Medicine
While this blog takes every opportunity to champion the essential role of family physicians in reforming our broken health system, I readily admit that the ability of primary care to affect the most important health problems in the U.S. pales in comparison to the impact of public policies. Restricting tobacco advertisements, raising cigarette taxes, and banning smoking in public places has done more for the health of Americans than thousands of clinicians advising their patients to quit. Laws that encourage the construction of sidewalks, parks, and supermarkets in low-income neighborhoods are more effective at increasing physical activity and healthful eating than armies of dedicated health counselors. Reducing highway speed limits and enacting seat belt and bicycle helmet laws has saved far more lives than injury prevention counseling from thousands of well-meaning pediatricians.
Why is it, then, that so much of our national conversation on improving health has focused on health care rather than public health measures? Why are we captivated by the interaction between a single clinician and his or her patient (the inviolate "doctor-patient relationship") rather than overwhelming evidence about interventions that could better the health of communities? The answer is that statistics are, by themselves, underwhelming. Most people are moved to action by anecdotes, a fact that politicians know very well. This is why there are always a few "special guests" sitting with the First Lady at every State of the Union Address for the President to use as props, and why speaker after speaker at February's health reform summit began their long-winded addresses with stories about individual citizens whose lives would be (depending on their political perspective) improved or worsened by the proposed legislation.
Dr. Alfred Somner, former dean of the Johns Hopkins Bloomberg School of Public Health, calls this the "girl in the well" phenomenon:
The world will watch with bated breath through a four-day rescue ordeal, while at the same time hundreds of millions of people go to bed hungry each night ... We accept the problems of the masses as just so much background noise; but it is background noise that causes immense, entirely unnecessary misery the world over and contributes in our own country to spiraling health-care costs.
For primary care to be most effective at improving health, it must work hand-in-hand with public health departments and community organizations, which themselves must be adequately resourced and funded. A case in point: the Communities Putting Prevention to Work Initiative, launched by the U.S. Department of Health and Human Services last September to target physical inactivity, nutrition, obesity, and smoking, takes the critical step of looking beyond the girl in the well, and in doing so, promises to make the one-on-one work of family doctors just a little bit easier.
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Disclosure: I am employed by the U.S. Department of Health and Human Services.
- Economics And Disease Prevention
In a brief, less than 3-page commentary in the February 4, 2009 JAMA, (“A closer look at the economic argument for disease prevention”),[1] Steven Woolf systematically, succinctly, and thoroughly addresses the breadth of issues surrounding assessment...
- Everything But The Kitchen Sink In Public Health
The buzzwords many use in medicine today are "personalized," "individualized," or "targeted." Rather than doctors prescribing tests or treatments that work in most people but might not work for you, proponents argue, we should tailor medical interventions...
- Changing Unhealthy Habits Requires Changing Environments
New York City Mayor Michael Bloomberg's recent proposal to ban sales of sugary beverages larger than 16 ounces has encountered opposition not only from soda manufacturers, but many others who are skeptical that such a ban would make any difference...
- What Soft Drinks And Cigarettes Have In Common
Judging by the outrage sparked by the American Academy of Family Physicians' agreement with Coca-Cola to produce patient education materials about obesity, and the respected ScienceBlogs website's brief flirtation with a nutrition blog sponsored...
- The Doctor Will "tweet" You Now
There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist...
Medicine
The Girl in the Well
While this blog takes every opportunity to champion the essential role of family physicians in reforming our broken health system, I readily admit that the ability of primary care to affect the most important health problems in the U.S. pales in comparison to the impact of public policies. Restricting tobacco advertisements, raising cigarette taxes, and banning smoking in public places has done more for the health of Americans than thousands of clinicians advising their patients to quit. Laws that encourage the construction of sidewalks, parks, and supermarkets in low-income neighborhoods are more effective at increasing physical activity and healthful eating than armies of dedicated health counselors. Reducing highway speed limits and enacting seat belt and bicycle helmet laws has saved far more lives than injury prevention counseling from thousands of well-meaning pediatricians.
Why is it, then, that so much of our national conversation on improving health has focused on health care rather than public health measures? Why are we captivated by the interaction between a single clinician and his or her patient (the inviolate "doctor-patient relationship") rather than overwhelming evidence about interventions that could better the health of communities? The answer is that statistics are, by themselves, underwhelming. Most people are moved to action by anecdotes, a fact that politicians know very well. This is why there are always a few "special guests" sitting with the First Lady at every State of the Union Address for the President to use as props, and why speaker after speaker at February's health reform summit began their long-winded addresses with stories about individual citizens whose lives would be (depending on their political perspective) improved or worsened by the proposed legislation.
Dr. Alfred Somner, former dean of the Johns Hopkins Bloomberg School of Public Health, calls this the "girl in the well" phenomenon:
The world will watch with bated breath through a four-day rescue ordeal, while at the same time hundreds of millions of people go to bed hungry each night ... We accept the problems of the masses as just so much background noise; but it is background noise that causes immense, entirely unnecessary misery the world over and contributes in our own country to spiraling health-care costs.
For primary care to be most effective at improving health, it must work hand-in-hand with public health departments and community organizations, which themselves must be adequately resourced and funded. A case in point: the Communities Putting Prevention to Work Initiative, launched by the U.S. Department of Health and Human Services last September to target physical inactivity, nutrition, obesity, and smoking, takes the critical step of looking beyond the girl in the well, and in doing so, promises to make the one-on-one work of family doctors just a little bit easier.
**
Disclosure: I am employed by the U.S. Department of Health and Human Services.
- Economics And Disease Prevention
In a brief, less than 3-page commentary in the February 4, 2009 JAMA, (“A closer look at the economic argument for disease prevention”),[1] Steven Woolf systematically, succinctly, and thoroughly addresses the breadth of issues surrounding assessment...
- Everything But The Kitchen Sink In Public Health
The buzzwords many use in medicine today are "personalized," "individualized," or "targeted." Rather than doctors prescribing tests or treatments that work in most people but might not work for you, proponents argue, we should tailor medical interventions...
- Changing Unhealthy Habits Requires Changing Environments
New York City Mayor Michael Bloomberg's recent proposal to ban sales of sugary beverages larger than 16 ounces has encountered opposition not only from soda manufacturers, but many others who are skeptical that such a ban would make any difference...
- What Soft Drinks And Cigarettes Have In Common
Judging by the outrage sparked by the American Academy of Family Physicians' agreement with Coca-Cola to produce patient education materials about obesity, and the respected ScienceBlogs website's brief flirtation with a nutrition blog sponsored...
- The Doctor Will "tweet" You Now
There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist...