AJPH NATIONAL PUBLIC HEALTH WEEK #NPHW, A Time of Global Assessment Last year we could reasonably expect public health progress to continue, with more insured people, less racism and sexism, fewer prisoners, and improving health indicators. But the first few months of 2017 have reminded us how much the impact of public health activity depends on the historical context—in particular the objectives of senior elected government officials and their staff. So far, the new US Administration appears to be taking positions that threaten science and public health. We have therefore assembled in this issue of AJPH an early assessment of the state of public health in the United States in which several scholars and public health practitioners from a variety of political perspectives describe the already observable consequences and those that are pending.
ENVIRONMENT The greatest immediate concern is about environmental protection and the science of climate change, and their consequences on health and justice. That the new administrator of the Environmental Protection Agency (EPA) has been battling the agency for years in defense of corporate interests exacerbates these apprehensions (http://go. nature.com/2kEEbcx). Gina McCarthy and Thomas A. Burke (p. 649) stress why it is indispensable not only for public health but for the economy and for all of society to have a strong
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EPA. Our air, water, and food all determine the health of our society. When President Nixon, in 1970, requested that Congress establish the EPA, he acknowledged that the protection of the environment had become a major concern for Americans.1 Considering the history of the past half century, we can expect that a large proportion of the public will oppose what appear to be current efforts to weaken and redirect the EPA. The tragedy of the Flint, Michigan, water crisis is an applied echo of the alarm raised by McCarthy and Burke. In 2015 and 2016 we were shaken by revelations of the eminently avoidable exposures of the population of Flint to lead in their drinking water. In the middle of the presidential primaries, Flint received much attention and many visits from the candidates of both major parties. A huge effort made by the local communities and health professionals, and funding from different sources, have circumscribed the disaster and set the foundations for reconstruction. However, as Mona Hanna-Attisha emphasizes in her editorial (p. 651), Flint was just the weakest link in a score of vulnerable communities in the United States already exposed to lead and other stressors. These affected communities in Detroit, Michigan; Chicago, Illinois; Philadelphia, Pennsylvania; and Baltimore, Maryland2 are all candidates for some form of human and ecological disaster relief. Weakening our scientific
defenses today will create the conditions for new “Flints,” where the most vulnerable populations are hit with lasting consequences to their health and to their existence.
LOCAL PUBLIC HEALTH BUDGETS Local health departments play a key role in the implementation of public health policy. This Administration has pledged to make fundamental changes to policies that vitally affect public health, including repealing the Affordable Care Act (ACA), closing the borders to refugees, deporting persons from the United States, and weakening public health regulations. To understand these proposed changes and what the scientific needs of local public health practitioners are, Paul Erwin (p. 653) describes a surveillance system put in place on the basis of local public health sentinels across the country. The objective is for this journal to comply with our mission to place the policies in historical context and provide evidence allowing an enlightened decision-making process. David Sundwall (p. 654) lists among the areas of concern the
repeal of the ACA and its public health provisions, in particular the Prevention and Public Health Fund. Disastrous consequences for public health programs at the federal and state levels can be expected if public health funding for the Centers for Disease Control and Prevention decreases by $890 million annually and for states by $3 billion over the next five years. Reduced Medicaid funding and enrollment also threaten many public health initiatives, including pregnancy and perinatal care, for a large fraction of the population. Block granting Medicaid to states may facilitate the weakening of this essential social health care program for families and individuals with limited resources.
IMMIGRATION The executive order signed by President Trump, titled “Protecting the Nation from Foreign Terrorist Entry into the United States,” may have generated the impression that the borders of the United States are currently porous for refugees. The truth is that the current system is already complex and paved with many obstacles, making the admission of refugees to the United States a very arduous process. Ann Philbrick
ABOUT THE AUTHOR
Alfredo Morabia is the editor-in-chief of AJPH. Correspondence should be sent to Alfredo Morabia, MD, PhD, Barry Commoner Center for Health and the Environment, Queens College, CUNY, 65-30 Kissena Boulevard, Flushing, NY 11367 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This editorial was accepted February 22, 2017. doi: 10.2105/AJPH.2017.303753
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AJPH NATIONAL PUBLIC HEALTH WEEK
(p. 656) describes this process and illustrates it with the case of a refugee, aged 23 years, from Somalia who arrived in the United States in late April 2016 with her husband and three children. She experienced having to deal with two very complex health care systems, delays in obtaining health insurance, and a disconnect between the available medical treatments and her religious beliefs.
