When I served as health commissioner in Baltimore, the Mayor would hold regular community meetings known as “Mayor’s Night Out.” The rules were simple: Any city resident could come and ask any question on his or her mind.
“Can we have more opportunities for bulk trash pickup?” someone might ask. The Mayor would turn to the Director of the Department of Public Works for an answer. She would refer questions on crime to the Police Commissioner and those on abandoned buildings to the Housing Commissioner.
Most nights, no questions came my way. “Health pitches another shutout,” the Police Commissioner would whisper in my ear as we left.
When I was new on the job, I was relieved to stay below the radar. But over time, I began to wonder why so few people were asking about health. The city faced a broad range of health challenges, and residents had every reason to ask what their Mayor was doing about them. My confusion eventually gave way to frustration as I realized that the topics raised at these community meetings were the ones that commanded attention inside city government.
People cared about trash, crime, and housing enough to engage with the political process. Why not health? The gap could not be pinned on the news media. Local media routinely covered our reports on infant mortality, cardiovascular disease, drug overdoses, and other relevant health topics. Yet those most affected by health concerns were often not able to attend Mayor’s Night Out—or if they did come, they always seemed to have a more pressing problem to mention.
The 2016 Presidential election has reminded me of Mayor’s Night Out. In addition to polls and gaffes of the day, the campaign largely centers on core economic concerns, terrorism, and foreign policy issues—the issues that surveys say are the 3 most important to voters. When the unemployment figures are revealed, or a terrorist attack happens, there is a buzz about the implications for the candidates. Most days, health pitches a shutout.
Pressing Health Issues
That’s not for a lack of pressing health issues. The Zika virus is spreading in Puerto Rico and Miami. The fentanyl crisis is claiming thousands of lives. Major changes in health care are transforming the practice of medicine.
There is, of course, the requisite campaign standoff over the Affordable Care Act, with health care the fourth most important issue to voters. The Democratic ticket wants to make the law better, while the Republicans want to repeal and replace it. Few details beyond these basic positions enter the national dialogue. Only very rarely can the voices of those who would be profoundly affected by major health care policy changes be heard.
Again, I can’t fairly place the blame on the news media. Both print and television news regularly cover important public health topics. When health does enter the fray, such as when major candidates called the childhood vaccine schedule into question, the matter drops from political discussion far more quickly than when a candidate calls the NATO alliance into question.
Two years into my tenure as health commissioner, the Health Department released reports detailing the life expectancy by neighborhood in the city. Our major finding was more than a 20-year gap in life expectancy across neighborhoods. We sent the reports to every community group we could find.
After the release of these reports, “Mayor’s Night Out” became a different experience for me. the Mayor would say, “I’ll let the health commissioner answer why heart disease is such a problem around here” or, “The health commissioner can respond to your question about whether a new bus line would help people access healthier food.” Some attendees expressed their frustration that more was not being done to advance health in their part of town. One night, sitting behind the Mayor, I was even asked more questions than the police commissioner.
Seeing the Connection
I came to the conclusion that what affects people’s lives drives local politics, and it’s often hard for people to see the connection between day-to-day worries and struggles and health. Most public health challenges are not at the top of people’s minds. This is why it may take crises, such as an outbreak of measles at Disneyland, or the spreading Zika virus, to prompt significant public engagement and political pressure for policy change.
In lieu of a health crisis—which by definition, would be preferable to avoid—it’s important for individuals and communities to be able to access local information that drives them to action. Drawing specific lines between health and economic policy can accelerate local engagement. In a recent article on politics and public health, Edward Hunter, MA, a former Centers for Disease Control and Prevention official who now serves as president and chief executive officer at the De Beaumont Foundation, Bethesda, Maryland, calls on health officials to “[p]rovide information relevant to real-world decision making by elected officials, including economic and other implications of proposed public health measures.”
When voters are engaged and passionate about health in their own communities, we’ll see much more meaningful political discussion of health policy—and far greater progress.
About the author: Joshua M. Sharfstein, MD, is Associate Dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is a consultant for Audacious Inquiry, a company that has provided technology services and other support to Maryland’s Health Information Exchange. A pediatrician, he lives with his family in Baltimore.
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