See our Q& A with Dr. Ge­orges Ben­jamin,

The Obama ad­min­is­tra­tion’s pub­lic health ef­forts fo­cused on ac­knowl­edg­ing that so­cial fac­tors such as poverty and food inse­cu­rity af­fect the health out­comes of com­mu­ni­ties. The elec­tion of Don­ald Trump wor­ries pub­lic health ex­perts such as Dr. Ge­orges Ben

Modern Healthcare - - NEWS -

Mod­ern Health­care: How do you see pub­lic health mov­ing for­ward in this cur­rent po­lit­i­cal en­vi­ron­ment?

Dr. Ge­orges Ben­jamin: We need to move for­ward with full force and ac­tion. The Trump ad­min­is­tra­tion has its agenda and we have ours. Our agenda is ab­so­lutely to im­prove the health and well-be­ing of the peo­ple of Amer­ica, for sure. We’re not sure what their agenda is.

MH: Do you still see op­por­tu­ni­ties to col­lab­o­rate with the ad­min­is­tra­tion?

Ben­jamin: Yes. De­spite the enor­mous skep­ti­cism we all have, we’ve al­ways been able to find a sweet spot on some­thing to move an agenda for­ward. The truth is also that stuff hap­pens. Trag­i­cally, there’s go­ing to be a dis­ease out­break. There’ll be some new dis­ease prob­lem that we have to ad­dress, and we’ll have to do that col­lab­o­ra­tively, oth­er­wise it doesn’t work.

“I think the ques­tion about whether or not health­care is a right in this country is over.”

MH: There’s been a steady de­crease in the num­ber of state and lo­cal pub­lic health work­ers across the country. The re­cent budget pro­posal by the pres­i­dent looks for sub­stan­tial cuts across the board in dis­cre­tionary spend­ing. How does this af­fect ef­forts to re­build that pub­lic health pro­fes­sional work­force?

Ben­jamin: We had hoped to start 2017 un­der the mantra of now that we’ve done health in­sur­ance re­form, let’s do pop­u­la­tion health re­form, which in­cluded pub­lic health as a com­po­nent of that. But we’re go­ing to have to step back and do some dif­fer­ent kinds of bat­tles. We’re go­ing to have to make sure that mem­bers of Congress re­main sup­port­ive of things like core re­search, pub­lic health in­fra­struc­ture, build­ing pub­lic health pre­pared­ness pro­grams, ad­dress­ing things like the opi­oid epi­demic and the obe­sity epi­demic.

The prob­lem is it seems like they just de­cided, “These are pro­grams we sim­ply don’t need.” And they just cut them out of the budget with an idea of try­ing to find a fig­ure to fund some of the in­creases in the mil­i­tary and the wall (along the South­ern bor­der), and, of course, that’s not the way to do pub­lic pol­icy, and that’s ab­so­lutely not the way to put to­gether a budget. They re­ally have un­der­mined (some ef­forts) and it doesn’t have pol­icy co­her­ence. So, we’re hop­ing that Congress will put some co­her­ence to that as they put to­gether at least a 2018 budget.

MH: Did the mes­sag­ing against the Repub­li­can plan to re­place Oba­macare pro­vide any lessons in terms of how to use, for lack of a bet­ter term, the bully pul­pit, in sit­u­a­tions when the ad­min­is­tra­tion is not be­ing very re­cep­tive to what you’re ad­vo­cat­ing?

Ben­jamin: We’ve been con­cerned for some time the last few years that the bully pul­pit didn’t mat­ter, that peo­ple weren’t hear­ing the mes­sage. The ques­tion is why are peo­ple vot­ing against their best in­ter­est? And, in ret­ro­spect, it turns out they re­ally weren’t. They didn’t be­lieve that the in­com­ing ad­min­is­tra­tion would do some of the things they said they were go­ing to do and thought it was all just pol­i­tics and rhetoric.

It turns out they meant to do what they’re do­ing, so I think the core ba­sic prin­ci­ples of ac­tivism and ad­vo­cacy are still in place. The pub­lic just needs to be well-in­formed, and I think once they know what’s not in their best in­ter­est, they’re will­ing to fight against it. The country is in no mood right now ap­par­ently to tol­er­ate things that are not in their best in­ter­est.

MH: Does the elec­tion of Don­ald Trump and the moves his ad­min­is­tra­tion has taken so far re­quire pub­lic health to change its di­rec­tion in terms of pro­mot­ing pre­ven­tion and pop­u­la­tion health, and in­stead solely fo­cus on main­tain­ing its

ca­pac­ity to re­spond to pub­lic health emer­gen­cies?

Ben­jamin: I think the cat is out of the bag on pop­u­la­tion health. We’re mov­ing very quickly to value-based health­care on the health­care de­liv­ery side. We can’t get to those goals with­out pop­u­la­tion health. And I think that’s a train that has long left the sta­tion. We have nu­mer­ous ex­per­i­ments where we’ve shown, by work­ing across sec­tors (busi­ness, faith, com­mu­nity), try­ing to tackle prob­lems in a col­lec­tive way, that you can have dra­matic im­prove­ments in not just the health of the pop­u­la­tion but in the eco­nomics of a com­mu­nity. There’s lev­er­ag­ing of re­sources, money and re­duc­tions in over­all cost for ev­ery­one.