COMMUNICATION AND EDUCATION What has been the role of poor or inadequate communication in lessening the appeal of the ACA to the Americans most likely to benefit from it? Four articles deal with this issue. Sarah Gollust et al. (p. 687) found that news sources at times preferentially covered political debates about the ACA over its public health relevance. Anand Parekh
(p. 639) and AJPH associate editor Hortensia Amaro (p. 671) both stress that good communication must become a core leadership skill for public health practitioners and that these skills must be integrated into core training. AJPH associate editor Roy Grant (p. 658) offers guidelines for scientific journals to adapt to this communication challenge.
retrogression offer reassurance that our generations, like previous ones, can reverse society’s misdirection and deploy the extraordinary opportunities for progress that lie around us.” History speaks against resignation.
Alfredo Morabia, MD, PhD @AlfredoMorabia
A GLOBAL #NPHW LESSONS FROM THE SIXTIES We close this series of contributions with an upbeat note. David Himmelstein and Steffie Woolhandler (p. 660), after reviewing the potential hazards of the new Administration’s procorporate agenda, still articulate a vision for public health progress in the 21st century. Looking back at the 1950s and 1960s, they observe that “past periods of impasse and
This issue focuses on the state of public health in the United States. But the United States is not the only place in the world that is either victimized or at threat of being victimized by forms of populism that have contempt for science and that aggravate social and ethnic tensions within the population.3 Moreover, the concerted activity of world scientists in international organizations such as the International Agency for Research on Cancer is being stressed and sapped.4
We Need a Strong Environmental Protection Agency: It’s About Public Health! Public health is rooted in recognition of the environment’s role in human health and disease. From the cholera outbreaks of the 19th century and the Great Sanitary Movement to today’s global threat of climate change and the Paris Agreement, the protection of public health depends on the protection of our environment. The Environmental Protection Agency (EPA) is a public health agency and a cornerstone of our nation’s environmental public health infrastructure. The
May 2017, Vol 107, No. 5
AJPH
Therefore, on behalf of the AJPH team of editors, let me reemphasize that the AJPH mission is to closely follow the global state of public health, to place it in its historical context, and to provide the ideas and evidence that may contribute to improve it.
core mission of the EPA is the protection of public health and the environment. Former Republican president Richard Nixon established the EPA in 1970 with strong bipartisan support from Congress. Since then, guided by a framework of national laws, the EPA has led national progress in improving air quality, cleaning up our waterways, reducing harmful pesticide exposures and industrial emissions, and providing support for states and communities to advance environmental health.
THE ENVIRONMENTAL PROTECTION AGENCY’S FUTURE Today, as we move forward with the new Administration and Congress, there are troubling signs that the
REFERENCES 1. Greenberg MR. Russell E. Train: a leading environmental figure of the 1970s. Am J Public Health. 2010;100(4): 606–607. 2. Wen LS, Warren KE, Tay S, Khaldun JS, O’Neill DL, Farrow OD. Public health in the unrest: Baltimore’s preparedness and response after Freddie Gray’s death. Am J Public Health. 2015;105(10): 1957–1959. 3. Rooduijn M. Simply studying populism is no longer enough. Nature. 2016; 540(7633):317. 4. Pearce N, Blair A, Vineis P, et al. IARC monographs: 40 years of evaluating carcinogenic hazards to humans. Environ Health Perspect. 2015;123(6):507–514.
future of the EPA and the future of public health will be affected. The leader of the new Administration’s EPA transition team has recommended elimination of the EPA’s scientific research efforts and cuts in the agency’s expert staff from 15 000 to as low as 5000. In Congress, legislation (HR 861) has been introduced to terminate the EPA. It behooves all of us to sit up, take notice, and make our voices heard.
