Monday, October 2, 2017

Be Part of the Conversation: Our Stories, Our Communities, Our Health

The theme of the 2017 Minnesota Community Health Conference was “Be Part of the Conversation: Our Stories, Our Communities, Our Health.” As Commissioner of Health, I welcomed the 400+ attendees and then set the stage for the opening keynote address entitled “Telling Our Public Health Stories” with these words:

Once upon a time, long ago, in a New Mexico pueblo, a wise elder sitting among the people in a council ring began to speak:
“I will tell you something about stories,
They aren't just for entertainment.
Don't be fooled
They are all we have, you see,
all we have to fight off illness and death.
You don't have anything
if you don't have the stories.
The evil in the world is mighty
but evil can't stand up to our stories.
So they try to destroy the stories
let the stories be confused or forgotten
They would like that
They would be happy
Because we would be defenseless then.
You don't have anything
if you don't have the stories.”
(From Ceremony by Leslie Marmon Silko, a Native American from the Laguna pueblo in New Mexico.)

The wise ones then and the wise ones now recognize that stories are powerful tools. They are powerful because stories help change our perspective. The Laguna people start each story with the phrase, “Humma-hah,” meaning long ago. We often start our stories with “Once upon a time.” Just saying those words puts us in a different mindset, one where we suspend disbelief and become more open to new ideas, different ideologies, and foreign notions. Stories can get us to think and act in different ways.

Besides being interesting, enjoyable, and effective in transmitting information and ideas, stories are also powerful because they link people to a broader more expansive narrative that underlies, enriches, and adds substance to the stories. That underlying narrative generally embodies the values, principles, and beliefs that a community holds sacred. Stories create, reinforce, and strengthen the narrative, make it more powerful and influential, and help carry it beyond the moment.

Despite what we would like to think, data, information, and even experience are not the things that most shape our behavior. That distinction belongs to the narrative which forms and shapes our beliefs, perspectives, and sense of responsibility and possibilities from which our actions spring. Stories help create and strengthen that narrative which is why they have such incredible power.

In fact, stories are so powerful that Plato warned "Those who tell the stories rule society…so we need to carefully control who tells stories.”

Abraham Lincoln sounded a similar theme. He said, “Public sentiment is everything. With public sentiment, nothing can fail; without it nothing can succeed. Consequently, he who molds public sentiment goes deeper than he who enacts statutes or pronounces decisions. He who molds public sentiment makes statutes and decisions possible or impossible to be executed.”

Stories and their underlying narrative (public sentiment) are powerful public policy tools thus they are also public health tools.

As public health workers, it is crucial that we tell a variety of stories that help shape the overall narrative about what creates health. We should tell stories about bad things that don’t happen because of our past public health investments in protecting people and that those investments have given us a longer and healthier life. We need to tell stories about what bad things might happen if we don’t change our current resource investment strategies which prioritize treatment over prevention. We must especially tell stories about disparities that have been caused, not by the lack of medical care or because of poor personal choices, but by policy decisions that affect income, education, housing, economic development, and the quality of communities – policies that have destroyed opportunities and hope for too many people in too many communities.

Public health stories are seldom about heroic actions or ground breaking technologies. They’re not about individuals pulling themselves up by their bootstraps or about short term miracles. Public health stories are about the basic needs of individuals and communities, about the need for a long term vision and shared responsibility for health, and about protecting the “commons” – the public good. Public health stories are about inequities in opportunities to be healthy.

The narrative behind the public health stories is that health is created in communities by communities, and that health is determined mostly by socio-economic circumstances and environments that have been created by public and private policies. Too often, these policies systematically disadvantage some population groups and communities and limit the opportunities for populations affected by these policies to make healthy choices which stifles their opportunity to be healthy. That narrative is a social justice narrative.

And, the social justice narrative is really the public health narrative. Bill Foege, former director of the Center for Disease Control and Prevention (CDC) reinforced that notion when he said, “The philosophy behind science is to discover truth. The philosophy behind medicine is to use that truth for the benefit of your patient. The philosophy behind public health is social justice.”

