The discussion of health in the current U.S. presidential race has largely been limited to loud calls for the repeal of the Affordable Care and Patient Protection Act by Republicans. Each has competed to be the loudest and most strident to denounce “Obamacare.” Many on the left are afraid that Obama may have squandered his first term by investing som much energy and political capital in health care.
Why then do we think that what we need someone to declare that they’ll be “the Public Health President?”
In a country deeply divided health is something we all have in common. No matter what one’s political inclination, age, gender, race, ethnicity, or whatever other distinction one might care to draw, everyone benefits from being part of a healthier population. Students will miss fewer school days. Workers will be more productive. Demands on the health care system will go down and with them so should costs. It will be easier to see one’s doctor when one really is sick. Of particular interest to politicians is that healthy people should be better able to get to the polls.
An interest-based approach, as we write in Renegotiating Health Care, is the most productive way to bring people together while ideological arguments ratchet up conflict and divisiveness.
The current debate is largely about cost, economic philosophy and concerns over the size of government. Population health is rarely mentioned. When is the last time you heard politicians debating health outcomes? No one seems to bring up that the World Health Organization ranked the U.S. 37th out of 191 countries for health performance despite having the highest per capita spending (a 2000 study which, to be fair, has been criticized as dated and not sufficiently compensating for distinct characteristics of the United States population – however 37th is far, far from first). The U.S. lags behind other industrialized countries in later studies by the Commonwealth Fund and others.
An article in the New England Journal of Medicine stated, “It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.”
We’d like to see a candidate boldy declare that in half-a-dozen key health indicators the U.S. will move into the top 20 globally in his or her first term and be in the top 10 within ten years.
This desire is not motivated by the hope that such a policy stance would lead to large pools of grant money flowing to the Harvard School of Public Health and our sister institutions. Rather we embrace it because it is, like JFK’s call to put a man on the moon, an audacious and aspirational goal that will yield significant benefits to citizens.
Second, these are goals that are independently measured and for which there is longitudinal data. Correlating policy to economic gains is blurred by the large number of independent factors that they are open to spin: no President has created or killed as many jobs as is asserted by supporters and detractors. The trend of lagging performance goes back as far as the 1970s so neither party can fully blame the other. It also means that a President who makes progress on health can legitimately claim the credit.
Third, achieving these goals will require much more than addressing the health care system. There is no way to get there without solving the challenges of education and jobs. The link between education and health is well established. The correlation between employment and health is more contested (Are healthier people more likely to get jobs or are employed people more likely to be healthy?) but it is not much of a leap to suggest that people who are employed are more likely to have money to spend on proper nutrition, preventative care, health clubs, and the like than are the unemployed. Thus becoming the public health President also comes with the title of being the jobs and education President.
The Republicans are ever closer to choosing their nominee. That person will go toe-to-toe with President Obama in the fall. There is still time for a leader to step forward and claim the public health mantel. Be bold, candidates, and put citizens’ health on the ballot.