Wednesday, November 6, 2013

APHA Opening Session


The opening session of the 141st Annual Meeting of the American Public Health Association (APHA) was keynoted on Sunday by Sir Michael Gideon Marmot, Professor of Epidemiology and Public Health at University College London, and author of "The Status Syndrome: How your social standing directly affects your health and life expectancy." He had spoken to this large public health assembly 5 years earlier and was making a reprise to demonstrate that not much progress has been made in reducing health disparities during that time frame.  

He began his talk by quoting from W.H.Auden's poem Crisis and Upheaval, written at the beginning of World War II when European countries were under siege and were waiting for some support from their allies.
In the nightmare of the dark
All the dogs of Europe bark,
And the living nations wait,
Each sequestered in its hate.

He used this quotation to make the point that the problems of disparities in the U.S. today, like the threat to Europe posed by the Nazis of the 1930s, are blatantly evident, yet policy makers and leaders in the public and private sectors are choosing not to act. He went on to highlight some of the "nightmares" that we are facing. Among OECD (organization for economic cooperation and development - "developed" countries) the U.S. has:
* the lowest life expectancy for men and second lowest for women
* the 2nd worst maternal mortality
* the 2nd highest non-communicable disease mortality
* the 4th highest infectious disease mortality
* the highest injury mortality
* and the list went on

He recognized the the need to develop sustainable programs and policies but reminded the crowd that "We don't do things because they are cost effective and cheap. We do things because they are right."  He emphasized that we must "Put fairness at the core of all policies" and stated the obvious that "Policies that don't lead to fairness are unfair."

He closed his speech with this line from Pablo Neruda:  "Rise up with me, against the organization of misery." He encouraged - he pleaded with - the crowd of several thousand to get engaged in addressing the social conditions within our society that are literally killing people. He urged all present to change the dominant narrative in our society from one that has led to the "organization of misery" to one that embraces collective societal responsibility and supports programs and policies that improve the health of all members of our communities.  

The speech by Dr. Marmot set the tone for the entire conference. The theme of disparities and health equity was evident in almost every session. It was underscored and addressed most bluntly in a session that reported on an Institute of Medicine (IOM) study (Poorer Health - Shorter Lives) that compared the health status of the US with other OECD countries. The data shared mirrored those presented by Michael Marmot. What was different was that the members of the IOM panel that carried out the analysis of the data from around the world, concluded that the health outcomes in the US are the result of "A culture that values individualism, individual freedom and survival of the most fortunate over social solidarity."  

This blunt statement reinforces the importance of the work that is being done throughout MDH to address disparities by actively engaging our community partners in developing a new  narrative about what creates health and what we need to do to "rise up against the organization of misery."  If we are truly data-driven, the disparities in our state should challenge us to do what defines public health - working with the broad community to "collectively create the conditions in which everyone has the opportunity to be healthy."


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