July | August 2017




by Joshua Sharfstein

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.—That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed."

With these famous words, Thomas Jefferson established that life itself could be a core measure of the trajectory of our nation. And indeed, over the course of U.S. history, ever-increasing numbers of Americans have been able to experience longer and healthier lives. In 1776, average life expectancy was about 40 years. Today, it is 79.
Yet, alarm bells are ringing. According to the National Academy of Sciences, the average life expectancy is lower in the United States than in other nations with advanced economies. Within our borders, African-Americans, rural Americans and poor Americans on average die years earlier than others. In fact, for some groups–including poor, white Americans–as a result of suicide, drug addiction and chronic illness, life expectancy is now actually falling.
It is no surprise that political leaders across the ideological spectrum increasingly are asking what can be done to protect and promote the health of their communities. In many areas, county and state governments are calling on state and local public health departments to deliver major improvements in health.
What does it take to save lives—not one by one through medical treatment, but hundreds of thousands or even millions at a time? This may sound like a crazy question, but it’s the right one to ask. Public health campaigns have in fact saved the lives of millions of people in the United States and around the world from malnutrition, infectious disease, unclean water and air, and other preventable conditions. In the United States, even today, up to half of all premature deaths are preventable.

Step One

Step 1 is to know your numbers. It all starts with understanding the problem. Health departments can determine which specific diseases and conditions that lead to premature death are affecting local residents at the highest rates. Mapping health data can pinpoint geographic hot spots in need of extra attention. Over time, governments can use information to figure out which responses are working and which are not. Effective use of data has been a key element of successful efforts to reduce infant mortality, lower the number of deaths from overdose, and reduce the toll of cardiovascular disease, diabetes and cancer.

Step Two

Step 2 is to convene your public and private partners around common goals. Maryland established 39 health goals for the state in five strategic areas—healthy beginnings, healthy living, healthy communities, access to health care and quality preventive care—and charged 18 local health coalitions with the responsibility to pick key targets and establish strategies for progress. Local hospitals, doctors, business leaders, school officials and others joined health officials in rolling up their sleeves and developing innovative projects.
State policymakers can support local initiatives in many ways. These include convening expert teams to provide input on strategy, such as Rhode Island recently did around an epidemic of overdoses. The state is now moving forward to expand access to life-saving addiction treatment. Similarly, states can adopt laws, regulations and policies that prevent asthma outbreaks from happening, for example, by modernizing housing standards and promoting reductions in tobacco use.
By coordinating with private employers and insurers, states also can seek more value from health care spending. Oregon, Tennessee, Maryland and Utah have all been leaders in paying for health care differently—paying more for improved health results and higher quality care, rather than for increasing volumes of services alone. Private and federal funding can be used to supplement many of these efforts.

Step Three

Step 3 is to empower your citizens with new and creative tools to improve their own health. This means seeking out those efforts that are likely to create the most opportunities for health and wellness, even if they do not look like traditional health projects.
For example, it might on first glance seem like a good idea to expand an educational campaign to help doctors tell their patients about the benefits of exercise. Yet for the same amount of money, a state or locality may have greater impact by creating attractive walkways, parks and athletic programs that draw people to participate. Similarly, efforts to expand access to fresh food, reduce housing hazards such as lead poisoning, address trauma and violence, and enhance educational opportunities for children will allow many more individuals and families to enhance their own health and well-being.

About the Author

Joshua M. Sharfstein, M.D. is associate dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health, where the mission is Protecting Health, Saving Lives – Millions at a Time.