When us health reform supporters claimed that last year's reform law had the potential to shift the paradigm from sickness treatment to health and wellness care, we weren't exaggerating. The administration and health reform advocates were ridiculed for backing this strategy that is essential for both a healthy population and in order to control health care costs. As President Obama says, however, cynicism is a sorry kind of wisdom, and reformers aren't much interested in it. Instead, the administration is moving forward with the country's very first National Prevention Strategy.
The National Prevention Strategy is rather comprehensive. But what stood out for me is that the understanding that when we are talking about prevention, we are not merely talking about reducing visible at-risk behavior of individuals but improving health in workplaces, communities and homes. As a country, we have been talking about tobacco use, drug and alcohol abuse, healthy eating and exercise, and injury prevention for a good deal, and all those things are essential and are addressed in the strategy. But prevention and healthy living are also integrally linked to what I believe are areas often missed in the national discourse (and frankly, kitchen table discussions) over preventive care: Environmental causes and health disparities in communities, reproductive and sexual health, and mental health and emotional well-being. It's those areas that I will be focusing on today.
Beyond the Usual: Environment and Health Disparities, Reproductive and Sexual Health, and Mental Health
When we think of healthy communities and preventive services, the things that most commonly come to mind are preventive screenings at your doctor's office, prevention of smoking and drug abuse, and healthy eating and exercise. But today, I want to talk about things that our society often skips when talking about healthy communities and prevention. We almost always focus on physical health, and in many cases, mental health is still a taboo. As someone who has survived clinical depression, this subject is near and dear to my heart. For some reason, we also seem to skip right over sexual and reproductive health, lest that raise unpleasant political topics like birth control and abortion. Last but not least, the disparities in diseases and health ailments in different communities (ethnic, gender, economic). For example, whereas more ethnic communities are affected by unhealthy living conditions, more native Americans and non-Hispanic Whites commit suicide.
Environment and Housing
Our environment is an essential part of health. Clean water and clean air help us live healthier and longer. Accessible public parks help us and our children stay active. Those are of course part of the prevention strategy. This strategy calls for increased monitoring and reporting of our water supply and water related risks to prevent contamination of the water supply. For clean air, it calls for improved fuel efficiency standards, the use of clean energy and cleaner fuels, and providing transportation choices that reduces dependency on our cars.
What we miss sometimes when we talk about healthy environments, though, is an environment we spend a lot of time in: our homes. In the richest country on earth, adequate housing is a luxury many do not have, and this problem is starker in ethnic communities.
To this end, the National Prevention Strategy commits the federal government to investing in transportation, housing and environmental protection, tightening environmental standards to reduce pollution and support healthy housing, promoting mixed-income neighborhoods with housing subsidies, and supporting community safety measures. It calls on state and local governments, community organizations and businesses, and individuals to help this process with a diverse workforce, incorporating healthy living standards as part of communities and workplaces, and adopt practices to reduce pollution.
Reproductive and Sexual Health
Okay, so the rabid Right is really not going to like his part. They may question whether there is such a thing as "sexual health" (OMG, it has "sex" in it! RUN!!!), but the National Prevention Strategy is an evidence-based program, and you cannot have a wholesome approach to prevention and health without addressing reproductive and sexual health, given that the US ranks 45th in infant mortality rate, finishing only slightly ahead of Belarus. A national health and prevention strategy can - and in this case does - address services like contraception, comprehensive and medically accurate sex education (yeah, not "abstinence only" - told you it was evidence based), pre and post-natal care, preventing domestic violence, screening for sexually transmitted diseases (including and especially for adolescents) and early detection of HIV.
Some of the commitments of the federal government on reproductive and sexual health (with my impression of right wing reaction in the brackets):
Mental and Emotional Health
- Increase access to comprehensive preconception and prenatal care, especially for low-income and at-risk women. [What? Prenatal and preconception care for poor women???? Soshalizm!!!]
