‘Peo­ple need con­vinc­ing there’s some­thing you can do about cli­mate change’

Modern Healthcare - - Q & A -

Since 2002, Dr. Ge­orges Benjamin has served as ex­ec­u­tive di­rec­tor of the Amer­i­can Pub­lic Health As­so­ci­a­tion. An in­ternist, he pre­vi­ously served as sec­re­tary of the Mary­land Depart­ment of Health and Men­tal Hy­giene. Be­fore that, he served as chief of emer­gency medicine at Wal­ter Reed Army Med­i­cal Cen­ter.

Benjamin has made the Mod­ern Health­care list of the 100 Most In­flu­en­tial Peo­ple in Health­care nine times, the list of the 50 Most In­flu­en­tial Physi­cian Ex­ec­u­tives and Lead­ers six times, and the list of the Top 25 Mi­nor­ity Ex­ec­u­tives in Health­care twice. His as­so­ci­a­tion is host­ing its an­nual meet­ing Oct. 31 through Nov. 4 in Chicago. Mod­ern Health­care reporter An­dis Robeznieks re­cently spoke with Benjamin about so­cial de­ter­mi­nants of health and his or­ga­ni­za­tion’s ap­proach to re­duc­ing gun vi­o­lence and ad­dress­ing cli­mate change. This is an edited tran­script.

MH: What has you the most ex­cited about this year’s APHA an­nual meet­ing?

Benjamin: The theme is get­ting lots of peo­ple to think about their role in health, even though they may not pri­mar­ily do health or health­care. That in­cludes the peo­ple who pick up your trash ev­ery day and the peo­ple who check your wa­ter sys­tem. We’re go­ing to be talk­ing about a range of ac­tiv­i­ties, in­clud­ing mak­ing sure you get health in­sur­ance.

One of our open­ing ses­sion speak­ers is Ed Be­g­ley, a well-known ad­vo­cate on cli­mate change. We also will have Free­man Hrabowski, pres­i­dent of the Univer­sity of Mary­land at Bal­ti­more County, a strong ad­vo­cate of ed­u­ca­tion, par­tic­u­larly for mi­nori­ties, in sci­ence and tech­nol­ogy. We’ll also have the health of­fi­cers from Chicago, the city of Bal­ti­more, and St. Louis County. All of those three ur­ban set­tings have had sig­nif­i­cant is­sues around vi­o­lence and poverty.

MH: What are so­cial de­ter­mi­nants of health and what is your or­ga­ni­za­tion do­ing in that area?

Benjamin: I trained in in­ter­nal medicine, but most of my time I prac­ticed emer­gency medicine. So I was al­ways fix­ing in­juries. But only 10% of what ac­tu­ally makes us healthy is based on the work that I used to do. The things that make you healthy are whether you ex­er­cise, what you eat, and whether you have ac­cess to af­ford­able, safe foods. Your doc­tor may say you need to go out and ex­er­cise more, and that’s a great pre­scrip­tion. But if you’re in a com­mu­nity with no side­walks and where it’s not safe to walk at night, you’re not go­ing to be able to walk. So the ab­sence of the abil­ity to walk safely is a so­cial de­ter­mi­nant that in­flu­ences your health.

Let’s say I tell you to eat a healthy meal. But if you live in a com­mu­nity with­out any gro­cery stores, it’s pretty dif­fi­cult for you to make safe and af­ford­able meals for your fam­ily. If you live in a com­mu­nity where, trag­i­cally, there are no health­care providers, and the trans­porta­tion sys­tems aren’t well-de­vel­oped so you can’t get to a physi­cian eas­ily, when you fall and in­jure your­self, you’re much more likely not to do well be­cause of the dis­tance you have to com­mute to get to that health­care provider. Those are things that have a much greater in­flu­ence on whether or not we’re go­ing to be healthy than many other things.

MH: What is your or­ga­ni­za­tion’s ap­proach to re­duc­ing gun vi­o­lence?

