Across the nation this month, public health students are graduating with high hopes and plans for improving population health. On May 1, APHA Executive Director Georges Benjamin, MD, spoke to students at the University of Pittsburgh School of Public Health in his commencement address. He talked about his path from emergency medicine physician to public health advocate and leader, and how graduates could themselves be leaders in improving health outcomes at a national level. These new public health professionals should take up the task of identifying new health threats, crafting solutions and strategies, and implementing them in people’s lives, he said.

There is an old African proverb that says, ”Until the tale of the hunt is told by the lion, the story of the hunt will always glorify the hunter.”

When I graduated from medical school, my parents had the obligatory graduation party for me. You know the one, where they invite all of their friends, so they get bragging rights. They were excited about me putting up my shingle and being a real doctor. Of course, I had to do my residency first and, since I was in the Army, they understood that I would be practicing and fulfilling my obligation to my nation first before I had my own practice.

However, I had a secret that they were not aware of: During medical school I had fallen in love with emergency medicine. My mother wasn’t sure that emergency medicine was being a real doctor.

I assured her I was a real practicing physician, but sometimes I was unsure that she was convinced. After I left the Army Medical Corps, I remained in emergency medicine. My mother continued to ask me when was I going to set up a practice and be a real doctor.

Later, as I went into administrative medicine, she remained hopeful that I would one day really practice medicine. And then I went into public health.
I knew then I had to come up with a better explanation to prove I was a real doctor. 

"Mom,” I said, “When I am in the ER and someone comes in with a rat bite, I give them the best clinical care I can. I clean the wound, put on a clean, dry dressing and give then a shot for tetanus. 

“But mom, when 10 people come into the ER with rat bites, I will be doing no one any good unless, in addition to taking care of the rat bites, I do something to get rid of the rats.” 

She got it. But she had a twinkle in her eye. And I suspect, because she was my mom, she had gotten it all along.

My journey into public health was an evolution in my understanding of my role as not only a health care professional, but as a leader in my community. I realized that if it hurt people or killed people it was mine, and that I also had a role in helping people achieve health.

Ensuring individual health is a complex process that is based on an interaction between our genetics, our environment — physical and social — and our behavior. It had also become clear to me that health was more than an insurance card and a doctor’s office.

Health was access to quality housing. Health was access to safe and affordable food. Health was about air quality, clean water, and climate change. Health was about quality education. 

If you live in a community with poor transportation systems that prevent you from getting to health care services, then your health is impeded. Where we dump our trash or build our homes in relation to environmental hazards is a health issue. 

Even having safe areas to play and exercise is important to our ability to be healthy. Rusty, glass-filled playgrounds with unsafe equipment is an impediment to effective play and well-supervised play is important for health, growth and development in kids. And stress caused by racism and discrimination, income inequality and violence plays a significant role in preventing both healthy people and healthy communities.    

It became clear to me that if I used my power as a community leader, I could have a health impact beyond what I could achieve in one-on-one relationships with my patients.  I learned I could, in fact, improve the health of tens, to hundreds, to millions of people using population health measures. For several years, I did both clinical practice and engaged in a range of activities on a population basis. While I eventually moved into public health administration full time, it was clear this was an opportunity to do both clinical practice and improve health through engaged advocacy as a community leader.

In fact, as a person entering or advancing your career in the public health, you too now have the opportunity to go beyond the provision of providing or supporting individual health services by the ones or twos to ensuring the health of populations. I believe you now have the responsibility to join me to get rid of the rats. You can do this by ensuring the conditions are there for people to be healthy in a way that is just and equitable. 

You now have a prominent role in being your neighbor’s keeper. And for those of you who believe in individual responsibility, as I do, this community duty is an important component to assisting the individual in meeting their own individual responsibility.

For example, while it is important for the individual to improve their nutrition and exercise regularly, it is very difficult to do so if the streets are not safe, or there are no stores that offer affordable fresh fruits and vegetables. As an expert you can help policymakers better understand this link.

It is difficult for our children to do their best in school, and you to do your best at work if you and they don’t have access to quality affordable health care. In the U.S. that means health insurance. You social workers can help all people achieve access to the many insurance options out there today. 

We know a lot about the basic and clinical sciences, and this is a research intense university. But if we can’t get people to wear a protective mask, receive a vaccine or take their medications as directed, then that knowledge — while wonderful for publication in the American Journal of Public Health and great for our CVs — is useless for advancing the public’s health if we cannot or will not translate it into practice. Good science is the key to advancing our society, but it must be adequately funded and used appropriately to craft sound public policy. 

For those of you going specifically into public health practice, you get to do it all. And, in addition, you have the special opportunity to provide the leadership central to assessing community needs and assuring they are met through sound policy and programs. Your family members, faculty and community leaders of all stripes can also play a role in demanding the changes to make our communities safer, healthier and more resilient.

Building the capacity for healthy communities to rapidly identify new health threats, craft solutions and effectively implement them is our task for the 21st century. We spend over $4.1 trillion in the U.S. and, as you know, we are not getting the best value for our dollar. We rank 34th among other highly developed nations in health. We spend less than 3% on public health. 

But suppose we decide to get what we pay for. Suppose for a moment we, as a nation, decided to be the healthiest nation on Earth. And imagine further, if we decide to do this in one generation. What a legacy for our children. Is that possible? Well, we had no idea how to get to the moon, but with focus and persistence we did it.

Your public health knowledge and skills are amazing, important and a remarkable achievement. But by themselves they are not sufficient to truly change the world and improve our health.  

Computer scientist Alan Kay is often quoted as saying, “The best way to predict the future is to invent it.” By focusing our efforts as a nation on the health of our communities, we can achieve a bright future in the 21st century. In other words, we have to create our future, act on it with deliberation and intent, and then tell our own story.  

I have always said the purpose of what we do as health professionals is to enable all of us to live as long as we can, as well as we can, and have a short but glorious ending. The work you do when you leave here is a key component to meeting that goal.

I welcome you all to the next phase of your lives in public health and I encourage you to work to make the well-being of our nation a top national priority. Congratulations!

Photo by John Altdorfer, courtesy University of Pittsburgh