The measles outbreak, the threat of Zika, and the contaminated water crisis in Flint, Michigan, all underscore a central point: we cannot take public health for granted. Despite its success — a century of disease elimination, injury prevention, and housing, transportation and sanitation systems that improve health and create longer lives — support for public health is waning. And as the example of Flint makes clear, when the nation stops investing in public health, the public's health is the price we pay. All Americans depend on public health, yet this critical part of society is rarely discussed on the presidential campaign trail.
We hear rhetoric about fixing health care in America, but not enough about the conditions that help us avoid getting sick in the first place — the conditions responsible for 70 percent of our health, according to decades of peer-reviewed scholarship. For years we had a great track record, when reformers fought for better conditions in crowded tenement houses and sweatshops, a movement that dramatically improved urban health. As these unhealthy conditions are no longer the norm, the need to keep monitoring working and living conditions is more commonly overlooked.
Building a consistent environment for public health requires an understanding of the wide range of factors that influence it. That, in turn, necessitates public support for funding to address those factors. Voters must demand that public health be a priority, or government officials, like those in Flint, will ignore it and force Americans to face unnecessary risk.
To build and maintain healthy environments, there is a wide range of needs that demand attention even without a looming crisis. They include essential delivery and regulatory systems that make day-to-day living possible: water, sewer, and trash collection systems and laws ensuring safe air, food, and water.
Will the water in Flint serve as the canary in our coalmine? As the city's failed water system is addressed, it should spark a nationwide review of water systems everywhere to ensure that this kind of failure does not occur elsewhere. According to the Natural Resources Defense Council, "Our nation's drinking water infrastructure often remains 'out of sight, out of mind,' yet it is in a state of serious disrepair." Flint's appalling crisis may end up creating an opportunity: not just to rebuild century-old water systems throughout the country but to build safer, more efficient systems that help us conserve a valuable natural resource.
The United States does not have the best record of maintaining our infrastructure. The American Road & Transportation Builders Association recently issued a report saying that nearly 59,000 U.S. bridges are structurally deficient. And that's visible infrastructure. It's even easier to underinvest in the mechanisms that are invisible -- especially water and sewer systems. According to CNN, 90 percent of Flint's water problems could have been avoided by adding an anti-corrosive agent that would have cost about $100 a day.
This is also true of food inspection, which takes place largely out of view and has historically been underfunded. According to The New York Times, the Food and Drug Administration needed $580 million from 2011 to 2015 to carry out changes required by the Food Safety Modernization Act. As of April 2015, Congress had appropriated less than half of that amount.
Other components of public health that require reinvestment are our basic living conditions -- how we live, travel, and spend our free time. Creating an infrastructure that makes it easier for people to walk and get exercise is vital to maintaining health and reducing obesity and chronic conditions that stem from it. Functioning mass transit gets people out of cars; new bike lanes enhance rider safety, and well-maintained sidewalks and parks encourage people of all ages to walk, exercise, and relax free of traffic.
Reinvestment is also necessary to allow the mechanisms for public health to be coordinated with health care systems. If high blood pressure or diabetes is widespread in a particular community, for instance, local approaches to reducing their incidence should be studied and implemented. Similar collaboration between medical care and a strong public health sector is needed to contain infectious diseases like measles. We need to find ways to align the goals of the medical and public health communities — and it starts with strong investment in prevention, which is necessary both to avoid disease and to care for the sick.
The presidential candidates should be talking about their commitments to public health. On March 6th, the Democrats will hold a debate in Flint, a perfect location for this discussion. But both parties should be making public health a top priority. With public health responsible for the health of most Americans, it must never be a victim of its own success.