Public health is due for an upgrade. That was one take-away of a recent lecture from a 20-plus year veteran of the field, Dr. Anne Schuchat, the principal deputy director for the Centers for Disease Control and Prevention. Public health 3.0 is what the Department of Health and Human Services has named its recent call to action to close significant health gaps - through collaboration across sectors to address systemic issues. Schuchat visited the University of Rochester Medical Center recently to talk about the past, present and future of public health, as part of the university’s Center for Community Health annual lecture series.
Schuchat reflected on the history of public health, dating back to the start of the 20th century. She pointed out that progress made over the last century has essentially increased average lifespan by 30 years.
She asked the audience to consider, “What did it take to get any one of these interventions through from idea to reality? And what can we make a huge impact on in this century?” It’s going to take concerted effort, she says, to keep moving forward. “Sometimes it seems that the progress of this century is going to be all about protecting the gains of the last century.”
The real challenge in public health, she says, is not a lack of advanced medicine, but actually implementing scientific breakthroughs and interventions.
Side Effects Public Media’s Karen Shakerdge sat down with Schuchat to debrief after the talk.
This interview has been lightly edited for clarity.
Shakerdge: In your talk you were discussing public health interventions and you said 'we can't leave successful tools on the shelf,' what did you mean by that?
Schuchat: I think often in research we think the result is the end - but that breakthrough, whether it's a drug or a vaccine or a just a strategy is only as good as the people that it reaches. So very much about public health is about making sure that intervention gets [out] not just out to the people that are nearby, but really to the last mile, to the folks that are perhaps disenfranchised or who have the highest burden of disease. In public health, we really do try to make sure the whole population is improving.
Shakerdge: Are there interventions that you think could be implemented more?
Schuchat: You know one of the biggest factors leading to deaths in the United States is high blood pressure. And it's pretty amazing that only about half of the people that have high blood pressure have it under control because we have many effective medicines. They're very inexpensive and it's not that hard to control blood pressure. But it means that we have to be much more attentive to recognizing who has it, getting them in care - and for all those people in care who have high blood pressure - to get them on a regimen they can stick with and achieve good control. It's not rocket science to do it but it takes attention and care and collaboration.
Shakerdge: Another thing you said was something like, ‘this decade may be about protecting the progress of the last decade.’ What did you mean by that?
Schuchat: We have extended life expectancy-- we have improved health in many ways, but we have a lot of threats. [For example,] we rely on antibiotics to treat infections, but more and more infections are becoming resistant to almost all the drugs we have and the medicine cabinet is getting empty. So we really have to use antibiotics much more carefully and control infections – hand-washing and infection control practices in the hospital and health care system – so that we can keep those drugs working for the long haul.
Shakerdge: I saw that recently $14 million was put toward antibiotic resistance.
Schuchat: There's been a great increase in attention and even resources for antimicrobial resistance. So across the government, there are more and more programs being supported. There's support for state and local health departments. There's support for research. There are increased dollars both going to practice as well as prevention research centers to really understand the next level of strategies that will work.
Shakerdge: To me, it seems like that is such a massive thing to try and shift. How do you do that?
Schuchat: Sometimes we think it's impossible to change practice - whether it's consumer practice - or clinician practice but we've made progress. So in the 1990s we started attending to appropriate antibiotic use in pediatrics because a lot of kids were getting antibiotics for the common cold. And we did see practice change but now we really need to attend to it in the health system both in the hospital and out of the hospital - for many conditions, even urinary tract infections. So we've got to get the right drug used at the right time for the right duration for the right purposes. We can't just take drugs for granted.
Shakerdge: With all the issues with getting Zika funding passed and you now finally have the $1 billion. How do you use that money? How does this work moving forward?
Schuchat: This is really a marathon. It's a new problem to have a mosquito-born virus that can cause birth defects. We have so much more to learn - to understand what happens to the babies who are born after Zika infection in pregnancy. To follow them for a couple years and see if they develop normally. We still have vector control or mosquito control challenges and we don't know how long this will be a problem for. Will it be multiple mosquito seasons or will everybody get infected and become immune? Work on a vaccine is going to take several years and so in public health and in the health care system, in affected states, we're really viewing it as a marathon. And we know even if your state, here in New York, is not one that has the mosquito vector, you still have travelers coming back everyday from areas where Zika is spreading. It's a common problem that we need to address.
Side Effects Public Media is a health reporting collaborative based at WFYI in Indianapolis. Karen Shakerdge can be reached at 585-258-0246 or kshakerdge@wxxi.org. Follow her on Twitter: @karenshakerdge.
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