A bright future for public health?

Like many public health workers, Julie Gerberding admits that sometimes the burden can feel too big — that sometimes it helps to seek out a different view.

That view, she told attendees at the Annual Meeting’s Opening Session on Sunday, can be seen from her garden, where sometimes she said she feels like reveling and other times, she feels like wielding a hatchet. Some nights, though, the director of the Centers for Disease Control and Prevention said she looks over her garden and notices fireflies hovering about — and she thinks of her fellow public health colleagues. Like fireflies, public health workers represent “flashes of brilliance” — and the efforts of such workers are extraordinary, she said. But while each worker flashes their own “light,” public health workers as a collective haven’t been able to link together in a sustainable way, Gerberding said.

Part of the reason is because of the country’s failure to invest properly in the public health system as well as its failure to truly address health inequities. Even though the United States is the wealthiest nation on the planet and we spend the most on health care, our health indicators lag far behind those of other industrialized countries. However, Gerberding noted that the time is ripe to establish a “new vision” for America’s health, to move toward creating a health — not health care — system driven by two principles: health protection and health equity. Such a system may seem far off, but it’s not “pie in the sky,” Gerberding said. Public health workers, she said in her closing remarks, can help “create an illumination that will change the world.”

Following Gerberding, award-winning public health author and practitioner Laurie Garrett spoke before the audience of thousands on the seemingly overwhelming state of global public health. The gaps in indicators like life expectancy and maternal mortality between the wealthiest and poorest nations is only getting wider and simply throwing money — even lots of money — at the problem won’t solve the issues, Garrett said. For example, many on-the-ground programs in Africa working on HIV/AIDS simply don’t have the infrastructure or the workers to effectively administer massive amounts of funds. One organization said it had spent more than a third of its funds just to build a road from the clinic to the community, Garrett told Opening Session attendees.

Garrett said one of the biggest obstacles to truly improving global health is the massive shortage of health care workers in places like sub-Saharan Africa — and the United States isn’t helping. Faced with our own shortage of nurses, Garrett said U.S. policy-makers have failed to invest more in nursing education or make sure nursing professors are paid a decent salary (a comment to which the audience gave a round of applause) and are instead recruiting health workers from abroad. In short, “we don’t have an HIV crisis, we have a health care worker crisis,” she said. A crisis that could be mitigated by investing in community health workers, Garrett said.

The billions of dollars already in the global public health pot must be used more effectively, Garrett said. Organizers must step away from the traditional charity model and move toward models that encourage dignity, self-reliance and sustainability.

Before Gerberding and Garrett took to the stage, previous speakers spoke of the need to continue building a strong public health movement, supporting fair public health policies and working to create unity among traditional and non-traditional public health partners. Opening Session speaker and APHA President Deborah Klein-Walker, EdD, seemed to sum up the Annual Meeting’s overriding theme best: “I am committed to public health because it is the practice of social justice.”

Did the Opening Session speakers talk to your concerns about the future of public health? Will it change your outlook as you spend the next few days learning about new ways to improve the health of your community?

— K.K.

For another take on APHA's 135th Annual Meeting Opening Session, visit the Pump Handle public health blog.

Gerberding photo courtesy EZ Event Photography