It has been an honor to represent you as APHA president. In my travels, I have often recounted the following story.
When my youngest granddaughter, Ty, was about 6 years old, I asked the usual question adults ask: “What did you learn in school today?” I expected the usual — “Nothing.” But one day, she surprised me and asked, “Did you know that eggs are really dead baby chickens?” I chuckled, “Yes, baby, I knew that.”
Her little face looked suspicious. “Then did you know that we used to be slaves?” Yes, I responded. She pointed her finger and shook it at me, saying, “You are supposed to tell us the important stuff!”
Despite reminders to Tyler and her big sister, Amina, to brush their teeth, cover their coughs, wash their hands and eat their vegetables, I had failed in my duty to tell them about the important stuff.
That is what children expect of grandmothers and what communities expect from public health. Our routine advice about exercising, avoiding tobacco, driving sober and eating fruits and vegetables daily helps people and even saves lives, but it is not the important stuff.
The huge jump in U.S. life expectancy that occurred over the past century didn’t happen only through individual lifestyle changes. It occurred because of basic changes to the conditions in which people are born, grow, live, work and age. Chattel slavery was ended, the nation was enriched by millions of immigrants, the eight-hour workday was won, workers organized and fought for the rights of ordinary folks and nutrition improved. Public health leaders saw issues such as mine safety, meat safety, sanitation and sewage infrastructure, slums and poverty as important battles. In the past, we did not pick battles simply because they were “winnable” by marking measurable progress in a few years. We picked battles because they went to root causes of the pain and suffering.
We have retreated to technocratic tasks, categorical programs and “evidence-based,” narrowly focused interventions while losing the faith of the people we serve. In America, your SAT score, your chance of chronic disease and the length of your life is determined by your gender, the color of your skin, the nature of your accent, the social class of your parents and the ZIP code in which you reside far more than individual attributes.
We need to speak clearly and forcibly to answer the important question for every policy, whether at the village or international level: Does it help or hurt human health? We must mobilize for the important battles directed at changing the inequitable distribution of power, money and resources that determines population health. We must renew our fight against racism and discrimination by ethnicity, class and gender. The core mission of public health is social justice. We must never forget the important stuff, because injustice is killing millions of people.
If we rally with the people we serve, then we can leave our grandchildren a world that is at peace, where justice rules, and its people — all of them — are healthy.
- Copyright The Nation’s Health, American Public Health Association
