Watch drug addiction decrease over the next decade, like Portugal did.
4
Education about all health-related issues should be at every grade in the public schools. A high school diploma should guarantee a minimum knowledge, especially regarding addictive drugs, nutrition, and child care. These preventive programs will save much of the public health burden.
6
And birth control.
National Sleep Campaign.
Lots of great suggestions, I would echo devoting more resources to children and preventable ACE , but would also suggest a national effort to increase our awareness of the serious ramifications of sleep deprivation. The epidemiological studies on the detrimental health effects of a lack of sleep are incredible. Obesity (including childhood obesity), cardiovascular disease, diabetes, dementia, psychiatric illness and much more have all been correlated to a lack of sleep. It would be a low cost initiative, an educational campaign only, and would not require pharmaceutical intervention.
4
I'm surprised reduction of unwanted pregnancy was not on the list. We are so divided on the issue of abortion but never talk about how we can significantly reduce the need for abortion through proven programs that can have a significant impact on unwanted pregnancies and that also work to reduce teen pregnancies. Unfortunately, for political reasons, these programs are rarely discussed or implemented. We could shift the millions of dollars spent on pregnancy prevention programs that don't actually work and use those tax dollars to fund programs that do work. I include funding to Planned Parenthood in that mix along with comprehensive sex education in schools.
19
Sleep deficit affects every major system of the body and is implicated in diabetes, obesity, high blood pressure and high cholesterol, immune system dysfunction, and mental illness. Sleep debt prevents learning, causes car accidents, and costs billions in health care resources and lost productivity. Sleep literacy and the value of sleep should be a foundational public health priority.
8
The spending is low because public health doesn't cost much and because the needs have been met. Almost everyone gets the recommended immunizations, our water is safe to drink, milk is pasteurized...even the rare episodes of food poisoning are tracked down and the causes found and eliminated (50 years ago these would have just been considered normal and ignored).
Low spending isn't necessarily insufficient spending.
1
What about a preventable condition which kills more Americans than AIDS, breast cancer, car crashes, opioids & guns yet gets $0 funding in the federal health budget to address? Blood clots known as deep vein thrombosis & pulmonary embolism (collectively called VTE, venous thromboembolism) are the leading cause of preventable maternal death & hospital death, yet there are no public health campaigns to address. Why? The Surgeon General identified it as a public health crisis in a 2008 report, yet nothing substantive then happened. Reports without action do nothing. People continue to needlessly die from a preventable condition they've never even heard of.
3
Addiction and Drugs
We must do preventive education immediately and long term.
3
Interesting to me is no mention of alcohol and it’s related deaths. Alcohol kills approximately 88,000 Americans a year about 35,000 more than opioids. In excess it is both physically and emotionally addictive. Aside from the high number of deaths, the untold results of alcohol are domestic abuse is more likely to result when men are drunk and more violence in general from alcohol abuse. America’s love affair with alcohol needs a public health initiative as much as some others suggested.
10
These are all such thoughtful and sensible comments and suggestions - and not a single one will be implemented in our current destroy-all-that's-good administration and Congress.
15
Dental care is neglected - and so much of it is preventative, but unaffordable. Ties into diet, nutrition, self image/mental health, et. al.
10
I could not agree more. Dental care is fundamental health care, but it's incredibly expensive! Few insurance policies cover it. Medicare doesn't cover it. So much of dental care is out-of-pocket, which means it's the first health care need to be neglected.
8
Lifestyle changes can go a long way. Eat more produce, and less sugar. Exercise.
One innovative idea for housing in northern Europe is shared housing. Families live in a large building with a communal kitchen, and small private living quarters. Once a month, each head of household has to cook dinner for everyone. Other nights someone else cooks. This arrangement is especially helpful for busy single parents. It buys time, cuts costs, and creates a supportive social network.
8
Taking a walk is social, not Socialist. Can likely help with Loneliness, too. It's a great idea.
PD Gupta comment either very funny or very dumb. TR, Seattle
2
Dr. George Vaillant's longitudinal studies show that more and better education is strongly correlated with better health over a lifetime. Let's focus on making schools places where all young people actually WANT to be. Keeping all young people in school and graduating on time should be a public health priority.
4
The risk of the next great viral pandemic is a greater threat to American lives than most, if not all, terrorist attacks. The CDC must be adequately funded in order to be both vigilant and proactive. Left ignored, and with funding cuts in place, literally millions of Americans, and many, many more worldwide, will be at threat. Millions.
