During a recent visit to one of APHA’s affiliated state and regional public health associations, I was asked what I thought was today’s greatest hazard to health. Dozens of topics flooded my mind, from HIV/AIDS to obesity, but instead of narrowing down to a single issue, I wanted to lift up an underlying threat or prime mover. Considering the menu of possible answers — such as racism, economic inequity or lack of education — I decided to talk about our lack, as a nation, of a culture of health.
During the past 20 years of my travels to Washington, D.C., I have been struck by the depth of understanding on health issues that nearly all of the taxicab drivers I encounter seem to have. The day health reform legislation passed I was in D.C., and found that every cabbie had an opinion, and a remarkably detailed analysis compared to the pablum I was hearing every day on the news. The drivers ranged from wildly enthusiastic to supportive but cautious.
But this does not just happen in D.C. I recall a long cab ride in Mexico City in 2004 that featured an in-depth discussion with my driver about the international health implications of a second George W. Bush presidency. And a visit to study black infant mortality in Cuba when I was having my visa checked by the “migración” officer who asked me what kind of doctor I was; when I told him public health, he said, “oh yes, you save women and children.” I also remember my airport shuttle driver in Oakland, Calif., who engaged me in a discussion about school food and its tie to his children.
Anecdotal as these remembrances may be, all of these conversations were about the “big health” perspective and all of the individuals engaging me in these conversations had lived most of their lives outside of America.
As American children grow more obese under the pressure of the fast food industry’s $360 million per year investment in free toys that entice them to buy and eat high-fat, low-nutrient food packages; as worker safety continues to take second place to the energy industry’s business model; and as real pandemic threats still fail to make sufficient traction with the American public to raise our vaccination rates above a measurable blip, I see a huge challenge looming for the public health profession in this country.
The Patient Protection and Affordable Care Act — the official name of the health reform bill — provides the first major investment in prevention programs in decades. We need to assure that these investments support efforts to lift the public’s understanding about, and commitment to, an environment that supports health opportunity for all and that our nation learns that a healthy community is essential for economic stability and social cohesion.
We have to guard against a “food fight” for our parochial program interests and join each other in building a new national consciousness and culture. It is our job to get the message out that prevention is important for our nation’s health, and that public health is about prevention for everyone without exception. We have our work cut out for us.
- Copyright The Nation’s Health, American Public Health Association
