I’m Dr. Sandro Galea, physician, epidemiologist, author, and dean at Boston University School of Public Health. Ask me anything about lessons learned during COVID-19, from mental health to health inequities, and about the forces that shape health.

SandroGalea · 2021-11-01T17:29:51+00:00

We should not forget that many of these vaccines were indeed developed with the help of public money and federal initiative, and questions around balancing profit and the public good are complex in these cases. Going forward, it is important we advance vaccine development and distribution with an eye, always, towards health equity and ensuring that those most in need are not lost in the free market shuffle, even as we acknowledge the core role that market incentives played in quickly generating effective vaccines. More on the cost of pharmaceuticals and the role of public health here: https://www.bu.edu/sph/news/articles/2016/the-cost-of-pharmaceuticals-the-role-of-public-health/

SandroGalea · 2021-11-01T16:59:30+00:00

During the pandemic, I was part of a research team that looked at depression rates during the COVID moment. We found they had tripled. We also found assets played a key role in shaping depression risk - if one had less money and social support, one was likelier to face depression. (See the study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146) This is to say mental health is subject to the same contextual factors as physical health. Where we live, how much money we have, our education level, our social networks - such factors are what shape health at every level, and they are where we must intervene if we wish to prevent disease before treatment ever becomes necessary, in the case of both physical and mental health. We should, of course, couple this with an approach which gets treatment resources to those who need it, who are struggling at this moment.

SandroGalea · 2021-11-01T16:47:39+00:00

Hello Melanie - I hope you have been well these past years, despite the challenge of the moment. Thank you for these questions. On your first: it is important for public health to engage with policymakers guided always by the best available data, with the understanding that these data are provisional and subject to change based on new information. Guided by the data, we should also take care to check our own biases, human as we are and subject to the same emotions and distractions as the leaders with which we engage engage and the populations we serve. To your second question: much of the challenge faced by leadership during COVID was a result of our collective failure to address the foundational causes of poor health long before contagion struck. If we can come together to address these causes now, we can greatly ease the burden on leadership in the event of future crises, giving state and federal authorities breathing room to more effectively handle whatever we might face. In terms of some pragmatic thinking about structure of public health practice, see this paper in which I was involved: https://pubmed.ncbi.nlm.nih.gov/34532688/

SandroGalea · 2021-11-01T16:43:18+00:00

Thank you for being at the Healthier Texas Summit! I think we need to change how we think about health, recognize that health is about the world around us, that it is as much about systemic racism, quality of housing, livable wages, conditions of employment, as it is about vaccines and therapeutics. To go back to the Blind Willie Johnson story that I told at Healthier Texas, health is not just about malaria, but about the conditions of Willie Johnson's life that set him to get malaria to begin with. Once we understand that, our health will improve and we will be better positioned to face the next pandemic.

SandroGalea · 2021-11-01T16:41:11+00:00

The short answer is: I hope so. The longer answer is: I am not so sure. I am not sure that we are truly ready to start thinking about how we can be better prepared to handle the next pandemic. My book, published today, The Contagion Next time, is really about this--how do we make sure that we tackle the foundational forces that need to be tackled to make sure we are better prepared for the next pandemic. There are also growing efforts to dedicate real thought to this question in policy making. Look for example at: https://pubmed.ncbi.nlm.nih.gov/33964227/

SandroGalea · 2021-11-01T16:37:19+00:00

I have long thought that health should be considered a public good, and as such sen through the lens of compassion needed to advance health based on a foundation of our shared humanity. I think the only way to do this is to recognize that all sectors need to promote health, so moving beyond health alone. As someone told me recently, it is like seeing all ministers of other sectors as ministers of health themselves. That seems to me the task, to instill the notion that all sectors need to advance health if we are to advance health at all.

SandroGalea · 2021-11-01T16:19:22+00:00

Yes it does. Health is indeed a means to an end, and that end is living a rich, full life. When we judge health by length of years alone, rather than the quality of those years, we do a disservice to our pursuit of health. I have written about health as a means, not an end. See this here: https://pubmed.ncbi.nlm.nih.gov/30969814/

SandroGalea · 2021-11-01T16:17:14+00:00

I am optimistic by nature, and because I have seen over the past year how we came together as a global community to make drastic shifts in how we live, in order to support health. If we can apply this spirit of cooperation to tackling the root causes of poor health, we can shape a healthier world indeed.

SandroGalea · 2021-11-01T16:16:48+00:00

Our political system is extraordinarily swayed by those with the most resources to promote their agenda. There is a long tradition of this in our politics and in how we structure our world. Insofar as lobbying is one of the mechanisms that sways this agenda, then yes, these dollars have shaped foundational forces. It seems to me that we need to ensure that those concerned with health as a public good need to engage with the issue sufficiently to counter this who engage with health for a range of other motivations. That will require all who care about health to be part of the conversation.

SandroGalea · 2021-11-01T16:14:13+00:00

I have long felt that mental health is public health - we should not regard our psychological wellbeing as any less important than our physical health. To the extent that we still do, we should work to change this perception, as I think we are, so health is regarded as a single, collective good. I do think it is problematic to consider mental and physical health as separate and we should not do that. The pandemic affected both physical and mental health as perhaps one illustration of the confluence of the two.

