The final Future of Public Health symposium took place on May 2 in Snyder Auditorium with a discussion of "Crossing Boundaries: Perspectives from Science, Economics, International Health and Public Opinion." The Robert Wood Johnson Foundation provided funding.

The International Health Perspective

Health in developing countries can be improved through mutually beneficial international collaborations, said Adetokunbo Lucas, an adjunct professor in the Department of Population and International Health.

A native of Nigeria, Lucas said that developed countries tend to make overly simplistic statements about poorer countries. He urged that people be more aware of the diversity, complexities and changes in other societies.

Disease distribution varies within nations, he noted and showed a map of Nigeria indicating the presence of different diseases specific to certain areas. Meningitis, for example, is found mainly in the north whereas "yaws," a bacterial disease that causes bumps on the face, hands, feet and genitals, is more common in the south. Even the prevalence of disease types is changing in developing countries. At a time when conditions such as leprosy and guineaworm are coming under control, rates of diabetes and heart disease are increasing.

When dealing with health in developing countries, the main issue is to achieve good health at low costs, said Lucas. Here is where he sees an opportunity to create international collaborations that are mutually beneficial to developed and developing countries. Such collaborations are more sustainable than those motivated by factors such as compassion or fear of disease spread, he said.

Lucas observed that developed countries have already benefited from research done in developing countries. For example, study of the disease kuru decades ago in New Guinea has led to a better understanding of particles called prions, which have been implicated in other conditions such as "mad cow disease."

Lucas ended his talk by offering a new definition of international health–it is "born of fear, nurtured by compassion and sustained by the realization of mutual benefit."

The Science Perspective

There are viable opportunities to build capacity in developing countries through sustainable development, especially after September 11th, said Bruce Alberts, president of the National Academy of Sciences (NAS), a service organization established by the US Congress in 1863 to advise policymakers.

In the hundreds of reports that the NAS has delivered, one of the most important is called "Our Common Journey: A Transition Towards Sustainability," said Alberts. Why? Because scientists project that by 2050 the earth will be home to nine billion people. Developed nations need to aid the training and support of scientists and engineers in developing countries to address issues related to the burgeoning world population, but there are several threats to global science, said Alberts.

Researchers in developing countries may have little or no access to up-to-date scientific literature. To address the problem, some publications are now offering their articles for free after a few months, a practice that Alberts supports.

Excessive intellectual property protections hinder science, he said, curtailing use of research tools.

A failure to harness the idealism of young scientists also negatively affects research, he said.

Now, post-September 11th, there are new opportunities to improve the state of science in developing countries and bring people a sense of hope about the future, said Alberts. Developed countries have grossly underinvested in supporting other nations, affecting the stability and effectiveness of the world order, he said. He quoted Kenneth Quinn, former US ambassador to Cambodia, who said that road-building, information and education managed to do in a short time what an army failed to do in Cambodia for years: bring down the Khmer Rouge.

Alberts described two academies created over the past few years that aid global science. The InterAcademy Panel on International Issues is an international network of 85 science academies that helps members participate in science policy discussions beyond university classrooms and research laboratories. The panel helps scientists have voices in policymaking in their own countries, said Alberts.

The InterAcademy Council (IAC) was established in 2000 by national science academies to provide advice to bodies such as the United Nations.

The Economics Perspective

The value of medicine in improving health over time has been underestimated, said David Cutler, professor of economics and John L. Loeb Professor of the Social Sciences at Harvard University. Cutler entitled his talk, "Medical Care vs. Public Health: Which is More Valuable?" He focused exclusively on health in developed countries.

Public health saw tremendous success in the first half of the 20th century, dramatically increasing life expectancies through the prevention of infectious diseases and other measures. Life expectancies continued to increase in the latter half of the 20th century, but Cutler attributed that success mainly to medical advances rather than public health. Specifically, he said that better care of low-birth-weight infants and decreased deaths from cardiovascular disease (CVD) account for much of the improved life expectancy rates in the past few decades (CVD mortality rates have decreased from a combination of high-tech interventions, pharmaceuticals and changing behaviors, such as quitting smoking, he said).

That is not to say that public health is unimportant, noted Cutler. From an economic standpoint, public health, with its emphasis on prevention, provides a bigger return on investment dollars than medicine.

The link between public health and medicine needs to be strengthened, he said. He asked why some campaigns, such as curbing drunk driving, are successful while others, such as preventing obesity, fall short? The answers may lie in improving the symbiosis between medicine and public health, two seemingly diverging fields, he said.

The Public Opinion Perspective

Humphrey Taylor, chairman of the Harris Poll, offered several insights into the way that Americans perceive public health.

In a 1996 poll, seven percent of Americans claimed they knew what public health was. In other polls, the majority of Americans revealed an understanding of what prevention is, and they perceived that the country faces major health problems due to health-related behaviors. However, a 2000 poll uncovered some misperceptions. The people surveyed then thought that fewer Americans will be more apt to die in the future from diseases such as diabetes than from homicides, suicides or gunplay, a conclusion that is not supported by statistical trends.

In 1999, people polled said that more money should be spent on disease prevention and health care promotion than on treatments.

In January of this year, survey respondents said that strengthening the public health system was an important issue facing Congress.

Taylor offered some suggestions on how to get public health messages out to Americans. Public health professionals should appeal to the hearts as well as to the heads of people, he said. Intellectual arguments are not enough. People need to feel empowered about how to prevent diseases such as diabetes.

Don’t underestimate the power of greed, said Taylor. The public sector may want to form alliances with private groups who can financially benefit from spreading a public health message.

Make public health messages voter-friendly and bipartisan so that politicians will look good by supporting them, he said.

Public health professionals should also work more effectively with the media, he concluded.