WTF Summer 2018

Are we prioritizing what we need to for a healthy future?

By July 24, 2018 No Comments

Are we prioritizing what we need to for a healthy future?

Dr. Sandro GaleaDr. Sandro Galea, Physician and dean of Boston University’s Robert A Knox School of Public Health

As an epidemiologist, Dr. Sandro Galea is always concerned with the aspects of our lives and environments that determine our health as individuals and society.

When he thinks What the Future, he’s worried that we’re not prioritizing the right things and that we don’t understand that the choices we’re making affect the policies we put in place. Those policies have huge impacts for equity of healthcare – even larger impacts than we might think.

People running on tredmills

GenPop: You asked about life expectancies and how those are different for the richest and poorest Americans. What did you think of the results?

Most understand that the rich live longeer than the poor, but many underestimate the disparitySource: Ipsos survey conducted between June 6 and 8, 2018 among 2,007 adults in the U.S.

Most underestimate how public policy and social status affect their healthSource: Ipsos survey conducted between June 6 and 8, 2018 among 2,007 adults in the U.S.


Dr. Sandro Galea: I thought it was clear that most people had the general idea [about the differences] and also clear that only a minority of people actually got the specifics and understood how big the problem is. What struck me is that the narrative about health inequality is out there, yet about a quarter of the people thought there was no difference at all [in life expectancies of the rich and poor]. But I’m an optimist. I think the fact that most people know the difference is good.

GenPop: And then on the flip side you asked about the factors that relate to our personal health. Despite the set-up question about inequality, income was not seen as a huge factor or at least it was well behind the big three: genetics, what you eat and how much you exercise.

Galea: Personal behavior matters only insofar as the other factors matter – like politics. And those were not understood to matter at all. It’s probably a good thing that people do think that these things they can control, like their exercise and their diet (to the extent they control those things), have an impact.

GenPop: That probably helps us make good decisions.

Galea: In theory it does. The challenge is that it makes us feel like the locus of control is entirely within us, which is actually deeply fl awed [thinking]. It reduces everything to a notion of personal responsibility. We asked questions about what percent of people understand the real gap between rich and poor and what percent of people think it’s all about personal behavior and genes.

If you put those two together you’re going to say most people understand there’s a gap between rich and poor and most people think that’s either genetic or because the poor don’t behave properly. That has real problems for how we think and the implications of how we think.

GenPop: Ipsos does a lot of research about what we call the Perils of Perception: How what we know today and what we think about the future impacts the policy decisions and the personal decisions we’re making today. What decisions could we make if we understood these two issues better?

Galea: If we think it’s all about genes, then we are going to invest all our money in trying to find some sort of magic genetic solution that’s going to improve our health when in fact we know full well that that has very little to do with the health challenges of our times. If we think it’s all about personal behavior, we are going to invest only in ways where we accept that individuals should do what is right for the individual, which means it becomes very easy for us to cast blame on people who are not healthy.

GenPop: What good changes would come if we had a better understanding of the impacts of these personal and political factors?

Galea: We create a world where we do what we need to do to generate health. There are three things that we do. Number one: We need to govern for health. We need to make sure that we make decisions that actually promote health. Number two: We need to make sure that multiple sectors act in a way that generates health. That means to make sure that when decisions are made about transportation or housing or income structure or employment, that we recognize that these have impacts on health. Number three: We need to create a demand for health. I don’t mean a demand for “not to be sick.” I actually mean a demand for health.

GenPop: What do you mean by that?

Galea: We need to collectively create a world where we agree we want to be healthy and we should be healthy. That ultimately results in governance for health.

GenPop: How do we create that demand?

Galea: We create an understanding of what really matters. Once we have that understanding, I have deep confidence in the wisdom of all of us as a collective. Then the question is how do we take that understanding and use it to make sure that all sectors that are important will act for health and that we govern for health.

GenPop: In some ways this has to become a consumer-driven process rather than a top down, “the government will just fix it for us” process. We are starting to see that in some ways in the food sector. People are demanding healthier options and the market is responding and delivering.

Galea: That’s correct. That’s a very good analogy.

GenPop: And we’re seeing that in housing and transportation in some areas too, and we know that where we live and how we move impacts our health.

Galea: There are plenty of examples where we’re doing the right thing. We’re just doing them in a small scale and particular places. We should do it in bigger scale.

GenPop: Say we figure this all out and create this demand and start making better choices. What does that future look like?

Galea: It’s a future where we see health as the ultimate goal of good governance and where policymaking takes human flourishing and human potential at its ultimate end. Healthy humans should be an inevitable and inextricable part of that. Various sectors across functional domains like transportation or housing must make decisions with a clarity about the health impact of these decisions. There is a popular clamor for a world where you can live healthy, be healthy and your children can be healthier than you.

July 24, 2018