“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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