Some days, it can be hard to stay optimistic.

Whether it’s climate change, vaping, gun violence, opioid addiction or vaccine refusal, our communities face a number of grave health challenges that threaten to roll back historic achievements in public health. But, today, at the official kick-off of APHA’s 2019 Annual Meeting and Expo, the prevailing message was one of hope.

Robert Redfield at lectern“These are perilous times,” Georges Benjamin, APHA’s executive director, told thousands of attendees at the meeting’s Opening General Session in Philadelphia. “We must redouble our efforts, do the research, translate science into practice and expand our grassroots advocacy to engage local leaders, build trust and change both the hearts and the minds in the vast middle…We have to be both ferocious and tenacious.” 

Benjamin and his fellow opening speakers zeroed in on the core pillars of public health that have guided the field through more than a century of health improvements and are reflected in APHA’s tagline — For science. For action. For health. — and in this year’s Annual Meeting theme. Here in Pennsylvania, for example, health workers have led a number of evidence-based efforts to reduce the toll of opioid addiction, which took the lives of nearly 4,500 Pennsylvanians in 2018. 

Opening session speaker Rachel Levine, the commonwealth’s secretary of health, said the state’s opioid strategy is rooted in three core tenets: prevention, rescue and treatment. Work includes: an opioid stewardship program that’s reduced prescribing by 30% in three years; the distribution of thousands of free naloxone kits that helped reduce overdose deaths by 18% between 2017 and 2018; and helping those struggling with addiction access medication-assisted treatment programs. 

Levine said state health workers are also working with policymakers to legalize harm reduction strategies such as needle exchanges, which could help prevent infections that often accompany spikes in addiction, such as HIV and hepatitis A. 

“You all stand on the front lines to make our communities stronger and healthier,” she told the opening session audience.

Robert Redfield, director of the Centers for Disease Control and Prevention, also spoke about the nation’s opioid epidemic, which killed 70,000 Americans in 2017. (That’s more than the number of U.S. soldiers who died in the Vietnam War, he noted.) Redfield said he didn’t fully understand the power of addiction and the stigma that comes with it until one of his own children nearly died in a drug overdose.

“We need to recognize (addiction) for what it is,” he told the opening session audience. “A chronic, relapsing medical condition and not a moral failing.”

Redfield said he’s focused on four major priorities in his role as CDC director: ending epidemics, eliminating disease, investing in global health security and domestic preparedness, and shoring up investments in the core capabilities of public health. For example, he said public health needs “world-class” data and analytics so practitioners can more quickly detect outbreaks and predict future threats.

He also stressed that “social determinants of health matter.” For example, he said the U.S. Department of Health and Human Services’ new plan to end HIV transmission by 2030, released earlier this year, must prioritize the social conditions that exacerbate HIV risk, such as homelessness and addiction.

Sandro Galea at lecternWhile the current challenges facing public health are formidable, Redfield said it’s also an exciting time for the field, citing efforts to shift the nation’s health system from one focused on treatment to a system grounded in prevention.

“Be disruptively innovative,” he urged the audience.

The session’s keynote speaker, Sandro Galea, dean of the Boston University School of Public Health, also opened with a message of hope — “Our health really has never been better than it is now,” he told the audience. Today, the world has less poverty, fewer struggle with hunger, more kids are going to school and global life expectancy is on the upswing.

“We are indeed living in a healthier world than ever before, but as you know, that’s not the full story,” he said.

While many of our health indicators are promising, many others are not. For example, Galea noted that U.S. life expectancy has dropped for the last three years in a row — a first since the 1918 global flu pandemic — and the country experiences far more preventable deaths than other high-income nations. The reason, he said: social determinants. Too many in the U.S. live in unsafe, dilapidated neighborhoods, lack affordable housing, don’t have access to parks and healthy foods, and can’t get quality early childhood education.

Another core determinant shaping poor health and inequity? Racism — “one of the country’s original sins,” Galea said.

The paradox is that while the U.S. has invested heavily in medical technology and innovation, many low-cost public health interventions can save just as many lives — sometimes, many more. The key, Galea said, is to take action on all we know about the social and economic conditions that afford better health and longevity.

“Is there hope? Yes,” he told the audience. “I’d argue hope is all around us.”

But, he said there are three main forces in our way: politics, the science and the story. On politics, polarization has colored how we see science; on science, much of the focus has drifted from population health to individual health; and on the story, many of the narratives about health focus on medicine instead of public health.

Annual Meeting attendees listening to speakerFortunately, Galea also offered the audience three solutions: demand health, make the case for prevention, and tell the story of the public’s health.

“We need nothing less than a world that generates health,” Galea said. “That’s what we need, that’s public health and that is the story that we must tell. Because if we do not tell the story, who else will?”

Above from top to bottom: CDC Director Robert Redfield, keynote speaker and public health dean Sandro Galea and some audience members at the APHA Annual Meeting Opening General Session. (Photos by Jim Ezell, courtesy EZ Event Photography)

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