Sadly, from my perspective, the dominant public narrative about what creates health (that health is determined by medical care and personal choices) is overpowering the social justice/public health narrative. That’s why we need to initiate and be part of the conversation about what creates health. That’s why all public health workers need to bring the health equity/public health perspective into those broader conversations. That’s why our stories need to be told in a way that expands our understanding about what creates health and helps create an alternative narrative that can guide the creation of policies, systems, and environments that allow everyone in every community to thrive.

That’s why you need to be part of the conversation that’s going to take place over the next two days – and beyond. Your stories are powerful. They are the best weapon “we have to fight off illness and death. You don't have anything if you don't have the stories.”

The stories I heard over the two days of the conference filled me with hope and convinced me that there are a lot of great public health story tellers in our midst. As they become a more integral “Part of the Conversation,” I’m anxious to see what impact their stories will have on “Our Health and Our Communities” in our state, our country, and the world. Living happily ever after may be how fairy tales end but I hope our real life stories end with everyone living equitably ever after.

Ed

Wednesday, September 6, 2017

The Work of Public Health

The Work of Public Health – Labor Day 2017

“A summary of the problems in our culture is that we made three bad philosophical bets along the way: we chose (Thomas ) Hobbs when we should have chosen (Émile) Durkheim, we learned to think of ourselves as individuals when we are really relationships – too individualistic and not communitarian; we chose (René) Descartes when we should have chosen Augustine (of Hippo), we think of ourselves as primarily cognitive feeling creatures when we’re primarily emotional longing creatures; and we chose (Jeremy) Bentham when we should have chosen (Viktor) Frankl, we think our lives are organized around pleasure and pain but really our secret and deepest desires are purpose and meaning.” -David Brooks, 2017 Aspen Ideas Festival Lecture

In the late 1970s and 1980s American society made some philosophical choices that altered the course of our collective history. The field of public health and the health of our society were particularly affected by those choices.

We had just lived through two tumultuous and chaotic decades. We had experienced the Vietnam War, the War on Poverty, culture wars, the Great Society Program, and movements for civil rights, women’s rights, and environmental protection. We had seen the rise of Black Power, Flower Power, feminist power, and community power. We had witnessed the emergence of the idealistic, obstreperous, and numerically powerful Baby Boom generation.

Amidst the turmoil and conflict of those years were some dramatic and positive changes in our society including expansion of voting rights, acknowledgment of civil rights, drafting of environmental protection laws, decreased poverty among the aged, expanded healthcare access, improved health status, and narrowing of health disparities. Yet, all of these changes were disruptive and a direct challenge to the political, economic, and cultural status quo.

We became uncomfortable with the disorder within our country and longed for stability. This desire led us to a crossroads of philosophical directions for the future. In the health sector, seduced by the promise of scientific and technological miracles, we chose a biomedical rather than a public health perspective. That choice mirrored those in all other sectors. We chose boot straps individualism rather than interdependence and social cohesion. We chose competition and free market solutions rather than solutions based on social responsibility and social justice. We chose to demonize government rather than recognize its critical role. We chose to invest in technology and specialists rather than support generalists.  And we saw structural discrimination as a thing of the past rather than a challenge for the present and future.

These choices brought us unimaginable technological advances and great rewards for some. But those came at a very steep price both financially and socially. Despite healthcare costs far exceeding those of any other country, we’ve been steadily falling behind in the basic indicators of good health status – longevity and infant mortality. We have increasing disparities in all sectors of our society, particularly those that impact health – income, education, housing, incarceration, and environment. We have disintegrating urban and rural communities. We have a rise in the diseases of despair (drug and alcohol use, suicide, mental illness among others) that threaten the long-term health of our society. We have a changing climate that threatens our very existence. And we have a rise in fear, hate, and discrimination that is destroying our sense of community and social cohesion that will be essential in creating a livable future.