8
All listed are notable for a public health campaign. An all out assault on the food industry would make the biggest public health impact. Health is directly linked to food; animal products, highly processed, sugar laden all wrapped in plastic. Not only personal health, but environmental health as well. Shift government subsidies from big agriculture, ranching and dairy to small farms. Allowing small farms to grow food locally and promote others to join in creating a more permaculture not agriculture practice. Provide money to promote healthy eating habits, by teaching meal planning and preparation. Heavily tax fast food. Hold fast food and supermarket industries responsible for non biodegradable packaging. Look at yourself. Are you contributing to the problem? Choose food wisely. Purchasing organic lettuce in a plastic container is a bit oxymoronic, no? Ever think about the environmental impact of that bacon cheeseburger? Do you contribute to the problem by supporting the food industries that are unhealthy; that promote obesity and disease? Public health begins with the PUBLIC. The public must demand policy change. Vote with your fork! Personal change can make an impact on the industry. Look at self. Change the habits that contribute to the problem.
20
Screening and prevention of Adverse Childhood Experiences, which contribute to higher rates of all the big killers; cardiovascular disease, diabetes, obesity, cancers- not to mention increased likelihood of mental health problems and suicide. It affects all demographics: all ethnicities, all socioeconomic backgrounds, and studies show that routine enquiry and therapy can dramatically decrease health care costs.
5
The fact that end of life care and advance directives didn't make it onto this list shows how direly the public needs to be educated in this area. Medicine has vast power to prolong lives, and unless people discuss and document their wishes about what kind of medical care they want to receive when they can no longer speak for themselves, there is a good chance they'll end up being kept alive by intensive medical intervention while their quality of life vanishes, something people often don't actually want.
16
1. Federalize Medicaid and combine it with Medicare. This will reduce costs and cover those in need in the states that refused to expand Medicaid under the ACA.
2. Extend Medicare coverage to vision, dental and long term care.
3. Negotiate drug prices to bring them in line with what the rest of the world pays. The same goes for surgical procedures.
4. Offer a public option, basically Medicare, under the ACA. If insurance companies can compete with that, so much the better. If they can't were well on our way to a single payer system.
62
The biggest public health crisis we need to address is the fact that two-thirds of the American population is overweight causing a whole host of health problems. Body positivity is good but it doesn't mean that overweight people are healthy. It just means that people shouldn't be made fun of because of their weight. People should still be told that being overweight is not healthy and that they should be losing weight. So many health problems we see in this country--diabetes, heart disease, etc.--are worsened because of how overweight people are. Encourage people to do more exercise, instead of treating heart disease and diabetes, let's put efforts in making people healthy and not just treating the disease.
13
Ditto to above. About 10 years ago I was diagnosed with "metabolic syndrome," the precursor to diabetes. I have kept diabetes at bay completely with diet -- low- (but not no-) carbs, protein every time I eat, and "safe" fats. (For me, that means lower fat than most low-carb diets allow because I am in the 20% of the population who cannot metabolize fats as well as the rest.) The cost in health care dollars? Zero.
There was the cost of one book that helped in particular: "The Schwarzbein Principle" by Dr. Diana Schwarzbein. She does an especially good job of explaining how cholesterol problems come more from eating carbs, rather than from eating foods with natural fats. (Except for those of us in the 20% cited above.)
It boggles the mind that a diabetic diet was formulated nearly a century ago, yet little is done to inform the public about it. Of course, successfully following such a food plan not only vitiates the need for high-priced diabetes meds, but also leaves out most of the packaged foods that line the shelves of our grocery stores, which may have something to do with it.
16
Food, how people eat is so important to many, many health issues. I am not as slim as I could be at 63 years of age but have always eaten quite healthy and never have to depend on doctors and a health care system to keep me active!
Moving from the West Coast to the Upper Midwest really emphasize how horrible so many people eat. I say “food desert” as decent fresh fruits and vegetable have not always been available so people are not in the habit of eating fresh!
Public health priorities are complicated but many issues would be cured or improved with decent eating habits. Healthier people would be able to focus on other important matters and not when they are next going to the doctor to tell them how to improve their lives.
2
I vote for all of the above, funded by reversal of the GOP tax cuts, reducing our ridiculous military budget, and allowing medicare to negotiate prescription drug prices. This would happen if Washington worked for the American people and not just the plutocrat donor class.
35
We should stop the harmful, unnecessary and disfiguring practice of routine neonatal circumcision.
