One day when he was 9 years old, Amartya Sen’s worldview changed. First one, then thousands of starving people streamed through the campus of his elite school on the way to Calcutta in search of food.
The Bengal famine of 1943 was on its way to killing three million people, yet Sen was completely unaware of it. No one in his social circle had even been affected. (Sen later learned that an inflationary surge in food prices, not vast crop failures, caused the famine.) This experience taught the future Nobel laureate in economic sciences how systemic social inequalities have powerful effects on human life and death.
I remembered Sen’s story as I was contemplating what to say about death for this special issue of the magazine. His intellectual awakening exemplifies a familiar tension in public health.
While we take a 30,000-foot, population-level view of mortality so that we can see patterns and advocate for policies to save millions of lives, we also recognize that each death is a profound experience for those who are left behind. The effect of a loss of a parent on the future health and wellbeing of a child, for example, can be overwhelming. And likewise the loss of a child exacts a terrible toll on parents and siblings.
It is this “right-brain” recognition that such data represent suffering and lives lost that drives public health professionals’ passion for prevention, while we use our “left-brain” analytic ability to interpret numbers and synthesize data. This combination of analysis and compassion strikes at the heart of what we’re trying to do in this special issue of the magazine. We examine the fragile balance between public health’s strengths in measuring and changing the great societal influences on health and the realization that each data point represents a human life.
As you read the articles in this issue, I know that you will be struck by the “right-brain” images, the stories of personal suffering and loss. For me, the article on “near misses”—women who almost die during childbirth—resonated incredibly because it mirrored what my first wife experienced during the birth of our first child. We were fortunate that the availability of intensive care and 15 units of packed red cells saved her life, an opportunity that women in many low- and middle-income countries do not have.
When I put on my epidemiologist’s hat, however, I know that the major influences on health and longevity may have more to do with the societies in which we live than the quality of health care we receive. Important drivers of the health of populations include factors like where we are born, what environmental exposures we experience, what our parents’ income and educational levels are, where we work, how effective our government is in responding to its people’s health needs, and how much autonomy we have in life. For example, my risk of getting malaria in the U.S. is nil because I’m fortunate to live in a society that has eliminated it.
On the other hand, I am at much higher risk of being overweight and obese living here than in some other societies because our policies promote cheap, calorie-dense foods and a built environment that inhibits walking and other physical activities as part of our daily routine.
Public health professionals, however, do not usually have the power to create jobs or change societal infrastructure. Instead, we generate evidence for how to improve health and prevent unnecessary death. These insights bring with them the responsibility to advocate for social and policy changes that make it easier for people to enjoy good health and make the right choices to avoid disease.
Our response to the recent unspeakable tragedy in Newtown, Connecticut is a poignant example of this approach. Daniel Webster, Jon Vernick and colleagues at the Johns Hopkins Center for Gun Policy and Research, with the strong support of President Ronald J. Daniels and faculty and staff from the School and the University, convened a Summit on gun policy just one month after the Sandy Hook school shootings. They brought together experts from around the world, including Mayor Michael R. Bloomberg, to highlight the evidence to prevent gun violence and to inform legislation being considered in Washington. In addition to presenting more than two-dozen policy recommendations at the close of the Summit, the experts worked with Johns Hopkins University Press to publish a book of research and legal analysis just 10 days later. It was a remarkable effort that demonstrates our commitment to bring science to decision making.
Death is an inevitable part of life. But death from preventable causes like cervical cancer, early heart disease, or gun violence is a tragedy. Whether expressed in dry, cold numbers or by the images of first graders smiling at the camera for their school picture, these tragedies will continue to motivate us to use both left-brain science and right-brain passion to improve human health and prevent unnecessary death.
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