- Public health is an important yet misunderstood concept
- Michigan lags other states in public health investment
- Michigan is less healthy than other states and faces numerous ongoing threats to health and safety
Everyone has a public policy issue they believe should be at the center of political campaigns. Jobs, schools, roads, and health care seem to be the usual contenders, but let us propose an alternative that state and local leaders should be talking about: public health.
A forthcoming report from the Citizens Research Council of Michigan looks at public health in Michigan. Much like infrastructure and public safety, public health benefits entire communities and has generally been a responsibility of state and local governments. The report finds that Michigan has failed to invest in these vital services over the last 15 years (arguably longer, but we only looked at 15 years of data), and ranks near the bottom among states in per-capita state funding for public health (again, not unlike our roads).
For a term that’s used in policy discussions fairly often, many have an incomplete understanding of what is meant by “public health” (often assuming it just means publicly financed health insurance). So just to clarify, let’s offer a definition.
Public health is the science of protecting and improving the health of people and their communities. Rather than simply treating illnesses or injuries when they occur, public health seeks to prevent them from happening in the first place. While medicine works to help people one at a time, public health works upstream to help entire populations. Moreover, public health relies on the understanding that health is not merely the absence of disease, but rather a state of complete physical, mental, and social well-being.
Average life expectancy has more than doubled since the mid-1800s (from 39 years to 79). While medical care looks to many like the obvious hero for this improvement, around 80 percent of this improvement is due instead to improvements in public health, like better nutrition and food safety, water treatment, sewage and garbage management, control of infectious diseases and immunization, injury prevention, and improved social conditions (like housing quality and education/literacy), as well as improvements in the public’s knowledge and understanding of health (e.g. the risks of smoking and benefits of healthy diet). All of these things fall under the umbrella of public health.
As the saying goes: an ounce of prevention is worth a pound of cure.
The economic (and human) cost of stopping epidemics and preventing environmental catastrophes is lower than the cost of treating diseases and cleaning up messes once they’ve occurred. Successful investment in public health requires long-term planning and broad collaboration, factors hindered by the tendency of state policymakers toward short-term thinking and partisanship. Lack of awareness among the general public regarding its importance is another important factor to consider regarding how the state invests (or doesn’t) in public health.
Contaminants like PFAS, lead, 1,4-dioxane, and cyanotoxins (from harmful algal blooms) continue to threaten drinking water safety throughout the Great Lakes State. Outbreaks of diseases like Hepatitis A (the worst in the U.S.), influenza, and measles have afflicted many Michiganders, and emerging disease threats like SARS, MERS, Ebola, and Zika, among others, provide reminders of how the public’s health can be imperiled by infectious diseases.
Emergencies, such as natural or man-made disasters or an attack with a bioterrorism agent (e.g., anthrax, smallpox, or tularemia), would require a swift public health emergency response. Public health emergency response is also sometimes necessary for tornadoes, flooding, environmental contamination, and disease outbreaks. In each case, risk can be mitigated by advanced planning.
Absent hypothetical disasters, Michigan has higher than average rates of infant mortality, smoking, and obesity. Prevalence of (and age-adjusted mortality from) multiple chronic diseases also exceed national averages. Moreover, evidence suggests that gaps in health and well-being are increasing among the state’s diverse citizenry.
Some may question if Michigan can afford to invest in public health as it struggles to fund roads and schools; given the manifest, multitudinous threats to public health facing Michigan, it seems just as reasonable to ask if Michigan can afford not to.
Here’s our stump speech: Public health is necessary for educational success and workforce performance. Additionally, successful health care reform requires a public health perspective that considers prevention, looks at the root causes of poor health, and considers why some people are healthier than others; indeed, questions of cost, access, and quality in health care are fundamentally public health concerns. Public health also helps us recognize the ways that our infrastructure is intertwined with health and safety.
Stay tuned for our upcoming report—the first in a series of reports examining public health in Michigan.