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Pumphandle Lecturer Answers The Question “What Pump Handles Need To Be Removed To Save The Most Lives In This Century?”

CDC Director Says We Must “Make Data Count”
 

“Give me the right place to stand, and a lever long enough and I can move the world.” This is how CDC Director Tom Frieden paraphrased the Greek philosopher Archimedes in delivering the 2012 Pumphandle Lecture to the John Snow Society late last year. According to Frieden, a pumphandle or public health intervention is a kind of lever, and public health is the right place to stand to reduce the most important causes of death in the world.

 “There is so much that we can do that with some effort can have a larger impact,” according to Frieden. He defined public health simply as determining what kills people, how it kills, and stopping it. He called reducing deaths the “first” priority of public health.

Tobacco

Frieden began his lecture on the most important causes of death in the world by focusing on tobacco. He noted that there were 100 million deaths caused by tobacco in the last century and that there will be 1 billion deaths in this century unless preventive measures are implemented. By causing an estimated 6 million deaths per year worldwide, tobacco kills more persons than HIV, TB, and Malaria combined, he said. 

According to Frieden, we know what to do to reduce the impact of tobacco and he cited the six public healthinterventions that have been bundled together as the MPOWER measures being promoted by the World Health Organization. These include 1) monitoring tobacco use and prevention policies, 2) protecting people from tobacco smoke, 3) offering help to quit, 4) warning about the dangers of tobacco, 5) using and enforcing bans, and 6) raising taxes.

Unhealthy Food

Frieden called unhealthy food such as excess salt and artificial trans fats as the second most important target of efforts to prevent deaths. He discussed the important role of high blood pressure and noted that we may be lulled into thinking that elevated levels are normal because they are so ubiquitous. He highlighted the importance of working in partnership with the food industry to achieve public health gains and used the example of his work with industry in New York City to help reduce trans fats in that population.

Alcohol

In naming alcohol as the next important cause of death, Frieden highlighted that it causes the widest range of health effects of all the major killers. And as with tobacco  control, reducing the effects of alcohol will require broad social change. Some positive results have been achieved in reducing drunk driving in the US, but greater use of existing interventions to impact price, access, and the image of tobacco will be required.

Environmental Hazards

We have “plenty of levers” when it comes to providing clean water systems, safe air to breathe, and safe and healthy food, according to Frieden.  For example, he noted that with only modest cost and a modicum of effort, public health could achieve significant reductions in neural tube defects and iodine deficiency.

Absence of Data

Stating that this cause of death was the hardest to explain, Frieden went on to make the case for “removing the absence of data” He quoted Ben Franklin who said the only thing more expensive than an education is ignorance, and a second popular saying, “In God we trust, all others bring data” to support his focus on the value of data. In fact, he said that data are the essence of what we need to exert a modest level of effort and leverage the multiple interventions we have and achieve a disproportionately large impact on death rates.

Closing Remarks

Frieden closed his talk by telling the audience that equity is the philosophy of public health, epidemiology the method, and partnership the mode of success. “You never know where you will find support, he said, and people convinced by data can rally to the side of public health to advocate, implement, and assure that pumphandles are removed.

To view the 2012 pumphandle lecture, visit the John Snow Society website at:  http://tinyurl.com/cqw9rah 


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