ABOUT THE AUTHORS Gina McCarthy is with the Harvard T. H. Chan School of Public Health, Boston, MA. Thomas A. Burke is with the Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Correspondence should be sent to Thomas A. Burke, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205 (e-mail: tburke@jhsph. edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This editorial was accepted February 14, 2017. doi: 10.2105/AJPH.2017.303728
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ENVIRONMENT The greatest immediate concern is about environmental protection and the science of climate change, and their consequences on health and justice. That the new administrator of the Environmental Protection Agency (EPA) has been battling the agency for years in defense of corporate interests exacerbates these apprehensions (http://go. nature.com/2kEEbcx). Gina McCarthy and Thomas A. Burke (p. 649) stress why it is indispensable not only for public health but for the economy and for all of society to have a strong
648
Editorial
Morabia
EPA. Our air, water, and food all determine the health of our society. When President Nixon, in 1970, requested that Congress establish the EPA, he acknowledged that the protection of the environment had become a major concern for Americans.1 Considering the history of the past half century, we can expect that a large proportion of the public will oppose what appear to be current efforts to weaken and redirect the EPA. The tragedy of the Flint, Michigan, water crisis is an applied echo of the alarm raised by McCarthy and Burke. In 2015 and 2016 we were shaken by revelations of the eminently avoidable exposures of the population of Flint to lead in their drinking water. In the middle of the presidential primaries, Flint received much attention and many visits from the candidates of both major parties. A huge effort made by the local communities and health professionals, and funding from different sources, have circumscribed the disaster and set the foundations for reconstruction. However, as Mona Hanna-Attisha emphasizes in her editorial (p. 651), Flint was just the weakest link in a score of vulnerable communities in the United States already exposed to lead and other stressors. These affected communities in Detroit, Michigan; Chicago, Illinois; Philadelphia, Pennsylvania; and Baltimore, Maryland2 are all candidates for some form of human and ecological disaster relief. Weakening our scientific
defenses today will create the conditions for new “Flints,” where the most vulnerable populations are hit with lasting consequences to their health and to their existence.
LOCAL PUBLIC HEALTH BUDGETS Local health departments play a key role in the implementation of public health policy. This Administration has pledged to make fundamental changes to policies that vitally affect public health, including repealing the Affordable Care Act (ACA), closing the borders to refugees, deporting persons from the United States, and weakening public health regulations. To understand these proposed changes and what the scientific needs of local public health practitioners are, Paul Erwin (p. 653) describes a surveillance system put in place on the basis of local public health sentinels across the country. The objective is for this journal to comply with our mission to place the policies in historical context and provide evidence allowing an enlightened decision-making process. David Sundwall (p. 654) lists among the areas of concern the
repeal of the ACA and its public health provisions, in particular the Prevention and Public Health Fund. Disastrous consequences for public health programs at the federal and state levels can be expected if public health funding for the Centers for Disease Control and Prevention decreases by $890 million annually and for states by $3 billion over the next five years. Reduced Medicaid funding and enrollment also threaten many public health initiatives, including pregnancy and perinatal care, for a large fraction of the population. Block granting Medicaid to states may facilitate the weakening of this essential social health care program for families and individuals with limited resources.
IMMIGRATION The executive order signed by President Trump, titled “Protecting the Nation from Foreign Terrorist Entry into the United States,” may have generated the impression that the borders of the United States are currently porous for refugees. The truth is that the current system is already complex and paved with many obstacles, making the admission of refugees to the United States a very arduous process. Ann Philbrick
ABOUT THE AUTHOR
Alfredo Morabia is the editor-in-chief of AJPH. Correspondence should be sent to Alfredo Morabia, MD, PhD, Barry Commoner Center for Health and the Environment, Queens College, CUNY, 65-30 Kissena Boulevard, Flushing, NY 11367 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This editorial was accepted February 22, 2017. doi: 10.2105/AJPH.2017.303753
AJPH
May 2017, Vol 107, No. 5
AJPH NATIONAL PUBLIC HEALTH WEEK
(p. 656) describes this process and illustrates it with the case of a refugee, aged 23 years, from Somalia who arrived in the United States in late April 2016 with her husband and three children. She experienced having to deal with two very complex health care systems, delays in obtaining health insurance, and a disconnect between the available medical treatments and her religious beliefs.
