Public health in the United States is far from perfect. Outbreaks of measles, a disease previously held in check, are making a comeback despite the unequivocal safety and efficacy of the MMR vaccine. Each day, many adolescents and young adults start smoking for the first time even though the health consequences of tobacco use have been drilled into their heads from a young age.
Of course, the root causes of these problems are too complex to be thought of simply as failures of public health. After all, a teenager doesn't start smoking because they mistakenly think it's a perfectly healthy thing to do. And parents who choose to not vaccinate their child have probably already been told that vaccines are safe and effective (as to why they remain susceptible to non-credible information is a conversation for another day). But focusing on the ailments and unhealthy behaviors that affect Americans might cause one to lose sight of the benefits public health efforts of the past century have afforded us.
It is an adage amongst public health professionals that 'public health is at its best when it is invisible to the public.' Do we see when a woman doesn't give birth to a child with spina bifida because of mandated folate fortification of cereals and grains? Or do we simply see a woman give birth to a happy and healthy baby? Do we see when a child avoids polio because they were vaccinated? Or do we simply see a healthy child?
In the field of epidemiology, the potential varying health outcomes that may affect someone is referred to as the counterfactual. This is what epidemiologists are trained to see: what health outcome would have happened if intervention X, Y or, Z had (or had not) been implemented. Unfortunately, this way of thinking is not always intuitive for many of us. This inability to recognize all the benefits our country's public health apparatus provides us with can sometimes result in public health being underappreciated.
To be sure, most Americans hold a favorable, trusting view of the CDC and other state and local health departments. However, that favorability hasn't always translated into funding. In addition to many state and local health departments having their budgets reduced in the past several years, the amount of money spent on public health is not proportional to the beneficial impact it has on our health. It has been estimated that 80% of our health is determined by our surroundings, and not directly the result of treatments or therapies provided by doctors. Yet only 3% of all U.S. healthcare expenditures go towards public health.
Even while operating on limited resources, public health provides a considerable bang for your buck. Even so, the benefits we as a society are afforded as a result of public health measures are not always visible (which usually means public health is doing its job). Working towards improved health outcomes is an unending endeavor, but we should never hesitate to take a moment to acknowledge how far we've come. Next time you're with your friends or family, think about the diseases or disabilities they never had to suffer from.