Like David Brooks, I believe we made some bad philosophical choices that have negatively impacted our society. But like the late 1970s and 1980s, we are at a crossroads.  We are in a time of turmoil and chaos and we again have the opportunity to choose the philosophical direction that we will take as a society. This time I hope we choose a direction that is more “communitarian” and one that gives our activities “purpose and meaning.”

I believe that our public health work is to collectively be the contemporary Durkheim, Augustine, and Frankl of public health. We must demonstrate that many of the choices that we’ve made are not socially, economically, or environmentally healthy for our country, our planet, or their inhabitants. Our greatest challenge is to build the public will to work collectively to assure the conditions in which all people can be healthy – conditions built on the philosophy of social responsibility, social cohesion, and social justice.

Ed

Tuesday, September 5, 2017

Health Equity and Social Cohesion

(The September/October issue of MetroDoctors (the journal of the Twin Cities Medical Society) is dedicated to “Striving for Health Equity.” The articles in this issue are accessible at: Twin Cities Medical Society: 2017 September/October Striving for Health Equity. A modified version of the article I contributed to the journal is included below. EE)

“The greatest epidemic today is not TB, HIV, or leprosy – it is being unwanted. … Being unwanted, unloved, uncared for, forgotten by everybody is a much greater hunger, a much greater poverty than (having) nothing to eat.” – Mother Teresa

The standard approaches of contemporary healthcare and public health have been insufficient to reduce the persistent and seemingly intractable health disparities in our society. This should challenge us in public health to rethink how we do our work. Given our current understanding of what determines health, we must expand our focus beyond clinical care and disparities to include the inequities in opportunities in our political, economic, educational, healthcare, and social systems that are at the core of health disparities and then work to change them.

We also must recognize that creating health and health equity is not just about the health of individuals but the health of communities. As poet/farmer Wendell Berry said, “…the community in the fullest sense is the smallest unit of health…to speak of the health of an isolated individual is a contradiction in terms.” Unfortunately, that’s not the common perspective. Most people focus on health as an individual issue which minimizes the importance of the community and social cohesion to health. Therefore, it is critical that we understand how the lack of community and social cohesion (a lack of belonging or “being unwanted” as Mother Theresa noted) is a health determinant that is at the root of many health disparities.

In its 2014 Advancing Health Equity Report to the Minnesota Legislature, the Minnesota Department of Health (MDH) made the case for addressing the root causes of health inequities and disparities by focusing on the social, economic, and environmental conditions that create health. In addition, recognizing that health disparities and inequities are particularly stark and persistent for populations of color and American Indians, MDH chose to lead this effort with a focus on racial equity, noting that race often compounds disparities and inequities linked to gender, sexual orientation, age, and disability. Advancing health equity is now at the core of the state’s Healthy Minnesota 2020: Statewide Health Improvement Framework and MDH’s strategic plan.

To more effectively advance health equity, MDH created the Triple Aim of Health Equity - a set of practices necessary for changing the work of public health. The components of the Triple Aim of Health Equity are based on a theory of change that builds the power and capacity to improve living conditions in every community. The Aims are:
Expand the understanding about what creates health,
Implement a health in all policies approach with health equity as the goal, and
Strengthen the capacity of communities to create their own healthy future.

With this framework, efforts are underway to expand the narrative about what creates health; that ill health is not just due to lack of access to healthcare and bad personal lifestyle choices but mostly due to the policies and systems that impact economic, educational, housing, physical, criminal justice, and transportation environments. The Triple Aim of Health Equity also recognizes that health is not solely the responsibility of the healthcare and public health sectors but is impacted by the policies in all other sectors of society. This recognition highlights the need for new and expanded partnerships to advance health equity. Finally, the Triple Aim of Health Equity acknowledges the importance and necessity of strengthening civic participation so the collective voice of community members can effectively impact decisions made by institutions and government at all levels.

