In a new book, ME vs. US, author Michael Stein — a primary care physician, researcher, and chair of the Department of Health Law, Policy, and Management at Boston University School of Public Health — explains why public health constantly loses out to medical care for attention and resources. Yet, public health holds the solutions to our most concerning health crises, from Covid-19 to obesity to climate change.
The US spends on average $11,000 per citizen per year on health care, but only $286 per person on public health. Stein offers eight reasons why. These include that public health often offers few opportunities for private entities to make money; its successes are incorrectly framed as cases prevented rather than as saving lives; and that it is often thought of as government work on behalf of only low income families.
In the end, he argues, health has to be recognized as a communal experience, not merely a private one. Medical systems, still dominant, need to embed public health thinking and practice in their functions. At the individual level, doctors need to help patients to think of their environments as drivers of health.
At the policy level, investments in our youngest children yield large value. There is an enormous “bang for the buck” associated with a range of programs for children, from early education to child health insurance and college expenditures. Additionally, Federal funding might move some of the dollars going to genomics (ME programs) to a new emphasis on implementation of effective prevention programs (US Programs). Health requires government to act as an authority that balances the ME and US perspectives for there to be any chance of success in a shared future. Health needs to be thought of as a common good.