Feds try everything to fix health-care system — except what works
We're not effectively protecting Americans from measles, air pollution or food poisoning
The public health infrastructure in America is crumbling. The evidence is accumulating as documented by the Centers for Disease Control and Prevention and other institutions. This includes reduced life expectancy, a higher incidence of suicide (across age, gender, race and ethnicity), continued contamination of public water supplies, an epidemic of fatalities caused by opioid overdoses and higher rates of chronic liver disease.
The major irony of these troubling developments is that progress continues to be made against some of the leading killers of heart disease, cancer and stroke.
When confronted with public health challenges in previous eras, governments at various levels and citizens responded effectively to eradicate small pox, improve food safety and provide cleaner air and water.
They did so by:
- funding research to develop better disease identification methods
- promoting broad-based education of public health risks
- mobilizing public opinion to support health and environmental policies
- applying more effective technologies and treatments
- instituting sensible rules and regulations
America spends more money on personal health care than almost any other nation. An examination of three current public health challenges provides key insights into why we're not effectively protecting public health today:
Across 15 states in just the first three months of 2019, the U.S. has already exceeded the number of measles cases reported for all of 2018. This for a disease that was reported to be eliminated in 2000.
While the inter-connections across cultures and economies certainly contribute to our susceptibility to infection, a unique and troubling factor is the growth of the anti-vaccination movement, now a global phenomenon.
Opposition to vaccination not only drives down inoculation rates, it continues to expand through a network of Twitter activists and support from Tea Party activists and other conservatives. The latter argue that parents' decision not to vaccinate their children is a matter of personal freedom and choice. Other anti-vaccination activists make the obscene comparison of mandatory vaccination to the gassing of Jews during the Holocaust. Public health authorities are left with no option except to take more drastic measures such as the declaration of a public health emergency in New York City due to a measles epidemic in Brooklyn.
- Air pollution
U.S. industry and taxpayers have invested hundreds of billions of dollars over the past 50 years to make the air cleaner and healthier to breathe. Success in reducing air pollution has been guided by a large and growing body of scientific evidence that informs scientists, decision-makers and consumers.
A recent study of 65 million Medicare patients, for example, concludes that reduced concentrations of smaller-size particulate matter has prolonged the lives of 50,000 Americans since such controls were introduced in 1997. Numerous independent scientific bodies have confirmed that air pollution regulations continue to be a sound public health investment.
Ideological opponents of this consensus, historically funded by various industries opposed to more stringent air standards, have moved beyond their goal of sowing doubt about this evidence into a posture of directly attacking existing health protections.
A leader in the assault is Tony Cox, a consultant to the fossil fuels industry and now chairman of EPA's Clean Air Scientific Advisory Committee, the most influential air pollution advisory committee in the nation. Cox, an appointee of disgraced former EPA Administrator Scott Pruitt, now states that there is no direct evidence associating small particle pollution and human health, the health benefits from controlling ground-level ozone are "exaggerated," and he concludes there is no proof that cleaning the air saves lives.
- Food safety
Every year, according to the Centers for Disease Control and Prevention, approximately 500,000 people get sick and 82 individuals die from eating contaminated pork products. The U.S. Department of Agriculture now plans to further jeopardize public health by finalizing regulations that will reduce the number of hog inspectors from 368 to 218 and no longer require tests for salmonella or E. coli. A major risk factor, detection of contaminated live hogs, will increase as there will be no controls on slaughter line speeds (currently set at 18 hogs per minute). Pork plant employees will replace USDA officials to conduct inspections.
Many past debates over public health protection involved disputes over scientific uncertainty or costs versus benefits of regulations. These examples provide direct evidence that the very foundations of our public health system are under attack by ideologues who don't believe in the legitimacy of government or lobbyists seeing to advance private at the expense of public interest.
These are no longer abstract debates but decisions that will mean life or death for people across the United States. The time for citizen outrage and participation to defend the integrity of public health decision making against an on-going coup d'etat is now.
Terry Yosie, Ph.D., is the former director of EPA's Science Advisory Board in the Reagan administration and a previous executive of the chemical and petroleum industries.