All these efforts are centered around building social cohesion, a prerequisite for achieving health equity. Social cohesion is defined as community force that “works toward the well-being of all community members, fights exclusion and marginalization, creates a sense of belonging, and promotes trust.”

Among the constituent elements of social cohesion are:
social capital – the resources that result from people working together toward a common goal,
social mobility – the ability to move up in social or economic status, and
social inclusion – having connection to and ownership of community goals, having a sense of belonging – being wanted and needed.

According to John A. Powell, director of the Haas Institute for a Fair and Inclusive Society, that sense of “belonging means more than just being seen. Belonging means being able to participate in the design of political, social, and cultural structures. Belonging means the right to contribute and make demands upon society and institutions.”

Social cohesion can be developed only if all parts of the Triple Aim of Health Equity are being actualized.
Expanding the understanding about what creates a thriving and prosperous community is essential for building the social capital necessary for a socially cohesive society.
An inclusive, coordinated, and accountable decision-making process that incorporates the views of all stakeholders in all sectors of the community enhances social cohesion.
Strengthening community capacity by providing community members with the opportunity to share their perspectives and impact policy decisions is fundamental to creating social capital and a sustainable, socially cohesive society. The process of policy making is often as important for building social cohesion as the policies themselves.

Public health is defined by the Institute of Medicine as “what we, as a society, do collectively to assure the conditions in which (all) people can be healthy.” Those conditions are influenced by the policy decisions made at all levels of society. If we are to change the policies to improve health equity, we must constantly ask the basic question: what would our work be like if health equity was the starting point for all policy and programmatic decisions?

Our work would be different. Our work would be shaped by the Triple Aim of Health Equity; we would expand the understanding of what creates health, implement a health in all policies approach with health equity as the goal, and strengthen the capacity of communities to create their own healthy future – all with the objective of increasing social cohesion and belonging. Our work would be to build a proper community as described by Wendell Berry: “A proper community…is a place, a resource, an economy. It answers the needs, practical as well as social and spiritual, of its members - among them the need to need one another.” Our work would be to create socially cohesive communities where no individual or group is unwanted and where everyone has a sense of belonging and the opportunity to be healthy.

Ed

Monday, July 31, 2017

Making A Way Out Of No Way

Greetings,

On my last trip to Washington, D.C. I was unexpectedly provided an opportunity to visit the recently opened National Museum of African American History and Culture (NMAAHC). My guide was Alice Bonner, a museum docent with a background in journalism and theater, which provided a unique perspective to my tour. She enthusiastically greeted me and was clearly pleased at the opportunity to share her passion for African American history and culture in a building too long in coming. It was also obvious that she understood the relevance of that history to contemporary society and its role in shaping our future when the first thing she pointed out was that “this building is located at the corner of 14th Street and Constitution Avenue. The 14th amendment to the U. S. Constitution gave citizenship to freed slaves and provided them equal protection under the law. The fact that the 14th Amendment is exactly in the middle of our 27 constitutional amendments and that this building is centrally located on the National Mall should remind us of the central importance of citizenship to the future well-being of our country.”

We began the tour at the lowest underground level of the museum and steadily worked our way up through three levels encompassing four centuries of struggle and oppression; from slavery to emancipation, from Jim Crow segregation to the Civil Rights movement, and from Martin Luther King, Jr’s assassination to our current situation of a society built around structural racism. Given my time constraints, Ms. Bonner suggested that we move quickly through these levels because “they depict some pretty dark and depressing times and events. Even though you need to understand what happened and why, the pain and sadness can be overwhelming. I want you to leave here with some optimism and hope.”

