portrait of Dean Klag

Open Mike: 10 Truths for Trump

Evidence-based advice on public health for the new administration

A Note from Dean Michael J. Klag, MD, MPH ’87

No matter your political stripe or which box you ticked in the presidential election, evidence-based public health truths should not be ignored. In this era of deep political divides and polarized opinions, we should let evidence, not politics, direct actions to benefit everyone in our country.

The health of societies is the responsibility of political leaders as well as individuals. Populations thrive and health abounds when governments and individuals fulfill their responsibilities. Individuals need to take responsibility for their own health and governments need to provide the infrastructure, environment, biomedical research and health care system that help people maintain their health.

Inequities are poisonous and lead to resentment, unrest and poor health outcomes. Poverty is a potent risk factor for illness, and addressing poverty is essential to bringing the country together. Reducing inequities is not only the moral thing to do, it makes good political sense. Resentment is perhaps more likely today than ever because of the ubiquity of modern media—especially social media—that makes disparities more evident.

Health, the environment and economic disparities are intertwined. Exposures from air, food and water affect health in ways we are still discovering. Air pollution, for example, has been associated with increased risk of autism in several studies. Impoverished communities—often communities of color like Flint, Michigan—are much more likely to experience toxic environmental exposures. Such disparate exposures lead to inequities in health.

Access to quality health care is a human right. In almost every country except the United States, provision of quality care to prevent and treat disease is seen as a basic human right. The need for access to health care is even greater now that noncommunicable diseases are responsible for almost two-thirds of deaths around the world. Watching a child or a family member die from a condition that is preventable or curable is no longer acceptable.

Health care costs in the U.S. must be contained. At 18 percent of GDP, U.S. health care costs are the highest in the world yet deliver only middling health outcomes. Controlling costs is important to ensure that future resources are available to invest in innovation, infrastructure and other drivers of economic growth. A major challenge: Cost containment has to occur while also improving health outcomes and enhancing patient experience, including satisfaction and quality. It’s not an easy task, but the federal government should continue to incentivize primary care and change payment systems to achieve this goal. It’s also essential to address the escalating costs of prescription drugs.

photo of a cityscape scorched by drought on one side and green and bright on the other

The current health care system is inefficient. The administrative burden imposed by our complex fee-for-service health care system with its many payers creates cost without creating value. Although it may be politically untenable to move to a single-payer system, the current system can be simplified. Moreover, fee-for-service is a potent incentive for providers to deliver more health care and use more resources, whether or not it improves outcomes.

Violence is a public health issue. It results from public policies that increase racial inequalities, promote mass incarceration and facilitate illegal access to firearms. “Law and order” crackdowns exacerbate these problems. Policies like requiring licenses to purchase handguns and the use of community-health interventions—based on the same principles used to curb infectious disease outbreaks—can reduce shootings and promote social justice.

Vaccines save lives and do not cause autism. Vaccines prevent disease and save lives as well as money. The claim that vaccines cause autism has been thoroughly debunked. Promoting this myth hurts our children and robs them of a healthy future.

Global health is our health. We keep learning this lesson over and over again. From HIV/AIDS to SARS, Ebola and Zika, outbreaks in today’s modern world rarely stay localized. Investments in global health and surveillance can protect health in the U.S. Although some may be reluctant to spend resources to keep other countries safe, it is in America’s best interest to do so.

Climate change must be addressed. The scientific evidence is undeniable, and its effects are already being felt in extreme weather events, melting of glaciers and rising sea levels. The health effects will be myriad—from a broader distribution of insects that cause disease to the loss of crops and famine. Climate change presents a clear and present risk to our national security. Ignoring the facts won’t help. As has been pointed out many times, the window of opportunity for action is closing fast.

These truths are based on hard-won evidence. We, as a society, have to decide whether we build on this knowledge or cast it aside. I would argue that President Trump and government leaders across the country should act, based on the evidence, to improve the health of everyone, no matter their political affiliation, ethnicity, race, religion or income.

Let’s put these truths to use for the benefit of all.