Building Health Care a Foundation

Health depends more on what you eat and drink, where you live, whether or not you have a job, how often you wash your hands, whether or not you smoke, how far you got in school, and where the factory next door dumps its waste than it does on high tech surgical procedures or the newest pharmaceutical drugs.

This is where public health fits in. Public health is the foundation of health care. As the Institute of Medicine has said, “The mission of public health is to fulfill society’s interest in assuring conditions in which people can be healthy.”

So how do the “conditions in which people can be healthy” relate to health care reform?

Let me give an example.

Let’s say two children are born on the same day, but in different communities. One is born to a mother who has carefully watched her diet throughout pregnancy and has abstained from alcohol and smoking. She lives in a village with pristine water and unpolluted air. The sewage and garbage in her village are transported far from town, where they are carefully processed and recycled. As she grows, her mother carefully teaches her about health and personal hygiene, and makes sure there is always plenty of nutritious food, soap and toothpaste in the house.

The second child is born a bit premature and is small for his age, due to his mother’s inadequate diet and heavy smoking throughout her pregnancy. He grows slowly because of his frequent coughs and bouts of gastrointestinal disease, and because he shares his limited nutrition with the hookworms he has acquired from running barefoot in the village. The water he drinks is questionable, and the air in his home is polluted from the coal-powered stove on which his mother cooks the meager fare which she is able to find in the marketplace. Outside, the stench is almost palpable from the garbage on the streets and the cracked and leaking sewage pipes. His mother knows little about hygiene, and is too busy with her other babies to teach him what she does know.

This exaggerated picture does have a message: It makes a big difference how much effort and the level of resources your community puts into assuring healthy conditions for you and your family. In fact, Dr. Herman Biggs, the Commissioner of Health for New York City in the late 1800s claimed, “Public health is purchasable. Within natural limitations a community can determine its own death rate.”

Now, if these two families came to buy health insurance from you, which would you prefer to insure? Before either child has even entered the “health care system,” you already know which one is going to have the highest health care costs. One has grown up in a community with a rock solid foundation of public health, and the other is attempting to survive in a community that is falling apart.

The choice is ours. “Within natural limitations, (we) can determine (our) own death rate.”

Treating STD's . . . A community Concern

I met your daughter’s boyfriend last night. Seems to have a good head on his shoulders. He says he wants to get into college on a football scholarship and plans on becoming an engineer. Nice kid. Good family. Bright future.

I felt bad I couldn’t do more for him, but you know how it is. With all the budget cuts lately, we really can’t afford to just give away medications in our sexually transmitted disease (STD) clinics. I’m sure he’ll come up with the funds somehow.

Seems funny now how things used to be. We used to get state and federal funds to treat kids like this. It had something to do with the old-fashioned concept that communicable diseases somehow impact the whole community. In fact, we were forbidden by the state legislature to charge for these services if the person couldn’t pay. How naïve we all were!

What a waste of money, trying to control things like syphilis, gonorrhea, tuberculosis, hepatitis and AIDS. Of course, we didn’t have things like HDTV plasma screen televisions to spend our tax rebates on in those days. I guess we could afford to be a bit more community minded back then.

But I wouldn’t worry too much if I were you. Like I said, your daughter’s boyfriend seems like a really nice kid. And I’m sure that “Just say, ‘No!’” lecture you gave her really sank in. It would be a real stretch to imagine she might be in that group of women (74%) who say they had sex before they turned 19. Besides, I’m sure he’ll come up with the money for the medications somewhere.

When Someone Sneezes

by Mark B. Johnson, MD, MPH
When someone sneezes, I usually say, “Bless you!” It’s a habit. And I want to seem polite. But what I’m usually thinking is, “Curse you!” Especially if they don’t cover, or if they sneeze into their hands.

I really get upset if someone near me on an airplane sneezes. By “near me” I mean in the same airplane. We all know they don’t circulate the air much, to save on fuel costs. But it’s really the dry humidity that messes up our sinuses. I almost always get a cold or a sinus infection after I’ve been on a long flight. I don’t know anybody cool who gets sinus infections.

I’ve heard we say “Bless you!” because people used to think we sneezed our souls out. The blessing was a way of protecting the soul while it was loose and vulnerable. Others thought the heart stopped when we sneezed. It doesn’t. During the Black Plague some believed a sneeze was a signal of impending death. A blessing was critical. It was a benediction for the soon-to-be departed.

But now we know better. Now we know those sneezing Black Plague victims killed a lot of those who were blessing them. They should have been cursing them instead.

I tell my staff that the most common bioterrorist is someone coming to work with a cold. Most of my staff hide from me if they have a cold. They think I’ll get mad and send them home. I probably would, but what I really want is for them to stay away from me. It seems to be working.

I’ve got to fly tomorrow. I’ll probably take some saline spray. I wish I could take more than just 3 ounces. The Transportation Security Agency guys will probably examine my bottle in the little plastic bag and then say, “Okay! Have a nice day!” I’ll probably say, “Okay! Thank you!” But inside, I’ll really be saying, “Curse you!”