On Thursday, the Dean’s Grand Rounds presented “Delivering Equity Through the Public Health System” where Harvey V. Fineberg, MD, Ph.D. and Julio Frenck, MD, MPH, Ph.D., spoke about the steps public health and policy need to take to help make access to the highest attainable standard of care a right and possibility for everyone.
Both speakers featured were past recipients of the Frank A. Calderone Prize in Public Health, a prestigious prize awarded bi-annually by Columbia’s Mailman School of Public Health. The award is held in the spirit and memory of Frank A. Calderone, for whom the award was named. His daughter, Francesca Calderone-Steichen, offered an introduction that commemorated her father and his work by highlighting the need for public health to be global health, describing the current state and progress through presenting a snapshot of an empty public health office display box. In the past, she remembered, it used to be filled with information, tips, and resources, but for two years, it has hung empty. This, she said, was indicative of the increasing amount of public health deserts and insufficient funding of health departments in places that needed them the most. Public health, she argued, is purchasable.
The problem with public health is that public health measures, when they work, are invisible. After all, Fineberg pointed out, we only measure the disasters that happened, not the lives that were saved or the deaths that were prevented. Now that the importance of public health has been thrust into the spotlight, we must make sure it stays there, and push for investment in structures that will ensure prevention measures. “Poverty and racism,” he said, “are the mothers and fathers of health inequities…but there’s a fundamental reason we tolerate such inequity in health and it goes back to the American concept of human rights as enshrined in our Constitution and Bill of Rights. Health isn’t a right articulated in our Bill of Rights or the Constitution.” He points out that the rights listed in those documents are civil and political rights that the government should refrain from infringing upon, and pointed out that “there’s not a word in our Constitution about a right to work, there’s not a word about a right to healthcare, there’s not a word about the right to education, there’s not a word about a right to old-age pension, there is nothing in our Constitution that guarantees every American a right to health.” Because of this, health is “a constant political struggle.”
Dr. Frenck, who previously served as the minister of health in Mexico, had introduced a program that offered all citizens in Mexico health coverage while articulating health as a human right. The articulation of health as a right, he showed, was the first step needed for equitable health systems. “Health has an intrinsic value, a value in and of itself,” he said, “but it also has an instrumental value because improving the health of people is the key for prosperity and for justice around the world and security in the broader sense of that word.” If we can address health inequities, articulate health as a right, and have systems that make the highest attainable standard of health attainable to everyone, both the cause and consequences of poverty and racism can be addressed.
COVID-19 has highlighted the ways in which the health of communities are increasingly connected with the health of other communities in an increasingly connected and global way. As Dr. Frenck said, “The reality of the world today is a reality of interdependence and the interdependence has made the distinction between global and national basically irrelevant. Everything is basically global and local at the same time.” While public health has made great improvements at increasing life expectancy and decreasing maternal mortality, our lack of preparedness and the severe consequences show us that these are not improvements that we should take for granted. While we have yet to know the full effects, the increase in maternal deaths and the undoing of almost two decades of health progress show us that underlying disparities and inadequacies of the public and global health system are not to be ignored.
These global conditions need a global response. Now, we need to take a “glocal” response that acknowledges that inequities on the local and national level are also expressed around the world and that weakness in the public health system anywhere in the world affects us, locally. While we should listen to health professionals, health is too important to only be left to them–it should be something that involves everyone because it impacts everyone. As we all work toward unification in divided times, our speakers remind us that health, with its intrinsic and instrumental value, can be a unifying value that we work together to maintain.
Image via Grand Round Series, Columbia Mailman School of Public Health