- Research and disseminate ways to effectively prevent premature birth, birth defects, and Sudden Infant Death Syndrome (SIDS). [Why do you wanna play God?]
- Support states, tribes, and communities to implement evidence-based sexual health education. [Omg they're going to tell kids about sex in school. If they didn't do this, teenagers would never know about sex and never be horny!]
- Promote and disseminate national screening recommendations for HIV and other STIs. [See, we told you the government is in on the homosexual agenda!]
- Promote and disseminate best practices and tools to reduce behavioral risk factors (e.g., sexual violence, alcohol and other drug use) that contribute to high rates of HIV/STIs and teen pregnancy. [Again, we told you the government is in on the feminist homosexual conspiracy!]
- Encourage HIV testing and treatment, align programs to better identify people living with HIV, and link those who test positive to care. [Fine but only if the people with HIV agree to seek Jesus.]
- Research and disseminate effective methods to prevent intimate partner violence and sexual violence. [What are you talking about? What don't you understand about the man being the boss?]
For all the jokes above, now we go into an area that is no laughing matter, literally. Mental health is a subject close to my heart, as a survivor, as I said above. The prevention of mental health problems, like the prevention of physical health issues, starts at an early age. Positive and lifelong human connections, positive parenting, a healthy home free of alcohol and drug abuse as well as of domestic violence or verbal abuse, and a community sensitive to the diversities and needs of our young people all come into play when we are talking about mental and emotional well-being.
Without going into medical details, from my personal experience, I can tell you that the clinical depression I suffered from as a 20-year-old was caused by many factors, but primarily the lack of reliable friendships (I used to be a bit of a loaner back then) an environment where I wanted to but did not dare come out as gay, and the drastic transition from high school to a big research university where I was lost. There is also something to be said for lack of exercise, and a healthy mind in a healthy body.
So I understand three things about mental health at a very personal level: first, that it hurts as much as or more than physical ailments. Second, the stigma surrounding mental health keeps people from seeking treatment or expressing their own health concerns. Third, and perhaps most importantly (because it connects the previous two points), I know that mental health ailments heal, just like physical injuries, with the proper treatment, and in many cases can be prevented by taking the proper measures.
Mental health is a concern among all of the population, but much more dominantly among men. Look at how much higher the suicide rate is for men than women in every racial and ethnic community:
Note that the dominant suicide rates for men could be tracked partially with a cultural dogma: our social construct of masculinity, which engenders an expectation that men ought not show emotions or be emotional, confuses "toughness" with non-expression of feelings, and an tells people to "man up" when they show an emotionally soft side. This problem is even worse among gay men and gay youth.
The national strategy of emotional bonds and connections, reducing household violence and abuse, coupled with a commitment to make mental health services and early detection available along with physical health, can go a long way towards preventing mental health problems and suicides. It can help people live healthier, more productive lives and build more productive relations and communities. The positive connections and community engagement will also make those at risk more comfortable to talk about their emotional well being, and being able to talk about it is nearly half the problem.
The above wasn't a comprehensive discussion of the full National Prevention Strategy. I will try to provide more specific area analyses later, but I hope you will forgive my narrow focus for today on three specific areas I just wrote about. I outlined them because, as I said, I think it's important to highlight the areas we talk little about while discussing a prevention strategy. It both highlights the administration's commitment to a comprehensive strategy that includes little-discussed but vitally important areas of health, and underscores the need for preventive services (both as a whole and in these targeted areas).
From something as basic as adequate housing to things as complex as mental health and as politically charged as sexual health - all of it has to be a part of the solution - evidence-based solutions. Just as the President and the administration is committed to providing national leadership, each of us must be willing to act in our communities. Reach out to pregnant teenager; don't shun her. Ask your neighbor who's depressed due to a job loss (or whatever reason), what you can do. Sometimes it will be just providing them company. Ask an elderly person what they need. Get involved in your local housing authorities to find out what they are doing about housing parity and affordable, safe housing. Each of us can do a little. And when each of us does a little, big things happen.