Welcome to the Public Health Perspective, a new biweekly column about public health at Yale and in New Haven. (Warning: It just may change the way you think.)
First of all, don’t expect your grandma’s public health column. I won’t be writing about sanitation, cholera or bubonic plague. The public health of the 21st century is about the real epidemics of our time, such as AIDS, pandemic flu, obesity and the uninsured. These are issues that you read about every day on the front page of The New York Times, but which too often seem far removed from our ivory tower. Now is time to change that perspective by offering some real solutions right here, right now.
As we look for constructive solutions, don’t expect another Dr. Phil, either. As a fellow Yalie, I know that in general, you know what’s good for you, but you’re just not doing it. I also know that complaints without solutions can fall on deaf ears, much like the fire alarm that keeps going off in my building without cause. People do not want to be told that they drank too much last weekend or that they took one too many Yale Sustainable Food Program organic brownies, and I must admit that all too often, public health can seem like the pesky parent continually telling you what you can or cannot do.
The public health of the 21st century, however, is different. Rather than tell people what to do, public health professionals work to empower individuals by making the healthy choices the easy choices.
Dr. Pekka Puska, the director of public health in Finland, perhaps best describes this philosophy with a small sketch that he first drew on a napkin. In the diagram, a person is pushing a large ball up a hill, which represents the health burden. To help, it seems natural to push the person up the hill, perhaps by giving him more health advice or by putting more money into his care. But pushing on the problem isn’t the only way. If we step back and take a look at the environment, we can change the slope of the hill to make the burden easier for everyone. In this way, we can not only save resources, but we can also help the millions of others who seek to climb the same steep slope.
Dr. Puska’s napkin drawing may sound abstract, but it works. In North Karelia, a poor area of Finland where he did most of his work, cardiovascular disease among middle-aged men was cut by about 73 percent in the past 25 years through a combination of community initiatives to reduce smoking and high-fat diets. “In the beginning, we were radical,” Dr. Puska told me. “But today we see that it is exactly like the theory said — when the risk factors in a community are reduced, the burden of disease can also be reduced.” The millions of lives saved by public health interventions extend far beyond Finland. Bans on smoking and promotion of condoms in the United States, for example, have been enormously successful, and even New York City’s controversial proposed ban on artificial trans fats — which no one asked for in their foods, anyway — could save hundred of lives a year. These aren’t just statistics on a page, but rather real people, like you and me, who have been given a second chance to live their lives to the fullest.
There is an old Finnish saying that Dr. Puska shared with me and which resonates strongly: “Keep your head in the sky, and your boots deep in the mud.” For Americans unfamiliar with the Finnish permafrost, this proverb translates as the ever-popular “Think globally, act locally.” With this spirit in mind, I want to use this column to address tough public health issues that we can address right here in New Haven. I’ll start by asking tough new questions, such as why YSFP doesn’t post nutrition facts with its food, why we don’t have towels with the soap in college bathrooms, why smart Yale students start smoking, why the New Haven needle exchange fails to achieve its potential, why Yale students should personally worry about Connecticut’s uninsured, and why Yale-New Haven Hospital’s million-dollar free-care fund just isn’t working. Then, applying the science and art of public health, I’ll try to offer some solutions for real change.
In the end, the public health of the 21st century is about challenging our paradigms. The job isn’t easy, but I plan to do just that. I expect criticism, and I welcome your comments, but I ultimately hope to change your perspective.
Robert Nelb is a junior in Timothy Dwight College. This is his first regular column.