Vol. 3, Num. 1: Contents | Editorial | Up Front | Abstracts

EDITORIAL
Scott C. Ratzan

NO HEALTH LEADERSHIP

This week President Clinton addressed over 10,000 public health officials in Indianapolis proclaiming his support for public health. Of course, this is not a political risk -- everyone is for health. However, during the Clinton presidency we have not had a leader for health. Following the first-term debacle to reform the health system, the modern maze of medicine has floundered to become "health as we know it." President Clinton's good intentions are insufficient.

The new "health as we know it" places more responsibility on us as citizens. The once trusted physician today is less esteemed, now spending on average less than one hour each year with any patient. Health care has moved from the hospital to the home. We now get most of our information from friends and the media; television, radio and newspapers are the new physician -- providing over 85% of health information.

While progress this century has discovered the miracle of medicine, we have benefited by advancements doubling the average life expectancy to nearly 80 years. While, we have all now heard that diet, exercise, and other lifestyle choices are responsible for early deaths, our emphasis remains on cures to cancers, heart disease and other ailments. Health progress has slowed.

Unfortunately, without clear leadership to advance health, we are forced to proceed at our own risk. This means new conflicting studies, mixed media messages and "progress" that cloud our health conscience on what is the right thing to do. A recent estimate (JAMA 9/24/97) suggests that over $15 billion a year in excess hospital costs alone are due to a functional illiteracy about health: The inability to understand prescriptions or seek preventive care. But even those who can read, many more in our society do not possess the knowledge to improve their health -- "health illiteracy" caused by conflicting messages.

The costs of the lack of literacy are quiet, yet staggering. Most do not know or practice simple activities that could help us live longer. For example, how many people over 50 do not practice simple health measures that have been proven to prolong life?

-- Taking one aspirin a day to prevent heart disease

-- Screening annually to prevent bowel, prostate, breast and/or cervical cancer

-- Increasing exercise and lowering cholesterol/fat intake to prevent heart disease

Without a leader for "health" we have misguided medicine aimed at intervention over prevention. Thousands of people over 65 will enter the hospital and many will die this winter because they did not receive a flu vaccine this year.

Furthermore, why do millions of us take antacids and drugs for the pain from gastric ulcers, while medical progress can cure most ulcers with a simple prescription of two weeks of antibiotics?

And, last year 10,000 Americans could have been saved from death due to heart attack if they took an aspirin at the onset of chest pain.

If we harness the power of health, we all will be better off. Honest, non-biased health information would go beyond economic value; health leadership could clarify what we could do to be healthier.

Looking to the future, there are areas on the horizon that leadership for health could assist. For example, the public belief of risks associated with electromagnetic fields (EMF-- cellular phones, wires, etc.) threaten our well-being. Consider that $1 billion each year is spent on concerns related to this area, despite the fact that no proven health harm exists from EMF. A health leader could help nullify ideas that Gingko can cure Alzheimer's, or that eating beef could make you mad. The communication mistake of mad cow disease cost the meat industry in the world over $10 Billion last year alone.

The attempt of utilizing outdated policy initiatives and pronouncements based on lobbyists, donors and pollsters input is a real health risk. And the so called World Health Organization and the U.S. National Institutes for Health contribute to a bureaucratic maze of "health as we know it." Instead, optimal health leadership should go beyond simple pronouncements and government programs that are focused on single issues. An appropriate balance of sense with science can be protective rather than detrimental to one's health.

What is required is a concerted effort to create a health literacy in our population so that everyone can share in the decisions to protect and attain optimal health. We need leadership that advances the ideal role of government proclaimed by Thomas Jefferson nearly 200 years ago: "The care of life and happiness, and not their destruction, is the first and only legitimate object of good government."

Clearly, as we prepare for the next century, we must now engage the private sector in leadership in health. The political will and wherewithal to protect public health has diminished. While the duty to foster public health is the government's, it is our own responsibility to make decisions that affect our individual health. We need health progress communicated to us accurately. While the president tries to find some positive legacy, he might at the very least offer more than good intentions and pronouncements and put real "health" on the American agenda.