Can We Bridge Public Health and Environmental Action?

Ashish Jha: 00:00:00

Hey folks, Ashish Jha from Providence, Rhode Island, coming back to you with a moment in health where we talk about one data point, we discuss one study and we answer one question. All right, so let's get right into it. Data Point. The data point I want you to remember is one in 10. One in 10

Ashish Jha: 00:00:26

Americans get their health care through a community health center. Now, if you're one of those, one in 10. You know how awesome these places are, these community health centers. But if you're not and don't know much about them, let me tell you, there are about 1400 of them. They're scattered all around the

Ashish Jha: 00:00:40

country, disproportionately located in urban areas, in rural areas, in classically medically underserved areas. That's where you tend to see these community health centers. They're largely funded by the federal government, and they're extraordinary. And while it's one in 10 Americans, it's one in

Ashish Jha: 00:00:58

five people who live in a rural area, for instance, that gets their care. And what kind of care do community health centers provide? Well, pretty much everything from preventive services to chronic disease management to acute care. So why do I think this is the interesting number of the week?

Ashish Jha: 00:01:15

That's because the new budget proposed by the Department of Health and Human Services would cut the funding to community health centers by 72% dramatic scaling back of these. Now what's unfortunate about this is community health centers have always been super bipartisan, Democrats, Republicans.

Ashish Jha: 00:01:32

Everybody loves them, largely because they're great they really do provide great service and a 72% reduction in community health services community health centers, funding means a lot of them will shut down places where people rely on them because they don't have alternatives. Like rural areas are going to become

Ashish Jha: 00:01:50

medical deserts. And I think, from a health and a public health and a medical point of view, this would be a terrible, terrible decision. So one in 10 Americans vulnerable to these cuts.

Ashish Jha: 00:02:06

All right, let's move on to talking about a study. The study this week that I want to discuss is from the April 24 issue of Jama. It's called modeling, re emergence of vaccine eliminated infectious diseases under declining vaccinations in the US. Let's cut to the taste of what this is. This is a study

Ashish Jha: 00:02:28

that tries to estimate what happens if vaccination rates fall further. We have seen vaccination rates coming down for measles, for moms, for rubella, and even for polio, and they asked, what is going to happen in America over the next 1020, 25 years, if we see further declines, if we stay at

Ashish Jha: 00:02:49

the current level? And as you might imagine, the news here isn't great if there's a 50% decline in childhood vaccination. Of the simulation, they did a modeling of this, and their simulation suggests a couple of million cases of measles a year in the United States. If you do the numbers,

Ashish Jha: 00:03:07

that's probably a couple of 1000 children every year dying of measles, and many more than that, getting very seriously ill. They estimate that we're going to see millions of cases of rubella and poliomyelitis. So we're going to have polio back in the United States, even at current levels, you're going to

Ashish Jha: 00:03:24

see some parts of the United States where measles might very well become endemic, where you start seeing it circulating on an ongoing basis with even modest declines, let's say a 10% decline. Here's the good news, even a small uptake, a quick reversal of the declines we have seen would essentially not just

Ashish Jha: 00:03:42

prevent this huge increase in cases, but again, make these diseases a disease of the past. So our work is cut out for us. We have got to get vaccination rates back up to where they were just five years ago, and if we do that, we can keep all of these terrible diseases at bay. So that's your study of the

Ashish Jha: 00:03:59

week. You all right. And now to the one question of the week, and for this week's question, I'm very excited to have Monica Medina, who is our Barnes lecture this week. This year, Barnes sector is a big lecture that we hold every year at the Brown School of Public Health. For those of you who don't know,

Ashish Jha: 00:04:21

Monica is the former assistant secretary of state for Oceans, international environment and Scientific Affairs under the Biden administration. Also was CEO of wildlife Congress. Conservation Society has been in and out of government, playing key roles in the broader issues of protecting our environment.

Ashish Jha: 00:04:38

And so my question for you, Monica, is this pretty straightforward one. Those of us in public health spend a lot of time thinking about how the environment shapes health, from climate to other environmental issues. How does it affect human public health?

Ashish Jha: 00:04:53

We worry. I worry, but I think others worry that

Ashish Jha: 00:04:56

people in the environmental movement don't spend nothing. Time thinking about people's health. They think a lot about the planet. They think a lot about about animals and trees and all sorts of important things that we care about, but at least we feel like maybe they don't spend enough time thinking

Ashish Jha: 00:05:11

about health. Is that a fair criticism? And if yes, what should we do about it?

