We are either part of the problem or part of the solution
When many of us were just learning about politics and government, President John F. Kennedy at his inauguration proclaimed, “ask not what your country can do for you…ask what you can do for your country!’ Today during the Coronavirus pandemic, in no other time of our lives has this statement been more important, individual responsibility needs to respect the good of all. This pandemic is not going away. Instead it is going to continue to spread unless we individually and collectively take the appropriate actions. Fortunately, there are tools to mitigate this global virus from further spreading of the illnesses, disease and an unimaginable scale of deaths.
Those of us in public health have heard about these legends in our toolbox that are now in the press. We see it under the rubric of Non Pharmaceutical Interventions (NPI) which assumes that we cannot wait for a miracle cure to prevent or treat the virus. In public health, you treat a population not just individuals. We create methods that benefit many, not just a few. The approach is not rocket science. Instead it is quite simple as being basically the promoting, protecting and caring for the health of populations.
The tools in the public health tool box can best be explained historically by examples such as: the water you drink; the toilets you flush; the seat belts you wear; the driving you do not do after drinking; the sanitation that is part of your everyday life; the traffic lights that you stop at; and the many safety laws that you obey. Whether it is drinking and driving, suicide prevention, firearms safety, nutritional messaging, environmental protections, tobacco cessation, or the advertisements for eating drinking and staying healthy. All of these health and wellbeing approaches come from the Public Health tool box. .
The most recent versions of NPI’s are already an integral part of the new social norms for the way we now behave, for instance instead of a handshake there is a bow or an elbow bump. Instead of a smile there are face coverings and instead of close up conversations there is social distancing of at least six feet. Other pre-pandemic normal human interactions like congregating in groups over ten are substituted with virtual events, canned audiences, and zoom meetings. Yet there are several important NPI tools that need to be expanded, as well as new tools that are just now being used along with some tools that are being miss-used to the determinant of the population.
For example, accurate, positive messages to the public are all important tools and can now benefit from new forms of social media, whether it is twitter, texts, Facebook, Instagram, Google, tic toc, or other methods of getting messages out to people. Fortunately, the emphasis on accurate scientific messaging is now getting more attention in the social media by self-regulating so that facts are being communicated rather than erroneous unfounded ideas. The more that these messages get on the same page and be consistent with scientific information, the better this tool can be used to mitigate health consequences.
In addition to the self-regulating, there is a need for consistent messaging that is based on science and does not contradict facts. There are clear ways to make this happen, especially if leadership acts as one common voice at all levels of governments, Local, State, Federal, and globally. The population should not be left confused and wondering what or who to believe. Subject matter experts should take the lead so the political and business leaders can publicly reinforce and use their bully pulpit to make it clear the importance of a public health approach. Leadership is also needed from corporations, industry, and thru the brilliance of Madison avenue style marketing, saturating the media to spread the messages that will make a difference.
Here is one example of how leadership makes a difference. In the late 1970’s Cari Lightner was walking in her neighborhood and killed by a drunk driver. Her mother Candace had the passion and smarts to form an organization Mothers Against Drunk Driving. This grass roots organization of family members traumatized by the personal loss of a loved one, changed the laws and social norms about drinking and driving. MADD’s efforts resulted in laws that changed an individual’s level of drinking allowed while driving, resulted in a new message that it was notok to be intoxicated and get behind the wheel of a 2,800 pound vehicle. For us baby boomers we saw how these laws evolved over our lifetime and the norms changed over the last forty years. Social norms and laws about other safety issues have also resulted in safer automobiles (seat belts and air bags) and alcohol beverage industry messaging (responsible drinking and “friends don’t let friends drive drunk”) about how individual behavior has societal consequences.
Non Pharmaceutical Intervention includes the approach known as social marketing where you have the media create messages to promote healthy behavior and change social norms. Consider the reduction of tobacco use in our society over the last fifty years. This approach has been mostly sponsored by governmental messaging. Today for the coronavirus pandemic, we see corporate America’s advertising muscle being exercised in media about social norms during the pandemic. For instance recent Travelers insurance advertising is not promoting Insurance, but instead promoting hope with a message that says changing tomorrow starts today with the background song “don’t stop thinking about tomorrow”; or another Travelers TV advertisement showing how during a pandemic, neighbors helping each other is so very important, accompanied by the song by Bob Dylan: “If not for you”.(https://www.youtube.com/watch?v=yyouhbgAiCA)
Bank of America is messaging that this is a moment in time, this is our commencement, our next chapter; emphasizing how strong we are, that there is a crack in everything and that is how the light can get in. Hewlett Packard reinforcing that technology has never been so important, living rooms have become our conference rooms, backyards are turned into school yards, Drs come into our homes virtually and securely thru telemedicine. CBS network encouraging viewers to talk about racism, how important it is to fight racism by keeping the conversation going.
Whether it is a Pandemic or systemic racism, we hear “let us take a public health approach.” What does that mean? It means the patient is the public, that we emphasize prevention not just treatment; that you understand that behaviors and environments have significant influence on health; that you think globally and act locally; that you can tell as much about a person’s health by their zip code as you can from their genetic code; that there are social determinants that influence health and wellbeing; that you use sophisticated methods of messaging as well as technologies in delivering messages.
We are talking about our generation, boomers that are concerned when we talk about lack of leadership in dealing with two co-occurring social crisis, this pandemic and the prominent issue of systemic racism. When we do not use all the tools in the public health tool box then we will fail. We then, can only conclude failure on the part of national leadership and a clear change that needs to be made, before it is too late. With any complex health or social justice issue, all sectors of society must rise to the occasion, join together, develop clear messages, and use all the Non Pharmaceutical Interventions available.