I think that is well within the con­cepts that even this ad­min­is­tra­tion was talk­ing about, such as state flex­i­bil­ity and en­gag­ing com­mu­ni­ties.

MH: What would you at­tribute the grow­ing pop­u­lar­ity of the ACA to?

Ben­jamin: We weren’t sure that peo­ple were valu­ing it, but when peo­ple started talk­ing about tak­ing it away it be­came a kitchen-ta­ble is­sue where folks said, “If I don’t have health in­sur­ance, then this is what hap­pens to me.” We know there are parts of the country where the rates are go­ing through the roof, and that needs to be ad­dressed. I think the ques­tion about whether or not health­care is a right in this country is over. I think that de­bate has been won.

I think the next thing we need to do is make sure peo­ple un­der­stand that the Af­ford­able Care Act is a pub­lic-pri­vate part­ner­ship; it’s not govern­ment health­care. The govern­ment reg­u­lates a lot of things. They reg­u­late how we drive, how we build build­ings, and they’ve been reg­u­lat­ing com­po­nents of our health­care system.

The health­care system does not func­tion like a reg­u­lar mar­ket. Pa­tients do not have the same power in health­care as they have when buy­ing a car, or ce­real, or a house. It’s not an equal play­ing field at all, and un­til we get that kind of trans­parency in pric­ing and an un­der­stand­ing of what you’re buy­ing in terms of qual­ity and value, then it’s not go­ing to be an equal play­ing field.

MH: Do you feel health­care providers will want to con­tinue their com­mu­nity en­gage­ment ac­tiv­i­ties even if Oba­macare is re­pealed?

Ben­jamin: I do. And this is not the only way to pro­vide health­care, but it is a way for them to deal with those in­tractable prob­lems—the pa­tient that you’ve been try­ing to get to lose weight or get to stop smok­ing, try­ing to im­prove sub­stance mis­use.

But we have these other tools to ad­dress them in a broader sense, that group of pa­tients in which their health­care doesn’t seem to be mak­ing progress, and ad­dress­ing those so­cial de­ter­mi­nants makes it eas­ier for them to make the healthy choice, the easy choice. It trans­forms the com­mu­nity into a more productive place, and, in my mind, aids the clin­i­cian. They will need some tools. We need to help them with data col­lec­tion. We need to give them the feed­back on per­for­mance.

MH: Have you had a chance to speak with the new HHS sec­re­tary, Dr. Tom Price?

Ben­jamin: I have not had a chance to meet with Dr. Price. We do have a let­ter in ask­ing for a meet­ing, so I’m hop­ing that we will have a chance to meet with him soon.

MH: What are your ini­tial im­pres­sions so far, given ev­ery­thing that’s oc­curred?

Ben­jamin: Well, you al­ways give any­one the ben­e­fit of the doubt and I think that, clearly, he’s got a lot to learn. He’s com­ing from both a prac­tice of clin­i­cal medicine as well as be­ing a leg­is­la­tor, and now he’s got to be the chief health of­fi­cial of the na­tion, so it’s a very dif­fer­ent role.

We hope to work with him in a productive way to both help him make that trans­for­ma­tion and help him move along an agenda that is cer­tainly much big­ger than one per­son.

MH: On what issues do you think there might be the best chance for you to work col­lab­o­ra­tively with the new ad­min­is­tra­tion?

Ben­jamin: We’re hop­ing that we will be able to work col­lab­o­ra­tively around build­ing on the pub­lic health in­fra­struc­ture. Defin­ing what ev­ery com­mu­nity should have in terms of pub­lic health ca­pac­ity—what is the role at the lo­cal, state, federal level.

While we know there is a role for each of those pieces, it has evolved over the years, and if we can get some bet­ter un­der­stand­ing of what those roles should be, who should fund what part of that, and how to ad­e­quately fi­nance the pub­lic health system so we don’t have yo-yo fund­ing—up one year and down the next—I think all of that is im­por­tant.

There’s no ques­tion that if we can reach a goal of the United States be­ing the health­i­est na­tion, that clearly aligns with the pres­i­dent’s po­si­tion of mak­ing Amer­ica “great again.”

MH: In terms of pub­lic health threats, what keeps you up at night?

Ben­jamin: I still think cli­mate change is the great­est pub­lic health threat we have. The thing that keeps me up at night is the in­fec­tious dis­ease threat that we don’t see com­ing. We’ve had, al­most ev­ery year, a new threat of some kind and of var­i­ous mag­ni­tudes. The most sig­nif­i­cant ter­ror­ist that we have is Mother Na­ture. Na­ture has the ca­pac­ity to evolve or­gan­isms to im­pact our health in sig­nif­i­cant ways and for many years. We’ve al­ways been wor­ried about the dis­ease process that’s com­ing from some place, only for it to come from some­place else.

I re­mem­ber when Zika first hit in Brazil and we were kind of watch­ing it and ev­ery­body said, “Well, it’s only Zika. It could be some­thing worse.” Well, it turns out that it was a mu­tated form of Zika and it was some­thing worse.

I re­mem­ber Ebola and peo­ple were wor­ried about Ebola, but we’ve had lots of lit­tle outbreaks of Ebola. But we hadn’t seen any­thing like the one we saw. So it’s that kind of thing. We all wor­ried about bird flu and while we were watch­ing for bird flu, we got SARS and that was a pretty sig­nif­i­cant out­break. So that keeps me up at night.

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