Opinion: Building a health culture in America

COVID-19 shows need for buttressing U.S. public health infrastructure.

The COVID-19 pandemic has revealed to all Americans how unprepared our country was for responding to this new virus.

The confluence of the COVID-19 pandemic and the Black Lives Matter movement has brought the nation to a moment when our society is focusing on racial, ethnic and gender equity, including health inequities. We should utilize this moment to find ways to eliminate these inequities and improve the health of Americans. To be sustainable, these strategies must have ongoing support from the majority of Americans.

For many decades, the strong scientific capabilities and educational achievements of our nation’s health system have been noted. America’s investment in biomedical research during the 20th century resulted in many scientific innovations and therapeutic advances. The mean life expectancy of Americans increased from 47 years in 1900 to 80 years today.

But these achievements are not sufficient to guarantee a healthy population in the twenty-first century if our citizens and our leaders fail to exercise their responsibility to protect their personal health, the health of their families, and their communities.

Dr. Louis Sullivan is former Secretary of the U.S. Health and Human Services


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Some elected state and national leaders have failed the country by ignoring, minimizing, or denying the recommendations of experienced, competent, and respected public health scientists. Such acts have added to the confusion and anxiety of Americans. This has resulted in recommendations from public health professionals often being received in a political context rather than as conclusions based upon sound scientific data.

COVID-19 is nonpartisan. It can – and does – infect, sicken and kill individuals of all political persuasions.

This virus has demonstrated in dramatic ways that our minority populations are more frequently and more severely affected. Data from the Centers for Disease Control and Prevention show that Blacks, Latinos, Native Americans and Alaska Natives have COVID-19 hospitalization rates four to five times that of Whites because of longstanding inequities in access to health services, social inequities (including poor housing and poverty), and increased rates of pre-existing health conditions. COVID-19 infection and death rates are disproportionately high among the nation’s minorities.

Steven Kanter, M.D.

Credit: contributed

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Credit: contributed

Our public health services at federal, state and local levels have been chronically underfunded for years, impairing abilities to plan and prepare for public health emergencies. The COVID-19 epidemic has given us stark evidence of this reality.

With the attention and support of every American, we must pursue initiatives that illustrate that a healthy population is a societal good. Good health is a prerequisite for a productive community, a population with less absenteeism, increased workforce productivity, improved earnings, and increased tax revenues.

Investing in a more effective and more efficient health system will strengthen our nation’s economy. Research by Harvard economists Nathaniel Hendren and Ben Sprung-Keys, published in August 2019 in the Quarterly Journal of Economics, found that investment in children’s health and educational programs actually made money for the government in the long run. These earnings came in the form of more tax revenues from higher incomes of the children in their working adult years, and their lesser needs for social programs. They found that, in states which expanded Medicaid coverage for mothers and children, there was improved health of the children and a positive economic return for government. This was not seen in states which did not expand Medicaid.

We should continue to grow our nation’s investment in biomedical research because of the ongoing need for new knowledge of human biology and human disease. But we should also invest to create a more robust public health system – federal, state, tribal, and local – to include better public health surveillance, enhanced health literacy and improved health behavior of Americans.

Increasing the diversity of our nation’s health professions workforce – by gender, race, and ethnicity would bring many benefits: better communications, improved understanding and more trust between our health system and our citizens, including our people of color. More trust leads to more understanding and results in greater adherence to health recommendations, such as utilization of vaccinations, and other health behaviors.

In the 20th century, the health of Americans increased significantly because of advances in public health (i.e., safe drinking water, better nutrition, vaccines for communicable diseases, seatbelt use in cars and trucks), expansion of science-based medical research, development of new medical technologies, and improved health professions educational programs.

For a healthier nation in the 21st century, we can build on these achievements with an emphasis on fair and equitable access to affordable health services, stronger public health programs, better health behaviors and enhanced health literacy of our citizens.

Improved health of Americans will lead to a strengthened economy. The two are complementary and are mutually reinforcing. Leadership must step forward in all of our institutions for this to occur – leadership in government, business, education, homes, religious institutions, health organizations, and all of our society’s entities – a culture of health for America.

Louis W. Sullivan, M.D., is chairman of the Sullivan Alliance, a program in the Association of Academic Health Centers in Washington, D.C. He was U.S. Secretary of Health and Human Services under President George H.W. Bush, 1989-1993. Steven L. Kanter, M.D., is president of the Association of Academic Health Centers.