Monica Medina: 00:05:17

Oh, well, thank you so much for having me on your podcast, and I think it's a completely fair question, and I often spent time thinking about how to connect people to nature and the environmental work that we were doing. So whether it was plastic pollution or water pollution or atmospheric

Monica Medina: 00:05:36

pollution that causes climate change, we really do have to bring it back to people, if we want people to care. And sometimes it's hard in the environmental movement, because we're we get sort of wrapped up in the data or in even changing industry, which tends to be more about industrial processes like

Monica Medina: 00:05:56

the clean energy transition, when instead, a way to appeal to people and to bring more people into the movement is to explain to them why it matters to their health or to things that they love, like nature and the environment. So you know, if it takes more focus from the public health community talking to the

Monica Medina: 00:06:15

environmental community, I'm all for it. I think that's going to make a stronger environmental movement, and we know, we know that the intricacies of an interconnectedness of environment and health are so obvious, just sometimes we overlook it. You know, when we think about the cost of

Monica Medina: 00:06:35

pollution to the world, it's $8.1 trillion people have taken the time to add up the cost in terms of human health, costs that we are exposing ourselves to because we over pollute, because we have way too much waste. So I do think it's a fair criticism. It's one that we should be reminded of all the

Monica Medina: 00:06:56

time, and it is one that's going to make the environmental movement stronger, not only for itself, but because of the connection with public health.

Ashish Jha: 00:07:04

You know, I think sometimes about like, if you look at polling, most Americans think climate change is an important issue that we should do something about. But then when you ask them to rank it on the list of things they're going to vote on, it's always economy first, and often health second.

Ashish Jha: 00:07:21

And so I have tried making the case that if we think climate is really going to drive health effects, or sometimes I use the phrase that health is the human face of climate change. It is how humans will kind of engage with climate change, then I have been puzzled why both people in health don't think enough about

Ashish Jha: 00:07:38

climate and the environment, but also why people in the environmental movement don't think more about health. But you sounds like you think there's a real opportunity here for us to do more together.

Monica Medina: 00:07:46

I think there's a huge opportunity for us to do more together. And politics bears that out. You know, the Make America healthy again. I'm gonna air quote that because I'm not sure that really it's it's gonna do that. I I'm pretty sure it's not. You know, the the new administration is not going to

Monica Medina: 00:08:01

make America healthier. They're going to make America sicker. But the idea that they campaigned on this and that it had some resonance with their voters tells me something that, you know, we need to be reaching across these lines and creating those connections. And I will say, you know, sometimes it is

Monica Medina: 00:08:20

about education, and here we are at Brown. So I salute the school for the public health school for starting a program that's focused on climate and environment and trying to make those connections. And I think, you know, it's on all of us to try to do more of that, because it will, I think, have these

Monica Medina: 00:08:38

ripple effects out there in the world and it, you know, in the environmental community, most people are, are taught to be ecologists, and they get sort of pigeonholed in their science. And if, if doctors get pigeonholed, and public health professionals get pigeonholed in their science, we end up missing

Monica Medina: 00:08:58

the big picture, which I think most people experience in their day to day lives, which is, their air isn't as clean as they'd like it to be, or their water might have some pollutant in it, or the plastic that they're heating up their food in every day in the microwave is leaching into their food. And we

Monica Medina: 00:09:14

don't even really make those connections very well. So it is on us. I think you and me and our all of our colleagues on both sides of this work to be doing that kind of outreach. It will, I think, help us to grow a movement that can be sustained, and that's what we really need in order to ensure our own

Monica Medina: 00:09:33

health and the health of the planet.

Ashish Jha: 00:09:35

Well, Monica, thank you for coming by. This was inspiring. I think if folks like you and folks like me work more closely together. I think we can see how we both improve the environment and improve human health at the same time. So thanks so much. Thank

Monica Medina: 00:09:49

you. All right, so that was

Ashish Jha: 00:09:51

a moment in health where we talked about one data point, one in 10 people get their care through a community health center at risk under the new budget. We talked about the one. One study that we'll see measles and polio and other diseases becoming endemic again if we see further declines in

Ashish Jha: 00:10:06

vaccinations. And we answered one question, which is, how do we get the environmental movement to care more about health, and in some ways, how do we get the public health movement to care more about the environment? And we had a terrific guest, Monica Medina, with us to answer that question.

Ashish Jha: 00:10:22

So that was your moment in health. Thanks so much for joining. On April 29 I will be testifying in Congress on some of these issues, including the declining vaccination rates, including what's happening with community health centers, and we will be back again very soon with another episode of moment

Ashish Jha: 00:10:40

in health. Take everybody you.