Benjamin: We know through mul­ti­dis­ci­plinary col­lab­o­ra­tion you can re­duce the like­li­hood of be­ing in­jured or killed with your firearms. It’s not about tak­ing firearms away, specif­i­cally. It’s about look­ing at the data and find­ing ways to make the firearms safer and make the com­mu­nity safer for peo­ple with their firearms.

We’ve been very suc­cess­ful in bring­ing down death and dis­abil­ity from cars. We made cars much safer with airbags, seat belts and laws against driv­ing while in­tox­i­cated. Through com­mu­nity ac­tion, we set up sys­tems where bars could help you get a ride home, and we pro­moted the idea of a des­ig­nated driver.

To­day, we’re work­ing on tex­ting and driv­ing. We’ve also made the roads them­selves safer. We changed the way peo­ple be­haved and the en­vi­ron­ment so that it was much safer. We can do the ex­act same thing for firearms.

“Cli­mate change will dra­mat­i­cally af­fect our health in a va­ri­ety of ways.”

MH: What is your or­ga­ni­za­tion do­ing on the is­sues of men­tal health and opi­oid abuse?

Benjamin: We’re very con­cerned about peo­ple who are de­pressed and we are con­cerned about sub­stance abuse. Be­cause physi­cians don’t pre­scribe opi­ates as well as they ought to, we have more peo­ple be­com­ing ad­dicted to opi­oid drugs.

We all have medicines we don’t use. We don’t clean our medicine cab­i­nets of­ten enough to get rid of them. At the meet­ing, we’re go­ing to talk about how you get rid of those medicines safely so they don’t end up in the hands of kids. Peo­ple can get ad­dicted, and some­times that serves as the gate­way for more se­ri­ous drug ad­dic­tion. So we’re talk­ing about ways we can in­ter­rupt that path­way so that peo­ple can be safer.

MH: What about cli­mate change as a pub­lic health is­sue?

Benjamin: Cli­mate change is a big one for us. Cli­mate change will dra­mat­i­cally af­fect our health in a va­ri­ety of ways. No. 1, more in­tense, se­vere and fre­quent in­tense storms put us at sig­nif­i­cant risk. We also know that as the world warms up, we’re much more likely to see things like dengue fever or malaria be­cause the ecosys­tem changes. And we have to be very con­cerned about the loss of in­fras­truc­ture in storms. We’ve seen tor­na­does go through com­mu­ni­ties, and you lose a hospi­tal. That health in­fras­truc­ture isn’t easy to re­place.

We know that cli­mate change is man­made, and there are some things that we can do to re­duce it and re­verse it.

MH: Are there peo­ple who still need con­vinc­ing in the pub­lic health com­mu­nity?

Benjamin: There are peo­ple who need con­vinc­ing that there’s some­thing you can do about cli­mate change. When you’re wor­ry­ing about mak­ing sure that all the kids in your com­mu­nity get vac­ci­nated, that the wa­ter is safe to drink, that your res­tau­rants are safe to serve food to pa­trons, and you have a lim­ited bud­get, try­ing to get this is­sue of cli­mate change on your agenda some­times is a lit­tle tougher. One of the things we will be do­ing is get­ting peo­ple more en­gaged. I think the so­lu­tion is giv­ing peo­ple ac­tion steps that they can do to make a dif­fer­ence.

MH: What are im­por­tant pub­lic health is­sues that haven’t ap­peared on peo­ple’s radar screens?

Benjamin: We’ve got pre­scrip­tion drug costs. It’s great that the Af­ford­able Care Act is there, but we still have peo­ple who want to cut the pub­lic health and preven­tion dol­lars in the law.

We’ll be talk­ing about ad­vo­cacy ef­forts to train peo­ple, to en­gage their pol­i­cy­mak­ers, to en­cour­age them to make fur­ther in­vest­ments in pub­lic health fund­ing.

MH: How do you keep the mo­men­tum go­ing af­ter a meet­ing like this?

Benjamin: We reach back out to our mem­bers, send them e-mails ev­ery day, con­tact them through so­cial me­dia. We’ve done we­bi­nars on cli­mate change, firearm-re­lated vi­o­lence and racism in health. It doesn’t just end when the meet­ing ends.

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