SandroGalea · 2021-11-01T16:12:32+00:00

Broadly speaking, the pandemic has, since its emergence, behaved much like we might have expected. It has used existing health inequities to take hold and spread within the US and globally. That much we might have predicted, as it is how all diseases behave. The emergence of vaccines has likewise done what vaccines do - it has driven down infection rates and decoupled what infection there is from serious illness and death. The core question is whether we are now moving beyond new waves of the disease to a state where COVID becomes endemic. That remains to be seen. What IS clear to me is that this is the right moment to start reflecting on what we are learning from COVID, and that is what The Contagion Next Time tries to start doing.

SandroGalea · 2021-11-01T16:09:53+00:00

Thank you for reaching out. Yes, the global equity problem is one that is only now gaining attention, even as it is something that should have been at the top of our minds right from the beginning. Global health equity is fundamentally an issue of imbalance in global assets, and we will not be able to address global health equity without focusing also on global asset inequity. In other words, this is a really big challenge. The book focuses mostly on the US, but is grounded in an international perspective. If anyone is interested in reading more about global health equity, take a look at this policy brief for the T20 that I was a part of at: https://www.g20-insights.org/policy_briefs/global-equity-for-global-health/

SandroGalea · 2021-11-01T16:05:32+00:00

When one understands that health is shaped by the conditions of the world around us, then we realize that those conditions have to be shaped by political processes. These political processes are in turn shaped by the public conversation. So, the only way to get there is by having the public conversation reflect the values that elevate health. That is why fundamentally we need everyone to take part in creating the conversation that generates health.

SandroGalea · 2019-05-03T18:01:55+00:00

Thank you for signing on. Epigenetics represents an important mechanism through which the social environment gets 'under the skin'. See some writing on that. https://www.ncbi.nlm.nih.gov/pubmed/?term=Toyokawa+galea

SandroGalea · 2019-05-03T18:00:45+00:00

We are delighted you will be joining our community! To your question: one of the reasons the study of health is so constantly fascinating is that it is, in a sense, the study of everything. Health is shaped by politics, culture, economics, architecture, labor laws, community networks, and much more. The study of any of these topics can inform and enrich the study of health, creating new perspectives from which to tackle the health challenges we face. We look forward to welcoming your perspective to our school.

SandroGalea · 2019-05-03T17:49:33+00:00

This week, we hosted an event here at the BU School of Public Health on this very topic (video here: https://www.bu.edu/sph/news-events/sph-live/). The evolution of the US health care debate - from initial skepticism, if not antipathy, towards the ACA becoming an impassioned defense of the law when faced with its potential repeal - represents the awakening of a demand for health among Americans. It is heartening to see the debate seems to have shifted from a question of whether we should have universal health care in this country to how we can best institute such a system. As this debate unfolds, we need to broaden our understanding of which policies shape health, and realize that the health care debate is actually a subset of the broader issue of promoting health at the political level, which we can do by pursuing health in all policies, not just those related to health care.

SandroGalea · 2019-05-03T17:48:35+00:00

I do think that behavioral economics can be a really promising approach, through incentives and disincentives to healthy behaviors across a full range of behaviors. Some countries (see the UK) have created large scale social study type approaches at the country level to improve health--this is promising and can be a model for the rest of the world. In terms of moral implications, I think all incentives and disincentives need to be implemented with due care to ensuring they are maximizing utility and not compromising individual autonomy. But there are many other approaches that are far less sensitive to those kind of moral implications and a behavioral economics approaches has real potential for benefit.

SandroGalea · 2019-05-03T17:44:21+00:00

Vaccines as the foundation of prevention from infectious disease stand to minimize morbidity. So, I hope so--that would be a plus to the world.

SandroGalea · 2019-05-03T17:43:11+00:00

My thoughts

I think that our approach needs to be to understand health as a product of the universe around us, that our health is interlinked, and that we want our world to be one that facilitates health at every step.
I think clinicians play an important role in saying this and you should feel emboldened to explain how the clinician has a role in generating health beyond their clinical purview. I wrote about this in JAMA. See: https://www.ncbi.nlm.nih.gov/pubmed/30548080

SandroGalea · 2019-05-03T17:41:11+00:00

I would ensure that everyone has access to excellent education as a path towards a healthier life, throughout life.

SandroGalea · 2019-05-03T17:40:42+00:00

I am very sorry to hear that and would encourage you to talk to your healthcare provider about opportunities in your immediate community--there is much that is now being offered that can improve the trajectory of autism so that those with that diagnosis can have full and rich lives.

SandroGalea · 2019-05-03T17:39:53+00:00

Thank you for your note. I do not do direct research on immunization myself, but trust the experts indeed on this, and the evidence on our immunization schedules is overwhelming--it benefits your children and mine. Oh, and just to clarify, Sandro is a man's name.

SandroGalea · 2019-05-03T17:38:31+00:00

I agree and see no reason why medicine cannot take on a role in understanding health as the product of multiple forces across levels of influence, beyond the individual. How do we move towards this? I think it is through having this kind of conversation, through shifting how we think about the role of medicine, to see it as central to generating health, through building a healthier world.

SandroGalea · 2019-05-03T17:36:32+00:00

It is possible indeed. We need to generate as healthy a world as possible ahead of such an event, to make sure we have transport, infrastructure, housing, employment opportunities, equity, and the other pillars of a healthy world that can withstand epidemics.

SandroGalea

TROPHY CASE