Expanding our view of health

BU public health dean Sandro Galea says we need a broader conception

WHEN IT COMES TO the state of our health, there is a glaring disconnect in the US, says Sandro Galea. We spend far more on health care per capita than any country, yet we’re far less healthy than those in many other developed countries as measured by all sorts of indicators, including life expectancy.

Our cutting-edge new medical treatments and drugs are wonderful, says the dean of the Boston University School of Public Health. But he says we are focusing on them to the exclusion of all sorts of factors in everyday life that have a profound effect on health. Galea joined John McDonough and Paul Hattis for the latest installment of “Health or Consequences” on the Codcast, where he unspooled his take on how we’re missing the boat when it comes to promoting good health.

A native of Malta who trained as in emergency medicine in Canada, Galea described his migration from work as an acute care doctor to the field of public health. When treating patients on the frontlines of medicine, “you are sharply aware of what really shapes health,” he said. “What drives health is not so much the immediate experience, but a lifetime of experiences in the world around people and the context in which people live.”

That broader view takes into account social and economic factors, from housing to transportation to exposure to gun violence, environmental policy, and the sort of dietary habits being promoted.

The author or coauthor of more 800 scientific articles and 13 books, Galea sets out his broad take in a new book, due out in May, titled Well: What We Need to Talk About When We Talk About Health.

Galea says many health indicators in the US started deviating from those of other advanced countries in the 1980s. “It really speaks to a shift in the past 30, 40 years in this country toward a very particular conception of a clinical, medical curative-first approach that really runs counter to this idea that our health ultimately is generated by the world around us,” he said. Galea ties the troubling trends in US health indicators to the “ascendance of what is broadly called neoliberal economic policies,” which “ultimately put a lot more confidence, a lot more faith in individual market-driven forces and started this systematic disinvestment from a more central investment in resources that keep us all healthy.”

Galea questioned the state health policy focus in recent years on keeping health care cost increases in check. “I think we’re missing the whole point,” he said. Despite the state’s “relative enlightenment,” he said Massachusetts “is also behind in wrapping its brain around this simple notion that to generate health we need a careful look at all these other non-health factors — that ultimately these factors all matter to health.”

Galea said he celebrates the gains in coverage from the Affordable Care Act and the tremendous advances from new medical treatments and drugs, many of them developed in the Boston area.

“My quibble is with the fact this is all we’re doing,” he said, referring to the neglect of public health policies and can keep people from needing access to those cutting-edge new treatments to begin with.

“Why is it that every headline in the country is not about the fact this is the biggest downturn in our life expectancy since the 1918 flu pandemic,” he said of data showing a drop in US life expectancy for three years in a row. “That should cause serious alarm,” he said.

All of that said, Galea points out the importance of taking a long view of the state of health.

Meet the Author

Michael Jonas

Executive Editor, CommonWealth

About Michael Jonas

Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.

Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.

Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.

Michael lives in Dorchester with his wife and their two daughters.

About Michael Jonas

Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.

Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.

Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.

Michael lives in Dorchester with his wife and their two daughters.

“I consider myself a radical optimist,” he said. “We can’t forget that for most of human existence life expectancy was around 40.” It has jumped to about 80 in many countries over the last 150 years, he said.

“So I would much rather be living today than at any other point in human history,” he said. “It is a real privilege to be able to say from that vantage point, how can we get even better? Part of what’s going on right now is we have become complacent, and I don’t think we should allow that to be the case.”