Top 5 Public Health Jobs (that have nothing to do with public health)

September 20, 2010

For a long time, I’ve had an idea for a post that I never fully developed. Finally, I’m going to post it. Perhaps some of the potential insights are only partially percolated in the post; regardless, we proceed.

To me, the question “How can I save the world?” always seemed to imply “How can I help the sick? How can I make people live longer, happier lives?” I’m not sure if this is a common association, but an enormous amount of impact can be made through broadly improving public health.

Almost all of the world’s greatest tragedies are issues of public health. While the discipline often focuses on disease epidemiology or health policy, other major events clearly affect the health of populations: war, climate change, mental stress, natural disasters. Objectively, public health is not just vaccinating children but bringing conflict resolution, preparing for hurricanes, improving family dynamics, paving roads, building bridges (physical and metaphorical), and improving the quality of life for large numbers of people.

Unfortunately, such a broad scope can’t really be covered in a Masters program. Instead, we learn biostatistics and memorize long lists of risk factors for cancer, infectious disease, and other behaviors that lead to sickness. (It turns out, being really poor makes being healthy really difficult).

All of these many health-related disciplines, however, need leaders. And since getting an MPH can slow people down for two years, I’ve compiled a personal list of the top five occupations that I believe achieve the most public health (i.e. save-the-world) impact.

1) Teachers
One of the most impressive correlations that exists (in my opinion) is the correlation between health and education. From a 2007 NY Times article:

The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. It is more important than race; it obliterates any effects of income.

Education improves the economy, decreases risky behavior, and even cuts down smoking; not to mention the vocational training in finding stable employment and improving the economy.

2) Engineers
According to charity:water, unsafe water and lack of basic sanitation cause 80% of diseases and kill more people every year than all forms of violence, including war. The social consequences are equally destructive:

In Africa alone, people spend 40 billion hours every year just walking for water. Women and children usually bear the burden of water collection, walking miles to the nearest source, which is unprotected and likely to make them sick.

Time spent walking and resulting diseases keep them from school, work and taking care of their families. Along their long walk, they’re subjected to a greater risk of harassment and sexual assault.

In many places, water is hard to come by. There needs to be water infrastructure and to create this infrastructure we need innovative engineers. Plain and simple.

Engineers have done a lot to help the world. From the CBS Business Network:

Engineers have built more than 36,000 large dams around the globe to control floods and provide hydroelectric power, irrigation, industrial supplies, and drinking water to an expanding population and economy.

3) Politicians (kinda)
Poor governance in low-income countries ultimately causes A LOT of global health problems. Poverty becomes exacerbated. Public interventions fail due to corruption. Private markets cannot be efficiently regulated and open the door to exploitation.

Maybe Wycleaf Jean had the right idea on how to help the poor: become a politician.

Admittedly, although many problems are caused by governance, I don’t know that being a non-corrupt, intelligent, or even musically talented politican is the best way to overcome the problem. Bureaucracy, international relations, and other social, political, and economic dimensions discussed in a long list of Yale seminars aren’t easily solved by one Senator’s voice.

But hopefully there will always be people like Nelson Mandella, John Adams, Ellen Johnson Sirleaf and others to prove me wrong.

4) City Planners
There are more people in the world that face obesity than malnutrition. When I first heard that I was amazed. Now, admittedly, it makes sense.

Coined the “obesity epidemic,” a epidemiological transition has led to heart disease, cancer, diabetes, and other BMI-related chronic diseases to (appropriately) take the foreground in Western health policy. (In just about every public health class I have ever taken, obesity is one of the first issues that is discussed).

What can be done to prevent obesity? There are lots of alternative ideas being thrown around: sugar taxes, gym subsidies, improved health education, high quality healthy foods in low-income neighborhoods. All have potential, but one area that needs more emphasis is city planning.

To improve food security, encourage walking, and get people out of the BK breakfast->cubicle->episodes of Lost->bed routine, we need city designers.

In New Haven, I ride my bike or walk everywhere. I have access to nearby healthy foods and a gym. I have groceries delivered to me from a nearby grocery store. (Incidentally, grocery story delivery man could deserve an honorable mention for this list: finally, a way to maybe get produce and fruit to low-income neighborhoods).

By creating cities that can be navigated on foot (with efficient transportation) instead of relying on cars and highways, urban planning can create metropolitan hubs that have improved access to healthy foods while increasing exercise and even decreasing a reliance on (economically- and environmentally-) costly vehicles.

5) Journalists
I like to think I’m an idealist and an optimist. Yet, I get overwhelmed with global problems and discouraged trying to make an actual difference. It is during these times I consider dropping out of school, becoming a Park Ranger, and leading a content life in the wilderness. Or, investment banking.

Despite basically focusing on many of the world’s greatest tragedies, journalists like Nicholas Kristof inspire me and get me back on track. In order to truly address the plethora of public health issues (whether germs, genocide or gender inequality), we need to hear about them. Journalists bring these issues into the spotlight. They inspire. They mobilize. They tell people about the enormous disparity and they recruit the future leaders that will devote their lives to ending them.

Oprah can mobilize a social movement. Ben Franklin used journalism to influence the American Revolution. Glenn Beck can (unfortunately) get millions of people to hang on to his every word. This is a powerful tool to create enormous shifts in our world. Unfortunately, the economic future of journalism remains uncertain so it probably won’t pay that well.

At least there are always blogs.

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Health Care Reform: A Big Deal

March 26, 2010

Originally printed in the Yale Herald, 3/26/10:

“Mr. President, this is a big fucking deal.”

Joe Biden’s whispered excitement, caught on media microphones at the recent health care reform bill signing ceremony, celebrates a historic event for the United States.