That optimism and hope came when we reached the above ground levels of the museum. The highest level joyously celebrates the numerous contributions of African Americans to our country and the world. Providing a transition to that level is one which explores themes of agency, creativity, and resilience of African Americans who challenged racial oppression and discrimination by “Making A Way Out Of No Way.” The exhibits in this section highlight the determination of a people, despite overwhelming adversity, to create strategies and specific actions that challenged the racial status quo in America. The unifying lesson emanating from each display is the importance of a sense of community for survival and how powerful a community can be in stimulating change on an individual as well as community, national and global levels. In the process, “Making A Way Out Of No Way” offers hope for the future and an example of what is needed if our society as a whole is to survive and thrive.

After thanking and saying goodbye to Ms. Bonner, I reflected on my visit and was struck by the powerful way the NMAAHC chronicles the magnitude of the centuries-long and on-going fight for social justice and how it clearly displays the formidable forces persistently in opposition. The museum also demonstrates that the most powerful and only way to effectively counter those oppositional forces is to create and nurture a sense of community.

Likewise, the core value of public health is social justice which strives for health equity and optimal health for all. Like all struggles for social justice, health equity can only be achieved in communities where there is social cohesion and where everyone has a sense of belonging and bears some responsibility for the community’s well-being as well as the power to help make needed changes. The work of public health is to create that kind of community everywhere, for everyone. Those of us who have some responsibility for our nation’s public health can learn from the struggles of our African American neighbors and adopt some of the strategies they modeled to advance social justice. Only then will we be able to effectively assure the conditions in which everyone everywhere can be healthy.

I hope Ms. Bonner somehow knows that as I left the NMAAHC, I was filled with optimism and hope.

Ed

Thursday, July 6, 2017

Life, Liberty, and the Pursuit of Social Justice

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Declaration of Independence, adopted in Philadelphia, July 4, 1776.

“…one Nation under God, indivisible, with liberty and justice for all. The Pledge of Allegiance, adopted by Congress in 1942.

As we celebrate Independence Day, think about Crispus Attucks, the first person to die in the American Revolution. He was a person of color who was part of a crowd in Boston standing up to British soldiers sent to quell the American resistance. The mob threw snowballs; the soldiers fired guns. The soldiers were put on trial for murder and defended by future U.S. president John Adams. His words describing Attucks have a modern tone, “This was the behaviour of Attucks;-to whose mad behaviour, in all probability, the dreadful carnage of that night, is chiefly to be ascribed.” At the end of the Boston Massacre trial six soldiers were found not guilty of murder. Two were convicted of manslaughter and given the penalty of thumb tattoos.

Justice was a central issue at the founding of our country and remains so today.

Public health is based on the principle of social justice – a recognition of the shared nature of our individual and societal welfare and a belief in the collective responsibility to assure that all people have their basic human needs met and no one unfairly benefits to the detriment of others. This foundational principle of public health is embedded in the stated American value that we celebrate every July 4th “that all men are created equal.” 

Despite our lofty democratic and public health visions of a socially just America, we are far from achieving that goal. Our societal shortcomings are seen in the disparities and inequities in health and economic status, educational achievement, and environmental quality that disproportionately impact populations of color, American Indians, the LGBTQ community, and people with disabilities.

A lack of social justice breeds social isolation, fear, alienation, and mistrust which impacts all parts of our society. I thought of those consequences of injustice as I watched and listened to the recordings of the shooting of Philando Castile and reflected on the “not guilty” verdict in the Yanez trial. I realized that if we are to learn from this event and move toward a more socially just society, our perspective can’t solely be a legal one. We must also focus on the emotional, ethical, and moral issues that connect us as human beings and which hold the potential to unify us as a community.

That human connection was palpable as I listened to the voice of the innocent 4-year-old child who had just witnessed a fatal shooting. Hearing the fear in her voice as she worried about her mother’s safety and recognizing her stress and anxiety as she took on the role of protecting her mother brought tears to the eyes of this pediatrician and pain to the soul of this grandfather. It made me sad and angry because I knew that this was an avoidable catastrophic adverse childhood experience (ACE) that threatens this child’s immediate well-being and her long-term health. All I could do at the time was cry and send prayers. But there is much more we can do – much more that we must do to create a safe, inclusive, and socially just society.

