Why 'public health' is more than a buzzword accompanying the measles outbreak

Feb 20, 2015

Credit Office of Emergency and Public Health Preparedness / Flickr

After the recent measles outbreak, citizens, medical professionals, advocacy groups and government entities were all talking about "public health." But public health is an ongoing issue -- one that requires more attention. That's according to Dr. Leana Wen, Baltimore City's health commissioner. This week on "Take Care," hosts Lorraine Rapp and Linda Lowen speak with Dr. Wen about the importance of public health.

Linda Lowen: We throw the term around ‘public health’ but not everybody may be on the same page as to what public health is. So, what is public health and what is the goal of public health?

Dr. Leana Wen: So, often people think about public health when they consider the bad things that happen. You hear about Ebola, you hear about measles… or people think about public health in their own backyard with rat control and mold. So, we don’t take a proactive approach to public health as much as we should. Instead, we think about health care when something bad happens. People think about health when they get ill, and they have to be in the hospital, they have to go to the ER, but that’s not where taking care of your health should begin. We know that what contributes to health isn’t even so much your genetic code, it’s actually your ZIP code. In D.C., in Baltimore, there are neighborhoods right next to each other where the life expectancy varies 20 years for neighborhoods that are right next to each other. That should tell us about the importance of the environment and how that contributes to our health.

Lowen: So does public health then concern itself with those individuals who are experiencing the greatest disparities -- the ZIP codes that suffer -- that don’t have the kind of opportunities that others do have?

Wen: That’s part of what’s important in public health, absolutely, but it’s not just about the individuals who are the most vulnerable. This is an issue that affects all of us; all of us are affected by outbreaks; all of us are affected by heart disease; all of us are affected by cancer. Public health is so often about what we cannot do but let’s turn the conversation around -- not just be reactive but be proactive and talk about what are the things we can do to improve health.

Lorraine Rapp: So how does a public health official assess what would be good for a community or a region?

Wen: There are some hard problems in our society. It’s easy, I think, to throw up your hands and say 'Well, poverty, drug abuse, disparities, these are the underlying issues.' We can’t solve reductions in teen pregnancies, we can’t make our children healthy unless we address these core issues.

Let me give you an analogy; this is a common scenario. A patient comes in that maybe isn’t very ill, but is feeling pretty bad. They’re lying in the hallway and they’re cold. The patient asks the first person who comes by, a doctor, ‘Can I get a blanket please?’ the doctor shakes his head and says ‘No.’ The nurse comes by; the patient asks ‘Can I get a blanket?’ and the nurse says 'No.' The tech walks by, the tech says 'No.' All these people walk by and say no because they don’t think it’s their job, they think it’s someone else’s job.

So often, it’s easy to do the same thing in public health. That people look and say, ‘Well this issue is too complex. We need police; we need criminal justice, drug courts. We need all these things to be fixed.’  Yes, that’s true. However, these are issues that are plaguing our public health system now. It’s up to each of us to take responsibility -- just like any of us in the situation with the patient could have gotten that patient a blanket. It’s up to all of us in health to say 'We know these are complex issues. We know it’s going to take a multi-faceted solution, however, we can begin today to address these issues.' It requires genuine engagement with a community not only to say ‘Here are the problems,’ but rather ‘What do you think are the issues? How can we best work together on these solutions? How can we tackle these serious injustices and problems together?’

You can hear the rest of Take Care's interview with Dr. Leana Wen this Sunday at 6:30 p.m.

Dr. Wen is Baltimore City's health commissioner, a Harvard-educated emergency physician and co-author of the book "When Doctor's Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests."