A health wish list for the president-elect
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President-elect Trump, I oversee health in Baltimore, a city where Democrats have a nine-to-one majority. I agree with you: our healthcare system is broken. 

Despite spending more than any other country, we continue to rank poorly on basic measures of health and well-being. Fifty-six countries have a lower infant mortality rate than we do. Fifty-two have a higher average life expectancy. We are paying more for less, and Americans are suffering the consequences.

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Discussions of health reform have centered on the Affordable Care Act. I urge you to go beyond the rhetoric and consider three strategies to improve American’s health, save the government valuable resources, and enhance our national security.
 
First, focus on the epidemic of drug addiction. According to the Surgeon General, one in seven Americans will face a substance use disorder in our lifetimes. Drug overdoses kill more of us every year than car crashes.
 
The federal government has taken steps to address the epidemic, including Congress’ recent passage of the 21st Century Cures Act that authorizes funding for drug treatment. While this illustrates progress, there is a question you must help us answer: What pain are Americans treating? The rate of drug use has skyrocketed in economically depressed areas where families suffer from unemployment, unstable housing, and uncertain futures. These are the same areas that showed the strongest support for you during the election.
 
When we understand addiction as the symptom of their discontent, the need for economic development and job creation becomes all the more urgent. When we understand addiction to be a disease and not a moral failing, it becomes an outrage that only one in ten people suffering from it can get the treatment they need. Prioritizing the crisis of addiction will also drive much-needed change in our criminal justice system and build trust between communities and police.

Second, change the way we invest in health. As much as 97 percent of total healthcare spending goes to hospitals, yet less than 10 percent of what determines the length and quality of a person’s life takes place in a hospital. The high costs of care for people after they become ill limit the resources that are available for preventing diseases from arising in the first place. This approach treats the symptoms without addressing their root cause. It is expensive, inefficient, and ineffective.

Early investments have the biggest returns. Programs for nurses visiting pregnant women in their homes not only improve birth outcomes, but also save $5.70 for every $1 spent. Removing lead poisoning hazards not only prevents irreversible brain damage in children, but also saves between $17 and $221 per $1 invested. Preventing one child born with microcephaly from the Zika virus will save society $10 million over his or her lifetime.

A commitment to fiscal responsibility is a commitment to public health. I urge you to shift spending to empower local jurisdictions on the frontlines with the funding and flexibility we need to protect our citizens. It is not enough to look at the cost of a program; you must also consider the cost of doing nothing.

Third, look to what is working. Cities like Baltimore have many long-standing problems including poverty and violence, but we also have pilot programs that are producing extraordinary results. As a result of a public-private collaborative that engages over 150 partners, we have reduced Baltimore’s infant mortality rate — once one of the nation’s highest — to its lowest rate ever recorded in just seven years. After adopting one of the county’s first needle exchange programs, we have reduced the percentage of people with HIV from intravenous drug use from 63 percent in 1994 to 7 percent in 2014. In the face of rising overdose deaths, we issued a blanket prescription of the antidote medication, naloxone, to every resident, which has empowered citizens to save the lives of 531 family members, friends, and community members.

These are just some examples of the innovative and successful programs that have emerged from our city. Just as we learn from partners in other jurisdictions, our colleagues around the country have come to us to replicate our programs. For example, the Maryland state legislature has just passed a statewide needle exchange bill, and multiple states have made naloxone available to save lives. In your efforts to increase access to services in rural and other underserved places, I urge you to look to the pilots that have proved effective on the ground and incentivize their expansion.
 
Last week, 11 city health commissioners who safeguard the health of 31 million Americans wrote an open letter to your transition team. Based on what we see on the frontlines, we proposed policy strategies that are not about partisanship, but about shared principles. It is in this spirit that I write this letter to you.
 
Quick fixes will not cure the ills of our healthcare system. What will is a total paradigm shift in our approach to health. Only by taking a public health approach will we ensure that our country’s tomorrow will be better than today, and that where our children live no longer determines if they live.
 
Dr. Leana Wen is the commissioner of health in Baltimore City. Twitter: @DrLeanaWen and @BMore_Healthy.

The views expressed by contributors are their own and not the views of The Hill.