“Trauma-informed care” is one strategy available to address childhood trauma, but in public health we must go beyond care to the prevention of ACEs. We must address the precipitators of events like this shooting; what I call “Adverse Societal Conditions” (ASCs) –– the racism, sexism, classism, homophobia, and intolerance of diversity that have been a part of America since its founding.

We know how ACEs impact an individual, but we must recognize the evidence that ASCs affect everyone. Not just African-Americans who fear for their life every time they are stopped by the police. Not just transgender people who are bullied for trying to make peace with their identity. Not just Muslim women who are harassed and attacked for wearing a hijab. Not just immigrants who are systematically labeled and derided as terrorists, rapists, and criminals. Everyone! Including affluent, educated, white, and politically powerful individuals.

Just as “trauma informed care” helps heal the wounds of ACEs, we need an approach to heal the wounds of ASCs – the social isolation, fear, alienation, and mistrust of diversity that is too common in our society. The path to that healing might be contained in the origin of the word “heal,” from the Old English word “hal” which is also the root for health, whole, and holy. If we are to become a healthy society, we must heal our societal wounds and become whole. That is our sacred duty.

Our focus on Advancing Health Equity has been a small step in this healing process. The Triple Aim of Health Equity is centered on the value of “social cohesion” and creating a sense of belonging. It’s a step in making the community whole that can lead to better health. Building on that belief, our 2017 Statewide Health Assessment focuses on that notion of “belonging.” My hope is that this assessment will frame the action steps necessary to build social cohesion and make our community whole and healthy.

Because of societal injustices we are all less safe, less secure, and less whole. We will never heal, we will never be healthy, until we can become whole. Our sacred public health work is to help create a socially just society that advances health equity. That is also part of our civic responsibility to build community and strengthen democracy so “that government of the people, by the people, for the people, (all the people) shall not perish from the earth.”

Happy Independence Day.
Ed

Tuesday, May 30, 2017

Laws and Sausages

“Laws are like sausages, it is better not to see them being made.” Attributed to Otto von Bismarck

The chaotic ending of the 2017 regular and special sessions of the Minnesota legislature prompted multiple references to sausage making. Most comments reflected the sentiment in the attributed Bismarck quotation. As someone with Germanic ancestry (where sausages are a staple of everyday life), a Minnesota citizen (where laws help shape our everyday life), and a state agency head (where I can actually observe how laws are made), I say baloney!

Even though I recognize this quotation as a “tongue in cheek” statement, the actions of the last few weeks make me wonder if others actually take it literally – that laws should be made outside of the view of the public. We need to reframe the discussion; laws are like sausages and it’s absolutely essential for our health and the long-term well-being of our society to see what’s in them and how they are made.

Sausage making is a traditional food preservation technique going back thousands of years. It is also a conservation technique that helped assure that no vital nutrients were lost or wasted. Sausages helped sustain societies through cold, tough times and fortified them as they grew and expanded. They also embodied a great deal of cultural variety and helped add flavor to an often mundane existence.

When times were good, choice cuts of meat were used to make sausages. When times were tough, less desirable parts of animals were included along with other fillers and, with various spices and preparation techniques, made to be palatable, even tasty. Because sausages were crucial to people’s survival, it was recognized early on that consumers needed to know what went into sausages and how they were made. Given the sausage-making process, it was too easy for unskilled or unscrupulous butchers to create tainted products that frequently led to illness and death. This need was graphically reinforced even into the 20th century when the 1906 book “The Jungle” by Upton Sinclair highlighted the unsanitary and unsafe working conditions in the meat packing industry. This book led to the passage of the Meat Inspection Act and the Pure Food and Drug Act, which established the Food and Drug Administration.

Today, sausages are produced according to recipes; the ingredients are specified, carefully measured, and accurately identified on a label. Inspectors from the United States Department of Agriculture regularly inspect plants that make sausages for public consumption. For our health, well-being, and long-term survival it’s important to know how sausages are made.

