Healthy Living

Perhaps it’s for the best that we really can’t grasp the enormity of the recent disasters in Myanmar and China. Our emotional capacity just doesn’t extend to the pain of tragic loss, tens of thousands of times over. If it did, we would all certainly be undone by the hundred-thousand or more lost to a cyclone and its aftermath in Myanmar, and perhaps as many killed by an earthquake in China. As it is, most of us are just going about our lives as before.
 
The news media understand this well. The emotional impact of “100,000 dead” doesn’t compare to a single, poignant human-interest story. So inevitably, our heartstrings are tugged by tales of personal struggle. Our emotions are far more responsive to a single pair of soulful eyes, the face of one bereaved parent, than to statistically anonymous masses lost to a cataclysm.
 
There is, quite simply, something rather numbing about huge numbers. It’s hard to see a face through the statistics.
 
This is a problem for the public health because it is all about populations, large numbers of people, statistics, and anonymity. I know the name and face of every individual patient I have ever tended. But there is no name or face for the public.
 
So public health doesn’t tend to get a whole lot of respect. I have never visited a public health department (in the U.S.) that didn’t look a bit shoddy and neglected, and I have visited many. Health directors and commissioners are generally too busy working to complain, but when asked they will acknowledge that they are perennially under-funded and short-staffed.
 
Only about 1% of the health care expenditure in the United States is for public health; all the rest is for individually oriented medical care. But of the 35 or more years of increased average life expectancy gained over the past century, more than 30 are due to public health advances, such as housing and sanitation, immunization programs, food safety programs, workplace safety programs, and so on.
 
That emotions and basic human reactions determine our responses to tragic news is just the way things are. But that the same emotional reactions seem to dictate policies related to public health is not necessarily the way things should be. In fact, the result can be downright irrational.
 
We are unwilling, for example, to neglect the victim of a tragic accident, or terrible disease, because they lack health insurance. Care is provided in an emergency to everyone. But until the emergency occurs, that same individual is simply part of an anonymous population of uninsured people. They are a lot easier to neglect. So this group tends to miss out on routine and preventive care. Getting some attention requires a name, a face, and a crisis.
 
Health insurance coverage for treatment is, in general, much more of a sure thing than coverage for preventive services, such as cancer screening. Preventive services are directed to populations, not an individual with an urgent need.
 
When a child develops type 2 diabetes, he is invariably treated. Who could argue with that? But we allocate minimal resources to ensure that children get the nutrition and physical activity that would help protect them from this threat in the first place.
 
Imagine for a moment an effort to determine how best to prevent the most suffering over the next year, or ten years, or more. We might find, and I think we would, that some shift in our resource allocations from acute care to public health programs would reduce the population burden of disease, premature death, and misery.
 
But any such exercise is unlikely for the very reason that the calculated benefits would pertain to a population, not a person.
 
The ability to see individual faces that make up a large crowd is not a new challenge. It was that very issue the preacher John Donne was addressing when he admonished his congregation to “never send to know for whom the bell tolls; it tolls for thee.” Enough of us, viewed from a distance, or summarized in a statistic on a spreadsheet, look like an anonymous mass. But behind that veil of anonymity are countless tales of personal triumph and disaster, laughter, sorrow, love, and loss.
 
That our personal emotions are somewhat shielded from the enormity of population-level tragedy is a survival mechanism, and thank goodness for it. That our policies and respect for public health seem similarly shielded is a shame, if not a tragedy itself.  The anonymous lives we might save, and the suffering we might alleviate, through more thoughtful allocation of resources to advance the public health are actually about real people, just like you and me. We simply haven’t seen their faces yet.



More Ways to Live a Full and Healthy Life
14 Ways to Feel Happy You're Alive
Build a Better Relationship With Your Doctor
Discover How Love Keeps You Healthy