After a 219-212 House vote, after a year of heated debate, after 100 years of effort, President Barack Obama signed into law the health care reform bill. Not a single vote in affirmation of the bill came from the Republican Party.

“This is a somber day for the American people,” said Rep. John A. Boehner (R-OH), the House Minority Leader. “By signing this bill, President Obama is abandoning our founding principle that government governs best when it governs closest to the people.”

While health care has clearly sparked many political passions, recent protests have been downright embarrassing. Racial slurs were chanted at civil rights hero Rep. John Lewis (D-GA), one demonstrator spit on Rep. Emmanuel Cleaver (D-MO), while Rep. Barney Frank (D-MA) faced insults about his openly gay sexual orientation.

Even congressmen have joined in the inappropriate revelry. Rep. Randy Neugebauer (R-TX) shouted “Baby killer!” during Rep. Bart Stupak’s (D-MI) speech on healthcare reform. Though passions regularly flare over important policy, GOP members associated with these outbursts should be ashamed.

The Republicans have pledged to block the measure, or at least use procedural weapons to delay its final ratification. “We will not allow this to stand,” promised Rep. Michele Bachmann (R-MN), a day after the bitterly partisan vote. Already in more than a dozen states, attorney generals have filed lawsuits arguing that measures in the bill are unconstitutional.

The response from Rep. Bob Filner (D-CA)? “It is time to chill out, Republicans.”

“Now it is a fact,” declared Sen. Max Baucus (D-MT). “Now it is law. Now it is history. Indeed, it’s historic.”

A long time ago, the healthcare reform debate stopped being about health and started being about politics. Countless committees, numerous reforms, many liberals losing hope, and one removed “Cornhusker Kickback” later, a bill has been signed into law that may finally offer improvements to our nation’s failing health system.

The bill does not include a public option that would allow people to opt into a cheaper health insurance plan provided by the federal government (one of the more liberal proposals advocated for by Democrats and Obama since the beginning of the debate), but still includes some important reforms. The bill is expected to cost some 940 billion dollars, but an additional 32 million Americans will finally receive healthcare insurance.

In addition to the expansion of the Medicaid benefit cutoff to four times the level of poverty (88,200 dollars for a family of four), federal drug benefits will improve. Children can stay on their parents’ insurance plans until a later age. Subsidies are provided to small businesses to help cover insurance costs. Coverage cannot be denied based on preexisting conditions. Out-of-pocket expenditures will be capped. Individual mandates will force everyone to buy insurance or pay a penalty fee. Many of these changes, however, will be gradual and won’t occur until 2014.

If you have coverage now, there won’t be many changes next year. In fact, if Republicans make substantial gains in the next elections, some of these provisions could be legislated out of existence before they even have a chance to take effect.

Obama said it best: “This is major reform. This is not radical reform.” The signing is only a small incremental step in getting America to where it needs to be. The lack of a public option does not mean this bill is a failure, but it does mean that it is lacking. Only with a public option can the government most effectively provide adequate welfare to the poor and the sick. Insurance companies have a long history of unjustifiable profits—profits that come from refusing care to the sick and exploiting those with preexisting conditions.

The bill isn’t perfect: It’s only gradual change, and it lacks a public option. But it is the first step in addressing the health disparity in our country. It’s the first step in creating a country of healthy individuals. It’s the first step in acknowledging that everyone deserves affordable access to care.

For all the hurdles that came with the push for reform, in the immortal words of Joe Biden, it’s a big fucking deal.


Why to Vote for the Unopposed

November 3, 2009

Today is the New Haven municipal election but there isn’t much activity at the polls in my ward (Ward 1).  That’s because the aldermanic candidate (Mike Jones, a Yale student) is running unopposed and incumbent John Destefano is expected to be a clear winner in the mayoral race.

I bumped into a friend of mine at the library and she asked me, “Have you voted today?”  While I admitted then (and admit now), I have yet to vote, I do fully intend to be at the New Haven library by the poll’s closing time.  But why?

  • Voting voices support.  Every vote for Mike Jones is a vote for confidence in our representative and his concern for our Ward’s issues.  You don’t have the option to vote against him, you can only abstain in protest or not vote.  The polls don’t distinguish between passive protests and sheer laziness (you have to actually get off your butt and fill in the Abstain bubble to show any real discontent).  An unopposed candidate with many votes demonstrates an ability to unite constituents. Each vote, therefore, provides future power to the representative and prioritizes the issues that concern his Ward.
  • Abstaining voices opposition.  Go walk to the polls and fill in that Abstain bubble if you don’t like the unopposed candidate.  It gets filed in official records and legal documents (and isn’t that what democracy is all about?).  You can still Rock the Vote and not actually vote for anyone–abstaining can actually hold a lot of clout (I imagine) in unopposed elections.
  • Voting shows participation. Unopposed candidates limit democracy and discourage political activism because citizens passively accept the inevitable outcome.  Taking the time to walk to the New Haven public library and cast a vote serves to maintain engagement in the local political process.  Voting shows the city (both officials and local neighbors) that individuals are still monitoring municipal politics, that individuals are concerned about local issues, and that individuals are still involved in bringing positive change to their community.
  • Voting increases accountability.  It’s harder to hold your local representative accountable if you had no role in their election. Frankly, he is your politician–whether you voted or not–but you get a lot more credibility (at least with me–and that’s important) if you demonstrated your political activism right from the start.  Go the polls, vote, and take ownership in your representative’s office.  Or go to the polls, abstain and then yell at him.  Either way, you’re more legit for being part of the process.
  • Voting demonstrates support for the primaries.  In Ward 1, Mike is running unopposed because he won the primaries last semester.  That’s not the end of the election process though.  If the above 4 reasons aren’t enough, my final bullet point is that he deserves another vote.  As a reward for winning.  Like a soccer trophy.  Go give your representative a soccer trophy.