Laws have been around at least as long as sausages (probably longer) and are even more essential to the long-term survival and prosperity of a community. Ideally, they add stability, fairness, security, and opportunity to a society. They help communities thrive during good times and sustain themselves during tough times. They help make best use of resources and help people optimally grow and develop. But that only happens when the lawmaking recipe includes openness to scrutiny, assurance that the voices of community members are part of the process, and lawmakers being accountable to their constituents. If that transparency and participation is absent, the needs of the wealthy are often prioritized over those of the poor, the community good is subjugated to the needs of some individuals, and long-term investments are delayed to meet short-term objectives. If we fail to inspect and monitor the process, a great deal of pork can get into laws leading to legitimate beefs by those left out. (Sorry about that.)

Laws are like sausages but for our health, well-being, and long-term prosperity it’s important to know how both our sausages and laws are made. We should never turn our eyes away from either and risk our health and the health of our democracy.

Now I’m going to go out and grill some well-inspected bratwurst – I think there’s a law that says you have to do that on Memorial Day.

Ed

Monday, April 3, 2017

Public Health Week 2017 – The Best of Times

In April 1859 the first of 31 weekly installments of Charles Dickens’s "The Tale of Two Cities" was published in a literary periodical titled "All the Year Round." The novel starts with the famous sentence: “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way—in short, the period was so far like the present period…”

I don’t know if Dr. Martin Luther King, Jr. had that sentence in mind when he gave his “I’ve Been to the Mountaintop” speech in Memphis 109 years later on April 3, 1968, but his words underscored the theme. With rhetoric that presaged his assassination the following day (which would lead to some of darkest days in United States history) Dr. King clearly stated that these were the best of times. “Something is happening in our world. … if I were standing at the beginning of time… and the Almighty said to me, …’which age would you like to live in?’ I would take my mental flight (through Egypt, Greece, Roman Empire, Renaissance, Wittenberg with Martin Luther, Emancipation Proclamation, etc.)… But I wouldn't stop there. Strangely enough, I would turn to the Almighty, and say, ‘If you allow me to live just a few years in the second half of the 20th century, I will be happy.’”

He explained that “…the reason I'm happy to live in this period is that we have been forced to a point where we are going to have to grapple with the problems that men have been trying to grapple with through history, but the demands didn't force them to do it ... (and) let us keep the issues where they are. The issue is injustice.”

April 3, 2017, the 49th anniversary of that speech, is also the first day of National Public Health Week. For those of us in public health, this truly is the best of times and the worst of times, the age of wisdom and the age of foolishness, the season of light and the season of darkness, and the spring of hope and the winter of despair. We are living longer than ever before but that progress has already been reversed in some sub-groups. Fewer babies are dying than ever before but we are falling farther behind other countries in this crucial health indicator. Tobacco use is falling while our weight is rising. Our air and water quality is generally improving but regulations are being promoted that threaten the quality of our environment and our health. And while the overall health of our society is quite good, an increasing number of our fellow citizens don’t share in our wellness. In fact, it’s these inequities that portend the worst of times to come. As Dr. King said, “The issue is injustice.”

The theme for Public Health Week is “Telling the Story of Public Health.” Our story of public health is an amazing one. It celebrates successes and it identifies the problems and challenges that exist. It honors the people who help make this world safer and healthier and it keeps us focused on the social justice and equity issues that serve as the foundation for a healthy society. The Story of Public health is based on social justice and health equity brought to life: it is the public manifestation of social justice.

For public health, as Dickens said, these are the best of times and the worst of times. As Dr. King said, there is no better time to be alive because we have the opportunity to grapple with problems that have plagued society throughout history. And, as Senator Robert La Follette, Sr, one of my public health heroes reminded us, “There never was a higher call to greater service than this protracted fight for social justice.”

Thank you to all the public health workers who grapple to make these the best of times, even at the worst of times.

Ed