By William A. Van Decker, MD
Irrespective of details and one’s personal views, many people, especially physicians, are pleased that a prominent part of Public Policy discussions both nationally and locally for the past two years have involved Health Policy. Health Policy is a key building block of any group civilization. While these discussions have clearly been driven by pragmatic economics, none of us should forget why health care delivered through health policy is so important.
A healthy population, physically and mentally, is a productive population. It feels well enough to perform productive work for the growth of the society as a whole and feels well enough to enjoy the tangible and intangible personal rewards that evolutionary and behavioral biologists point out come from grouped societies with shared values. Such a society lives longer not only able to personally enjoy more of the fruits of their efforts but also to see more generations come up behind improving on the value base. A healthy population takes personal interest in its lifestyle. Would a cave man tease a cheetah into a race? Let’s look for disease at its earliest intervenable moment, methodically treats chronic disease and efficiently delivers advanced care. Behavioral and evolutionary biologists tell us that animal behavior frequently changes by the “carrot and stick” feedback mechanisms of nature (In human group societies, some would call this government policy).
PCMS is pleased that the local Philadelphia Government has made Health Policy a top priority. Philadelphia’s rates of smoking and obesity are the highest among the 10 largest cities in the US. The health effects of obesity and smoking are well scientifically documented. Many would applaud the City’s welcoming of First Lady Michelle Obama to the City to support the fight against obesity. One must acknowledge a problem exists, shine light on it, and engage the people in seeking a solution.
“Carrot resources” must be made available to encourage personal involvement in the issue. Education is a start but must also have a pragmatic operation plan. The City is to be applauded for recently being competitively peer-review awarded two large grants from the CDC stimulus money. Over two years, the City has been awarded one grant of $10.4 million dollars to decrease smoking and second hand smoke exposure among city residents and a second grant of $15.0 million dollars to promote healthy nutrition and increased physical activity. PCMS was honored to write a letter of support for these proposals and the large number of other respected organizations who did as well shows that we sometimes have trouble defining quality but we know it when we see it. We look forward to healthier school lunches, encouraged exercise options, and all the good this effort will bring. Health Commissioner Donald F. Schwarz, M.D. is to be commended for his work.
This leaves the question as to whether humans need a “stick” to become a healthier population. Certainly, the government has used “vice taxes” in many ways and many formats in the past. Lotteries and casino slices fund much in the way of public good. Cigarette taxes are cited by some behavioral biologists as an example of incentivized “stick” behavioral modification, even though this is not 100% effective . The current proposal of a “Sweetened Beverage Tax” will certainly bring new concrete discussions and evolutions to this debate. I personally remain most bemused by the concept of a personal body mass index (BMI) tax someone once advocated to me which I am sure would engender loud conversations. In the end, society is governed by what the majority of the people will accept at any point in time, but the discussions and debates on healthy lifestyles are important to have and continue for better refinements.
PCMS recommends healthy lifestyles for all of our patients within the city and looks forward to aiding our patients efforts in this regard. We look forward to Philadelphia being the healthiest of the top 10 largest US cities. If we can help members with any questions, please do not hesitate to call.
Dr. Van Decker is president of the Philadelphia County Medical Society (www.philamedsoc.org).