OU Public Health Speaker: 'We Need a New Conversation About Health'

To turn around America’s dismal health outcomes, a change in the way we talk about health and healthcare is crucial.

That was the message Tuesday from Sandro Galea, M.D., who spoke during the 2019 Hudson Fellows Symposium at the OU Hudson College of Public Health. Galea, who also holds a master’s degree and doctorate in public health, is dean of the Boston University School of Public Health. He has been called one of the “World’s Most Influential Scientific Minds” for his expertise and advocacy around changing the conversation about health.

Galea has written 18 books, including “Well: What We Need to Talk About When We Talk About Health,” which served as the basis for his presentation in Oklahoma City.

“My goal was to write a book that makes the case that we are misunderstanding our health, and that it is on all of us to understand health better, so we can educate the population about what really generates health -- because that is the only way we’re going to generate positive health,” Galea said.

The United States’ health statistics tell the story of why a change in conversation is needed. America has a higher death rate from conditions like cancer and heart disease than any other high-income country in the world. The paradox is that the United States spends more on healthcare services than any other high-income country, yet people largely accept this inconsistency with a shrug, Galea said.

However, America has not always had such poor health. In 1980, the country was in the top half of health worldwide. Since then, health outcomes have plummeted to the bottom.
“Insofar as our health is worse than it is in all other high-income countries, this is something that we have brought on ourselves in the past 40 years,” Galea said. “We are the country that has been lagging; other countries have been passing us by.”

Galea made several recommendations to begin shifting the dialogue about health:

• Health is not healthcare. People use the terms interchangeably, Galea said, but they are not the same. A person may die of a disease, but it isn’t just the disease that takes the life; it’s also forces like poverty, domestic violence, racism, poor access to care and homelessness. “Healthcare – medicine – is critical … but if we want a healthier country, we have to invest in what makes people healthy,” he said. “It’s as simple as that.”
• Health emerges over a life lived. People tend to think of health as a person visiting a doctor asking for help with a specific problem. That problem can be addressed, but the patient is actually there because of the sum of their life lived and the experiences they have had. “Once we understand that, we realize that we’re never going to emerge from our health rut as a country unless we invest in structures that keep people healthy throughout their entire life,” he said.
• Power, politics and money are health. The number of people killed by guns in the United States is more than the number of American soldiers who have died in war since Vietnam. More children are killed by guns in the United States than die of cancer. “We are in a place in this country where we cannot have this conversation,” Galea said. “The gun discussion, which is ultimately a health discussion, cannot be had in this country without reckoning with the political forces and the forces of power that shape this conversation.”
• There is no health for the many if we exclude the few. America is a charitable country – philanthropic giving dwarfs that of other counties. However, Galea said, charity exists because systems and structures exclude so many people. That reality is tolerated because “while we may care for them, they’re over there and don’t affect us.” That’s simply not the case. For example, he said, when people decide not to vaccinate their children, other children face a higher risk of disease. “Our health is inextricably linked,” he said. “If we want our health to be better, we have no choice but to care about the health of all of us. It’s a pragmatic point – I want my health to be better; therefore, I have to care about your health.”
• Compassion, rather than empathy, has to be at the heart of health. “Compassion says, ‘What is causing the suffering to begin with so that we can fix it?’ The absence of compassion is where we are not able to recognize that there is a shared humanity that should transcend what we do. Health is a universal value that matters to all of us.”