The Congress of public health
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This week, Congress has an unprecedented opportunity to use public health to transform the nation’s future.

At stake is a set of bills that aim to prevent the next mass shooting, provide emergency funding to address the threat of Zika, and tackle the opioid epidemic.

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Will Congress step up to protect the health and safety of the people they are sworn to serve?

A core tenet of public health is that prevention is the best medicine. It is too late to prevent the deaths of the 30,000 people lost last year from gun violence, but Congress has the chance to pass common-sense legislation around gun control, including to allow doctors and scientists to clinically and extensively study gun violence as a disease. We cannot continue to ignore these appalling acts of violence, especially in the wake of tragedies in Orlando, Baton Rouge, Minnesota, and Dallas. In the ER, I can resuscitate my patients who have been shot, but Congress has the ability to prevent bullets from striking many thousands.

When faced with global health crises, it is also the role of public health to do everything possible to mitigate the harmful effects. Yet, after months of posturing, Congress has still failed to approve the President’s $1.9 billion request to fight the alarming infectious disease threat of the Zika virus.

This is an issue of national security. As a result of continued inaction, the Centers for Disease Control and Prevention (CDC) has been forced to shift funding from local public health to cover the check. This, in turn, will cut local jurisdictions’ ability to respond to emerging crisis. In Baltimore, our emergency staff would be cut by a third—the same staff who respond to hurricanes and bioterrorism, who help keep our city safe.

Not investing upfront in Zika can also have catastrophic economic consequences. According to the CDC, one child born with severe birth defects from Zika can cost society up to $10 million of health and educational costs. In Brazil, more than 1,600 children have already been born with microcephaly. At that rate, one year of the Zika epidemic in the U.S. would cripple our economy. Southern states will bear the brunt of the effects, as will urban, inner-city communities that are already hardest hit by poverty and disparities.

At the same time, it would be inappropriate to place restrictions on reproductive health services in exchange for this desperately needed funding. We know that the Zika virus can be spread through sexual transmission. It therefore makes no sense to place limits on Planned Parenthood. Unfortunately, that’s precisely what is being considered.

The CDC and the World Health Organization have declared Zika to be an impending global public health emergency. What other alarms must sound before sufficient funds are allocated to keep communities across the country safe and secure?

In the case of the opioid crisis, prevention and mitigation are too late. Heroin use affects over a million of our citizens and the prescription opioid crisis has swept the country. Every year, more people die from opioid overdose than from motor vehicle crashes.

In Baltimore, we have launched an aggressive overdose prevention program, including issuing a blanket prescription for the antidote, naloxone, to every single resident. But while this medication will save a person’s life today, it is not a long-termremedy. We know that we are just treading water unless we can get people into treatment when they need it.

Such evidence-based treatments exist. The science is clear that addiction is a disease and that recovery is possible. However, nationwide, only 11 percent of patients with addiction are able to access the help that they need. In my medical practice, I have turned away hundreds of patients who are desperate to seek assistance for their addiction. It is an indignity not confronted by individuals with any other disease—imagine if we were to tell patients with kidney failure that they have to wait weeks or even months to start dialysis. Some of my patients wait and get treated; some suffer and relapse; others go home, overdose, and die.

The House has taken promising steps to combat this epidemic by advancing the Comprehensive Addiction and Recovery Act (CARA). Notably missing, however, is funding to put these policies into practice.

During this election season, candidates from both parties have relayed stories of constituents, friends and family members who suffer from addiction. It is a step forward to bring addiction into the light. But will our elected leaders follow rhetoric with action? Will Congress vote to adequately fund addiction treatment? Or will local jurisdictions be burdened with unfunded mandates at a time of when all have professed to the necessity of treating this epidemic?

In medicine, there are many ailments that do not have a vaccine or treatment. Congress is fortunate that the three issues they are confronted with do have a ready diagnosis and an effective cure. This week, Congress can follow the principles of public health to prevent illness, mitigate harm, and treat diseases that will save millions of lives.

They can go beyond the national outcry following recent events to prevent bullets from taking lives and wreaking tragedy. They can invest in the security and economic future of our country by stopping the impending scourge of Zika that would otherwise affect generations of our children yet unborn. They can channel our national angst about addiction into a sound plan to treat patients with urgency, rigor, and humanity.

Congress, you have three critical decisions this week with one thing in common. Be on the right side of history.

Don’t fail the public’s health.


Dr. Leana Wen is the commissioner of health in Baltimore City. Twitter: @DrLeanaWen and @BMore_Healthy.