four people on stagePhiladelphia’s own Ben Franklin said “an ounce of prevention is worth a pound of cure.” So, it was especially fitting to ask thousands of public health professionals gathered in the City of Brotherly Love if this axiom still holds true.

Last night at APHA’s 2019 Annual Meeting and Expo, Brett Giroir, assistant secretary for health at the U.S. Department of Health and Human Services, kicked off the Monday General Session — titled “Is an Ounce of Prevention Really Worth a Pound of Cure?” — by reporting that his office has been “driven, perhaps a little obsessed” with helping improve the health of Americans.

“I am here with you because I can no longer accept a health care system that costs too much and delivers too little,” Giroir told attendees. “For $3.6 trillion — nearly 18% of our (gross national product) — we deserve more than a life expectancy that ranks 28th, infant mortality that ranks 32nd, a suicide rate that ranks 33rd and health disparities that have had near zero improvement in the last 25 years.”

Brett GiroirGiroir said HHS is working on multiple projects to transform the U.S. “sick care” system into a “health promoting” system that provides everyone a fair and realistic opportunity to optimize their health. His team is working on an evidence-based road map for the nation’s health. This includes updated physical activity guidelines released last year, Healthy People 2030 (now in draft), new dietary guidelines that will be completed in 2020, and national plans on vaccines, viral hepatitis and HIV/AIDS. In addition, HHS plans to release the first federal action plan for sexually transmitted infections next year.

While prevention is the centerpiece of public health practice, we all know it’s still undervalued in many circles. Following Giroir, a four-person panel — moderated by Karen DeSalvo, former U.S. assistant secretary for health under President Barack Obama and now Google’s first chief health officer — discussed whether prevention remains a “best buy.”

Health services investigator Aaron Carroll, pediatrics professor at Indiana University, challenged the very notion that being a “best buy” is necessary.

“We have not done an adequate job in selling public health and selling what prevention can actually get us,” he said. “Even in [this panel] we’re trying to focus on: What is the return? How much economic benefit will we see in terms of doing these things?”

There’s this sense that prevention must come with cost savings, he said. Yet, no one ever expects good health care treatment to save money. That double standard leads the general public and policymakers to think public health can be done “on the cheap,” he told the audience.

“There’s not this general appreciation that public health and prevention can be an incredibly good thing, but it’s an outcomes good,” Carroll said. “It’s how much healthier we will be, it’s how much more productive people will be, it’s how much better lives people will have if we manage to prevent bad things from happening.

“We have to start recognizing that…prevention is an outcomes good, and that sometimes good things cost money,” he continued. “And we have to start making the pitch that there needs to be serious investment into these things, that they can’t just be done easy and quick and cheap.”

However, Stuart Butler, a senior fellow in economic studies at the Brookings Institution, said we shouldn’t understate the importance of a return on investment.

“That’s unfortunately what you have to do with policymakers to get their attention, to get them thinking about this,” he told session attendees. “Then you can move forward.”

Still, it’s a bit of a trap, Carroll said: “If I save a child’s life, it’s phenomenal, but they’re going to live the rest of their life and cost us all a fortune in terms of health care and services, and that’s fine. I think we all agree that that’s amazingly great.”

Karen DeSalvoTo wrap up the panel discussion, DeSalvo asked the speakers: If you could be “benevolent dictator” of the world for a day, what public health issue you would address?

Butler said he would break up the silos among various organizations, departments and agencies so they could work together on common goals.

“Look at how you can build the trust within a community and get the benefit and experience within the community — the buy-in — and make these things happen,” he said. “It really does take a village to get prevention.”

J. Nadine Gracia, executive vice president and chief operating officer at Trust for America’s Health, pointed out that 2019 is the 400th anniversary of the first enslaved Africans being brought to the U.S. At a recent event at the National Museum of African American History and Culture, Gracia was inspired by a speaker who said that to be able to create the systems and structures where everyone has a fair and just opportunity to reach their full potential for health, we first have to understand the architecture that built it.

If Gracia could make that happen, it would “truly transform and create healthy communities,” she said.

Delaware Secretary of Health Kara Odom Walker said she would focus on children and youth.

“If we could talk about childhood poverty in a way that influences education, the family unit and other opportunities upstream, that’s an important place to start,” she told the audience.

Carroll used the question to circle back to his remarks on public health investment: “I’m going to stick to my guns: I’d invest. We need moonshots for public health, not just for cancer.”

Photos by Jim Ezell, courtesy EZ Event Photography