We have recognized and accepted that the genital mutilation of women and girls is a human rights issue. It is high time that this same awareness is extended to boys and men, recognizing that all forms of genital cutting are damaging and a violation of human rights.
4
Reduce the horrific income inequality: great economy, soaring homelessness. Improve affordable quality daycare, preschool, K-12, and college.
17
We should be spending much more money on public health. We should start with a single payer health care system that has realistic cost controls.
17
We need to look at actual research--not funded by financially interested parties--before we go after sugar. There are far worse problems with our diets. "Sugar" blaming is an uninformed response. Sure, it's not good for you, especially in large amounts, but perhaps we should look at evidence, rather than reader opinion. Or, we can spend the next 10 or 20 years on sugar before finding out it doesn't change much.
I’d like to see hearing conservation addressed. Amplification devices used in subways and other public places should be banned. Excessive noise is not in anyone’s best interest.
6
I think Mental Health needs to be at the top of this list. Many of us reading this are fortunate enough not to have serious mental health issues, or at the very least, we might know or have had periods of loneliness, sadness, or temporary depression (due to the death of a loved one, the end of a romantic relationship, etc.) But imagine going about your life, 365 days a year, 24 hours a day, when you are in a virtual prison of your mind....where you hear voices... where you are schizophrenic....angry at the world... socially awkward... alienated....scared of the world and those around you.... where you can't hold down a job...where your family and friends eventually disappear one by one because they can't 'deal' with your illness....where society shuns you...people avoid you....look at you with a scared look.... You have no job, no money, no home. No one cares about you. You are alone. In pain. And for whatever reason....you don't have the wherewithall to take care of your illness. Imagine that being your entire existence?
When we see a person with a physical ailment, we all feel sorry for them and want to help. But when we see a person with a mental illness, we generally don't try to help them. We avoid them. We ignore them. Pretend not to notice them.
I try to put myself in their shoes, and can't even begin to imagine the suffering. We must do better for such people, not only for them as individuals, but to benefit our society as a whole.
25
This! I, too, believe that mental health needs to rise to the top of society's concerns. We are dealing with more people with more significant problems than ever before, and this is not going away anytime soon.
As an educator I would like to see so much more done to address mental health concerns of children especially.
13
Exercise! Even if it is just wide-seat exercise bikes at the Y and walking through awimming polls (easier on the arthritis.)
And working the body can't make up for going carb crazy.
8
Cell phones. At least three of them tried to mow me down on the highway today already.
8
Combat the "cholera and plague" of the 21st century - noise pollution,
4
Adult playgrounds with slides and monkey bars and climbing domes sized and strengthened for their larger sizes.
Most exercise is boring as all get out, we need a place to play.
9
Yes, and swing sets!!! I've been saying this for years.
1
Overpopulation. The planet is more than FULL. The sooner we can reduce birth rates around the World, the greater chance of survival for our Species. PERIOD.
23
"Kids who experience traumas have more cancer, heart disease, diabetes, depression, suicide and addiction as adults."
Given this well-supported consensus regarding the numerous ill effects of extreme trauma and pain in infancy, it stands to reason that American doctors' bizarre obsession with circumcision has had significant negative impact on American men's mental and physical health for the last century. The vast majority of circumcised men received no anesthetic for the procedure, because our genius doctors believed into the 1990s that babies felt no pain (seriously). This means the experience was likely the most painful one these men will ever endure - inflicted at a time when they were maximally impacted by it.
So let's start by banning circumcision. And prosecuting all the quacks who broke the Hippocratic oath to line their own pockets.
5
Easy to blame cancer on obesity. Not so easy to admit that we need to do the research on genetic mutations that make large percentages of people unable to get enough of vitamins D and B12 to keep cancer at bay. They overeat, trying to satisfy the body's demand ...but will never be able to get enough from ingesting whole foods. Come on, help them out. Get the research done.
4
Public health often emphasizes the greatest good for the greatest number, leading people to focus on the ailments which are most common. That sounds fine until, as I did, you come down with a rare disease. Public health should not be run as a popularity contest, but should aim to make high quality health care available to all. And yup, that costs money.
3
Excellent idea. Thank you for polling readers on this. These are all vital Social Impact Issues that will probably be swept under the carpet as a result of GOP Tax plan and closing of Social Safety Net. We are now a Datrwinian Society more than we are not.