COMMUNICATION AND EDUCATION What has been the role of poor or inadequate communication in lessening the appeal of the ACA to the Americans most likely to benefit from it? Four articles deal with this issue. Sarah Gollust et al. (p. 687) found that news sources at times preferentially covered political debates about the ACA over its public health relevance. Anand Parekh
(p. 639) and AJPH associate editor Hortensia Amaro (p. 671) both stress that good communication must become a core leadership skill for public health practitioners and that these skills must be integrated into core training. AJPH associate editor Roy Grant (p. 658) offers guidelines for scientific journals to adapt to this communication challenge.
retrogression offer reassurance that our generations, like previous ones, can reverse society’s misdirection and deploy the extraordinary opportunities for progress that lie around us.” History speaks against resignation.
Alfredo Morabia, MD, PhD @AlfredoMorabia
A GLOBAL #NPHW LESSONS FROM THE SIXTIES We close this series of contributions with an upbeat note. David Himmelstein and Steffie Woolhandler (p. 660), after reviewing the potential hazards of the new Administration’s procorporate agenda, still articulate a vision for public health progress in the 21st century. Looking back at the 1950s and 1960s, they observe that “past periods of impasse and
This issue focuses on the state of public health in the United States. But the United States is not the only place in the world that is either victimized or at threat of being victimized by forms of populism that have contempt for science and that aggravate social and ethnic tensions within the population.3 Moreover, the concerted activity of world scientists in international organizations such as the International Agency for Research on Cancer is being stressed and sapped.4
We Need a Strong Environmental Protection Agency: It’s About Public Health! Public health is rooted in recognition of the environment’s role in human health and disease. From the cholera outbreaks of the 19th century and the Great Sanitary Movement to today’s global threat of climate change and the Paris Agreement, the protection of public health depends on the protection of our environment. The Environmental Protection Agency (EPA) is a public health agency and a cornerstone of our nation’s environmental public health infrastructure. The
May 2017, Vol 107, No. 5
AJPH
Therefore, on behalf of the AJPH team of editors, let me reemphasize that the AJPH mission is to closely follow the global state of public health, to place it in its historical context, and to provide the ideas and evidence that may contribute to improve it.
core mission of the EPA is the protection of public health and the environment. Former Republican president Richard Nixon established the EPA in 1970 with strong bipartisan support from Congress. Since then, guided by a framework of national laws, the EPA has led national progress in improving air quality, cleaning up our waterways, reducing harmful pesticide exposures and industrial emissions, and providing support for states and communities to advance environmental health.
THE ENVIRONMENTAL PROTECTION AGENCY’S FUTURE Today, as we move forward with the new Administration and Congress, there are troubling signs that the
REFERENCES 1. Greenberg MR. Russell E. Train: a leading environmental figure of the 1970s. Am J Public Health. 2010;100(4): 606–607. 2. Wen LS, Warren KE, Tay S, Khaldun JS, O’Neill DL, Farrow OD. Public health in the unrest: Baltimore’s preparedness and response after Freddie Gray’s death. Am J Public Health. 2015;105(10): 1957–1959. 3. Rooduijn M. Simply studying populism is no longer enough. Nature. 2016; 540(7633):317. 4. Pearce N, Blair A, Vineis P, et al. IARC monographs: 40 years of evaluating carcinogenic hazards to humans. Environ Health Perspect. 2015;123(6):507–514.
future of the EPA and the future of public health will be affected. The leader of the new Administration’s EPA transition team has recommended elimination of the EPA’s scientific research efforts and cuts in the agency’s expert staff from 15 000 to as low as 5000. In Congress, legislation (HR 861) has been introduced to terminate the EPA. It behooves all of us to sit up, take notice, and make our voices heard.
ABOUT THE AUTHORS Gina McCarthy is with the Harvard T. H. Chan School of Public Health, Boston, MA. Thomas A. Burke is with the Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Correspondence should be sent to Thomas A. Burke, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205 (e-mail: tburke@jhsph. edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This editorial was accepted February 14, 2017. doi: 10.2105/AJPH.2017.303728
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