At the opening general session of the American Public Health Association’s 135th Annual Meeting in Washington, DC, speakers urged the public health professionals in attendance to address the glaring inequities in the U.S. and throughout the world.

Carlos Cano, interim director of the DC Department of Health, told the audience that in the District of Columbia, a few blocks from the Capitol building, exist “some of the most glaring health disparities in the Western Hemisphere.” CDC Director Julie Gerberding stressed that as a nation, we’ve failed to address disparities not only in healthcare, but in access to opportunity. Keynote speaker Laurie Garrett, author of The Coming Plague and Betrayal of Trust and senior fellow for global health at the Council on Foreign Relations, focused on the inequities between the rich world and poor world, which are visible in dramatically different life expectancies and maternal mortality rates.

Speakers offered a range of solutions, most of them linked to this meeting’s theme of politics and policy.

APHA President Deborah Klein Walker’s overarching call was to use public health solutions to fight for social justice; within that, she advocated specifically for the current SCHIP legislation, a universal single-payer healthcare system, fully funded public health infrastructure, ending the war in Iraq and reinvesting the resources in common solutions, and signing all of the treaties regarding chemical and nuclear weapons.

Gerberding, probably aware that the president who appointed her doesn’t enjoy overwhelming popularity within the public health world, steered clear of specific policy suggestions but called for a shift in the way we approach health. Too much emphasis – and the vast bulk of resources – is placed on care for people who’ve already developed disease, she explained, and not enough on keeping people healthy and reducing vulnerabilities. Public health tends to emphasize the latter, and that emphasis needs to be reflected system-wide to establish a “health system” rather than a “healthcare system.”

Garrett identified several flaws in the way that donor nations direct aid to poor nations, particularly in sub-Saharan Africa. HIV threw aid efforts off-course, she explained; emphasis shifted from traditional public health efforts focused on water, sewage, and vaccinations to medical care delivery. The problem is that we have no model for delivering health care in poor countries, which lack health care workers and infrastructure. Most efforts have tried to expand what are essentially cottage industries, which have no experience with huge budgets and capacity building and don’t scale well.

The world is short 4.3 million healthcare workers, Garrett said, but the shortage is far more acute in poor countries because many of their doctors and nurses are following the money to the U.S. and other wealthy nations. (Garrett’s suggestion that we pay nursing school professors more so that we can train more U.S. residents spurred loud cheers.) New NGO programs focused on HIV/AIDs are also luring many healthcare workers away from their public sector jobs with 10-fold salary increases. “We don’t have an HIV crisis,” Garrett told the audience. “We have a healthcare worker crisis.” (For more on this, see Garrett’s article in the Jan/Feb 2007 issue of Foreign Affairs.)

Garrett suggests setting up an alternate system of healthcare workers – instead of expecting nurses and doctors to distribute ARVs, train community health providers, like the “barefoot doctors,” and devote more aid money to developing the healthcare workforce. She also urged the public health community not to disdain the public sector, but to embrace the mentality of investing in broad health systems and stop focusing so much on grant programs that are designed to continue indefinitely.

Having been reminded of the glaring inequities present in this city, country, and world, meeting attendees will now begin presenting and discussing approaches and solutions. Deborah Klein Walker reminded attendees of one step to take while in DC: visiting their members of Congress and advocating for public health priorities.

Liz Borkowski works for the Project on Scientific Knowledge and Public Policy (SKAPP) at George Washington University’s School of Public Health and Health Services.

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