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Open Mike

Politics May Be a Dirty Word But It's Also an Essential Means for Improving Health

A Note from Dean Michael J. Klag, MD, MPH ’87 • Photography by Chris Hartlove

“Medicine is a social science, and politics is nothing else but medicine on a large scale.” —Rudolf Virchow

In 1848, government officials in Berlin dispatched a 36-year-old physician to Upper Silesia. They sent him to investigate a typhus epidemic and a famine. The conditions he found were horrific. In one district, 10 percent of the population died in a single year.

The officials wanted a report on what was being done and what could be done. They got much more than that from Rudolf Virchow.

He had a succinct and direct prescription for helping the people: “Full and unlimited democracy.”

The authorities had an equally direct response: They fired him. Virchow pursued a groundbreaking career in research, ultimately shaping modern thinking about the mechanisms of disease and earning the title of “Father of Modern Pathology.” (Our founding dean, William Henry Welch, made the pilgrimage to Berlin to learn from him.) For Virchow, however, it wasn’t enough.  He sought public office and was elected to the Berlin City Council and the Prussian Diet. He wanted to improve human health by shaping government policies based on evidence.

Virchow saw beyond the cellular level. One of the first proponents of social medicine, he understood that the major determinants of health are social: where we live, the jobs we hold, the air we breathe and the water we drink. To advance public health by making a difference on those levels, you need enlightened government policies. Who better to enact those policies than public health experts?

Our students learn to see the “big” picture. They acquire a diverse set of skills tailored to their career aspirations, but all have a deep understanding of the determinants of a population’s health—such as socioeconomic and environmental factors, education, the autonomy to make decisions about how to live and access to resources, among others. As Virchow wrote after the typhus epidemic, “If medicine is to fulfill her great task, then she must enter the political and social life. Do we not always find the diseases of the populace traceable to defects in society?”

Our students follow many paths once they leave the School: research, academia, health agencies, NGOs. A few, however, choose Virchow’s path.

The past primary election saw a bumper crop of our alumni run for office. Val Arkoosh, MD, MPH ’07, ran for Congress in Pennsylvania’s 13th district. Jordan Cooper, MSPH ’12, competed to be a state delegate in Maryland, while Clarence Lam, MD, MPH ’10, won his primary and is running for a seat in Maryland’s House of Delegates. And Andrew Harris, MD, MPH ’95, has been in the U.S. House of Representatives since 2011 and is running for reelection. In addition, one of our adjunct faculty, Dan Morhaim, MD, has represented Baltimore County in the Maryland Legislature since 1995.

Rudolf Virchow lecturing Bettman Collection/Corbis Images

Of course, our School is named for Michael R. Bloomberg, who personifies good governance in the advancement of public health. As mayor of New York City from 2002 through 2013, he and his team relied on data to generate policies that improved the health of millions. His leadership in banning smoking in public places has been credited with preventing at least 10,000 smoking-related deaths among New Yorkers. He also led the trans-fat ban and enacted regulations that chain restaurants post calorie amounts for their food items. Under his watch, average life expectancy was extended by three years. That’s a remarkable testament to what can be achieved when government prioritizes population health.

More often, our faculty provide and interpret the evidence for policymakers. Keshia Pollack, PhD '06, and Shannon Frattaroli, PhD '99, MPH '94, both associate professors in Health Policy and Management, spend one day a week volunteering during the Maryland legislative session with Dan Morhaim to translate evidence about health issues to inform policy discussions.

Politicians often get a bad rap in our society. For evidence, look no further than the cellar-level approval ratings for the U.S. Congress. Unfortunately we live in an era of hyper-partisanship and polarization that make it very difficult, but not impossible, to agree on big policy changes that advance health. As former Senator Tom Daschle and Professor Karen Davis, PhD, discuss on page 24, transformative policies like the 2010 Affordable Care Act can still be achieved—under the right circumstances.

As Mayor Bloomberg recently told The New York Times: “If there is one thing that I learned from 12 years in government, [it] is that you can effect change, pull people together and face big societal problems.”

The commitment to unite people and confront the great health challenges is an attitude that I think we need to see more of in government. The political process is—no surprise—fraught with politics. It’s messy, difficult and frequently compromised. “Full and unlimited democracy” often is.

But as history shows, government really can make dramatic improvements in health. The probability of creating policies that help all of society is higher when people who know the science, inside and out, follow the Virchow path.

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