Improving
Health, Climate Similarly
Daunting
Challenges
Stormy weather temporarily disrupts our physical environment
- and an insightful song of that title describes disruptions
of our emotional environment. Global warming is a threat
to the way we live. Which category does Hurricane Katrina
fall into?
We're not that adept at distinguishing between weather,
which is endlessly interesting and transient, and climate,
where change is difficult to detect but can prove devastating
over time. Any dinosaur can confirm that.
Those of us who think about health and medical issues
face the same problem - distinguishing the interesting
daily blips from changes that are simultaneously more
subtle and significant.
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|
Jessie
Gruman
President
and Executive Director
Center for the
Advancement of Health
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It is particularly
frustrating when we analyze the role played by
the journalists who serve as intermediaries between
the experts and the general public. Their focus
on the interesting but personally irrelevant (separating
Siamese twins) is a distraction. Their search for
a daily miracle that will upset conventional wisdom
threatens to sabotage public health campaigns that
seek to make behavior consistent with basic, healthy
principles.
The fact that their emphasis is a fairly accurate
indicator of public priorities causes added pain.
Journalists can't stop talking about the weather.
There's an entire cable channel devoted to it.
Climate, by contrast, doesn't have the pace they
prefer.
If we dress in layers and always carry an umbrella,
we can each cope personally with weather issues.
Climate, by contrast, requires a community response.
Unfortunately, there's often no bright line that
allows us to distinguish between the two. Aggregate
a few years of bad weather and the topic slowly
shifts to climate change.
So separating the important from the interesting
in the worlds of health and medicine is a challenge
on several levels.
Personally, it is an issue each of us faces as
an individual. When should a new ache or pain be
considered serious enough to require a professional
assist? Most things that bother us cure themselves
without outside intervention. But some will get
worse in a way that penalizes us for our initial
indifference.
Attempting to make such distinctions also raises
a broader issue - what should the health and research
priorities of American society be? Is offering
new mothers an overnight hospital stay such an
overriding priority that it deserves to be one
of the few services that Federal law requires insurance
to offer?
National health priorities have been distorted
more than once by our human responses to stories
that are quite sad, but ultimately insignificant
when the underlying data is examined.
That's one explanation for our focus on medicine
rather than health. We make big investments seeking
cures for diseases, each of which is represented
by a compelling poster child. But keeping people
healthy is a lower priority.
Even a rich land like ours has limited resources.
If things aren't clearly broken, we find it hard
to justify spending money on them. That's why we
allow our physical infrastructure - roads, sewers
and power grids - to be stretched to the breaking
point. When they finally - and inevitably - break,
we start to think about fixing them.
From one perspective public health is like the
power grid - humming along in the background and
presumed to be functioning well until there's evidence
to the contrary. But from another vantage point,
there's a big difference. When the power grid fails,
we rebuild it. But when the public health system
deteriorates, we instead spend money to restore
the victims of the failure.
It might be helpful to think of medicine as weather
and health as climate. Gradual changes in society's
health become manifest as pressures on our medical
system.
As the waters rise and we take the threat of global
warming with increasing seriousness, there may
be a lesson to be learned about how to better deal
with the nation's health. |