5
Mental health, especially depression. Depression is linked to many of the chronic illnesses that affect our population, such as drug/ alcohol addiction, obesity (with all its sequelae), and dementia. Yet mental health is poorly addressed by our health care system, when it is addressed at all.
26
To the extent that public schools still teach physical education classes, those classes tend to focus team sports. But for most adults, team sports is not a realistic option for maintaining physical fitness, especially after 30.
For most adults, physical fitness depends on other activities, like walking. Public schools could make a real contribution to life-long fitness by emphasizing these individual activities and starting kids off on life-long habits of health and fitness.
21
School sports should be for ALL children, not just for semi-professional athletes.
11
I find that team sports in school were a good introduction into MOVING with your body, though I was not particularly talented and did not practice them after leaving school.
Now I walk but if they had made me walk in school I would have been bored to death.
So I support all efforts schools make to get us in touch with our bodies, with physical effort and discipline, it helps.
.
1
I strongly second investing in the development of new antibiotics. In addition to the obvious and historic infectious diseases spread through contact and wounds, a lot of surgical and other procedures, which are important to maintaining and improving quality of life, depend on antibiotics to treat infection. Many of these have downstream health effects (joint replacements enable continued physical activity which seems to improve and maintain overall health). Many did not exist or were not widespread before the availability of antibiotics. So, if we lose antibiotics, we will lose a lot more than what first comes to mind.
13
Public health dental care for poor children in the inner cities and in rural America. Lack of good dental care can lead to facial disfigurement, inability to chew and digest food, and heart problems.
22
With the focus on actual diseases, it is important not to lose sight of effective public health processes. While diseases may have similar manifestations, they affect individuals in vastly different ways due to genetics, socioeconomic status, race, culture, norms, living environment, etc.
It may be easy to encourage walking but if someone lives in an area that's not conducive to walking then that intervention is not very helpful and goes into another issue of making the area more adaptable to walking. The best that public health professionals could do is to encourage and lobby for environments to be more conducive to walking. If an investment is made to make a particular area more conducive to walking, will people actually use it?
Every community in the United States is different and what works for one may not work for another. My suggestion is to focus on a Community-Based Participatory Research (CBPR) approach to tailor interventions and health messaging to specific communities using behavioral models and public health conceptual frameworks as a guide while involving community members in the process to ensure sustainability after the intervention. Another important aspect is to always evaluate the intervention to determine the impact and continuously make improvements to the process.
Public health is not straight forward but, with the shift in focus from infectious to chronic diseases due to morbidity and mortality rates, this approach is very important.
17
Every single dollar that is not invested in the young but into the elderly are 1000 dollars wasted.
Thus be generous on spending for babies, children, and their care givers and scrutinize every dollar spent on the elderly.
The current spending pattern is out of balance. It will prove fatal for the nations future.
19
On the surface that sounds good until you become one of the scrutinized elderly. I think this is especially true as our country is getting the hit of huge numbers of baby boomers growing old.
4
Income and wealth inequality.
Insecurity in housing, food, health, education, and other essentials are rampant. There is enough income and wealth in the nation to take care of these concerns for all of us, but too much ends up at the top, leaving too little for workers, the poor, and their families.
Tax policy could fix this, but we just went in the wrong direction.
46
I love the walking after dinner idea, and a campaign on the dangers of loneliness!
9
traffic violence
5
Including prevention of noncommunicable diseases systematically in how we finance health in the US is one of our greatest challenges,. Sustained and sufficient funding to support the preventive strategies we already know work, such as those outlined in the other comments, are essential. We have a great many proven effective and often cost-saving interventions that we know can improve the health of our nation, but that we fail to implement even as we pay for the latest drugs and gadgets. It's time to change that. States as diverse as Oklahoma and Minnesota have created state funds to do this. This needs to happen nationally and in each state. Just a modest amount of resources can have transformative impact.
4
Ignorance and illiteracy are rampant in the US. How about tackling them, along with 'magical thinking' that denies science and refuses to accept facts? You can't educate people to make better health choices if they are denying the knowledge of scientific findings and refusing to respect the advice of trained and informed medical personnel.
35
That includes the "magical thinking" behind the past 50 years of "whole language" reading instruction. There is no scientific basis whatsoever, for whole language instruction, yet our teaching colleges still subscribe to it. Add in "dyslexia denial" of the 20% of the population who have it. and we have the recipe for the "rampant ignorance and illiteracy" you cite. Meanwhile, scientifically validated reading instruction has been known for decades, and was codified in the report of the National Reading Panel in 2000. Still waiting ...
Major missing issue: Alzheimers and dementia. This is a quiet looming calamity. If we cannot find a cure or at least some degree of prevention, these diseases will bankrupt our Medicare and Medicaid systems, squeezing out all support for the other valid concerns.
26
We also need to ask ourselves, as what point does it still make sense to keep people with severe Alz or dementia on 'life support'....whereby they are merely breathing, ingesting soft/liquid foods, and defecating. But otherwise, they are not engaged, they are not enjoying life, their brains are essentially 'dead', and their remaining family members are in some sort of a limbo...their family member with Alz/dementia is for all intents and purposes 'gone', but yet, society, families, religious groups etc., have us convinced that such people should merely be 'kept alive', in some instances, for a decade or more. How does this value the individual, their families, or society as a whole? I know that if I were to get severe Alz., I want my family to 'put me down' with love, much as we do our own pets. Then use all my retirement money for charities, instead of wasting it all to keep me 'alive'.
20
"Public health." An oxymoron for a nation that does not provide universal health care for the citizens. Yet we have "experts." Sad and bewildering.
52
Public health is concerned with population health. As a field of work, it isn't *necessarily* concerned with the direct provision of care to the individual. The Venn diagram of public health and health care services includes significant areas that don't overlap.
9
The US government needs to look at the standards for well-being put into place to protect these basic human needs: healthcare, housing, nutrition, and education as other countries in the world have done, such as in the EU. By being willing to look at the advantages for everyone (preventing the incarceration cycle many people who live in poverty become a part of and the price tax payers pay to support the prisons and jails as well as the price prisoners pay in being unable to break out of this cycle and being stuck in an unfortunate rut due to what they have waiting when discharged). Paying for these basic needs to be provided for all, it would be a mature and long-term way to create a sustainable environment for people of all ages to live in, without fear of homelessness, going hungry, being chronically ill, etc. All of our children deserve to live a safe, secure, and healthy life, not just those who are lucky and are born to parents who can provide for these needs due to their income and education.
8
At the root of most of the issues listed is poverty. As a matter of public health as well as curbing the outrageous costs of healthcare in the US, we must address the crisis that is poverty. Poor people are sicker, require more ER care and die younger than non poor people
49
And while not P-C to mention, we need to figure out how we can break the pattern of poor single women bearing (often multiple) children they cannot afford. This simply creates a never-ending pattern of poverty, which we see replicated one generation after the other. The problem is not 'accidental' pregnancy so much as it is particular women seeing few other options in their lives, no good role models, and never getting out of their little 'cultural bubble' to see that there are other paths in life.
13
Issue #1 thru #10: OBESITY
A public campaign against fat will go over like a belly flop in an empty pool.
14
We need to support each child in the context of their family. This begins with universal standards of maternal and infant care and continuing to include fathers as family life begins. Unfortunately our country has come to see pregnancy as a medical problem over an natural process. Providing quality care to mothers and infants can be done through Midwives and Nurses. Social Workers are important to assist families with their adjustment to parenthood. This type of care can be cost effective compared with the hoopla a typical pregnancy entails. With the excessive focus on women's rights, fertility is being taken for granted. In reality it is time limited and will decline after age thirty. Our birth rate declined at the last measurement. As a result new families are not forming. While many people focus on over population, I think it discourages the formation of families. As humans we need the next generation to continue. In accepting the need to ensure the best for the future of our planet, we need to nurture , care and love each new life.
14
It doesn't many with many of these issues if we don't have a national, affordable, quality health policy like the rest of our peer countries have.
We can't deal with many of these issues if millions of Americans cannot afford their doctors, programs etc.
65
One in 36 children has autism. This is a public health crisis. It starts with genetic vulnerabilities but is created by environmental factors. With scientific talent , courage to address powerful forces, and resources devoted to environmental causation, we can bring this epidemic to an end. The public health community has yet to call it a crisis.
Indeed, Poverty! It's not literally a capital P/capital H public health problem, but poverty and many other issues commentors have raised has made me think about "Predation." If you're poor, you're not only excluded from much of the legimate health and well-being systems, you're an easy mark for any scam, quack, trickster and low-life out there. How many desperate lives and bucks are lost into the maw of predators because people don't have healthy alternatives? Are Wendy and Ronald McDonald predators? Lending Tree?
Maybe this isn't for the current round of "Public Health" scoping. When we get to Human Nature, maybe...
1