The cost of health care in the United States is nearing 20% of gross domestic product; at the same time, our life expectancy is lagging. We can do better!
The scope of public health efforts is broad. These efforts include rules for preparing foods, pharmaceutical regulation, air and water pollution control, workplace safety, smoking restrictions, and science-based vaccination policies. Further, social determinants of public health—poverty, education, and access—are essential for improving healthy life expectancy, which prevention-first strategies can enhance.
Comprehensive public health systems promote health education, monitor outbreaks, set safety standards, and organize emergency responses. The World Health Organization estimates that 60% of premature deaths from non–communicable diseases are preventable through public health interventions and reduced risk factors. More, not less, health-related research is needed.
Public health measures are not one-time interventions; they require continuing effort and continuous improvement, which in turn require societal and individual buy-in.
Although its roots in combating infectious diseases go back centuries, public health has often been considered a third-world problem. That is, until COVID-19. It reminded us that public health systems attempt to address inequities, because no matter who people are or where they live, some face worse health conditions and outcomes than others. We must improve access to care, nutrition, housing, and education.
We need accurate public health information; not the widespread circulation of misinformation and flawed health care guidance available online, sometimes generated by artificial intelligence or an unreliable source. Once deeply rooted in social networks, misinformation is difficult to overcome. Trusted information should be based on evidence from leading health organizations or from high-quality, independently reviewed research.
The medical self-help movement has democratized both access to and the creation of health knowledge. However, in some cases, it has also led to questionable practices that don’t help users.
Public health involves building and sustaining health care infrastructure. Resources such as doctors, nurses, and research findings must be accessible, which is challenging in our fragmented American health care system.
Behavior counts. Diet matters. Smoking can be deadly. Exercise and sleep are beneficial. Access to health care depends on provider incentives, locations, healthy food availability, and whether preventive services reach those in need. Investing in housing, healthy food access and assistance, and mental health care is also crucial.
A health care system that manages chronic illnesses and focuses on prevention, not just acute episodes, is inherently complex. As health actuaries know, the system must be based on four core considerations: access, choice, cost, and quality.
Acting for the common good, personal health is optimized through both personal responsibility and social guidance. When an individual’s actions can adversely affect others’ health, it is sensible for society to take action, for instance, in the case of infectious diseases, pollution, and misinformation, each of which can spread and harm others.
Globally, according to the International Labour Organization, unsafe work environments cause nearly three million deaths and 395 million injuries annually, with long working hours being a leading risk factor, followed by respiratory hazards. Workers’ compensation, Occupational Safety and Health Administration standards, and regulation of toxic substances, including asbestos, lead, vinyl chloride, and benzene, can improve health outcomes.
A healthy population is a public good that benefits society. It reflects a country’s strength and vitality. Prevention—through healthier environments, behaviors, and treatments—lowers health care costs, reduces workplace absenteeism, and minimizes economic disruptions.
When public health works well, we hardly notice it—but when it fails, the effects are swift and widespread. Since U.S. life expectancy and health care costs continue to lag behind other high-income countries, we must expand our efforts to enhance effective and safe public health measures, including those directed at establishing sustainable health care infrastructure, preventive care, and accessible, evidence-based health information.
From disease outbreaks to natural disasters, public health systems are responsible for preparedness and quick and effective response. They can be taken for granted, their value questioned when outcomes are not evident.
Recently, public health has become a political battleground. Disagreements are, of course, reasonable—but this public good should be cherished and enhanced, not politicized. Such altruistic efforts should not be turned into a political issue.
We are all affected.
SAM GUTTERMAN is chairperson of the Social Security Committee and member of the Retirement Practice Council.