Public Health Challenges in the 21st Century

Kenneth E. WarnerDean, University of Michigan School of Public Health

State and Local Public Health Retreat

E. Lansing – October 2, 2008

Coverage

1. Contributions of PH

2. Principal substantive issues confronting us today

3. What explains (lack of) support for PH?

4. Toward solutions to our problems

Contributions of public health

1. U.S. life expectancy ↑ from 47 in 1900 to 78 today

2. Infant mortality ↓ from 100 to 6.3 per 1000 live births

3. Age-adjusted CVD death rates ↓ > 2/3rd since 1950

Age-adjusted deaths from cerebrovascular disease, US, 1950-2005 (per 100,000 population)

020

4060

80100

120140

160180

200

1950 1960 1970 1980 1990 2000 2005

Contributions of public health

1. U.S. life expectancy ↑ from 47 in 1900 to 78 today

2. Infant mortality ↓ from 100 to 6.3 per 1000 live births

3. Age-adjusted CVD death rates ↓ > 2/3rd since 1950

4. Age-adjusted lung Ca death rates declining

5. See PHS’s 10 Great PH Achievements of 1900-1999

Issues of concern today

1. Chronic disease, especially behavior-related

Michelangelo’s David visits the U.S. for 2 years

Before After

Issues of concern today

1. Chronic disease, especially behavior-related

2. Infectious disease

3. Poverty and urbanization

4. Population growth

5. Water and food (supply and cleanliness)

6. Aging

7. Health insurance

8. Climate change

9. Reduction in disparities

Why PH?

1. Effective

2. Typically inexpensive and cost-effective

3. Addresses equity

It’s the right thing to do.

Why not PH?(Why the lack of support)

1. Its invisibility (when successful)

2. Lack of public understanding3. Lack of urgency (contrast with “rescue

function”)

4. (Relative) lack of interest groups

5. Therefore, lack of demand6. Its “publicness” (no private market)

7. Politicians’ discount rate

Toward solutions

1. Investment in PH infrastructure

2. Education

3. Research

4. Communications/marketing

5. Collaboration

Investment in PH infrastructure

1. Physical plant, especially and state & local levels

2. Scientific capabilities (labs, etc.)

3. Personnel

4. Review, revise, beef up regulatory authorities

It’s hard to do the job when you don’t have the basic tools.

Education

1. Graduate

2. Undergraduate

3. Workforce

4. Continuing ed for professionals

Research

Serves two of three core functions of PH:

1. Assessment

2. Policy development

Communications/marketing: The challenge

How can we unite constituents, elected officials, the professional community, and others in the PH system to ensure an effective and sustainable PH system?

Constituents must demand progress from their elected officials.

Communications/marketing:Creating a demand for PH

1. PH needs “brand identity”

2. Many efforts in recent years (e.g., “This is public health” stickers)

3. Need for professionally developed, large, and sustained marketing campaign (“A day in the life…without public health”)

Collaboration

1. Leverage our modest resources– Efficient use of resources– Extend our impact

2. Work with communities and other interested parties (requires organizational and political skills)

3. Assurance function (3rd core function of PH, through law and moral suasion)

Toward solutionsRoles of UM SPH

1. Investment in PH infrastructure

2. Education

3. Research

4. Communications/marketing

5. Collaboration