Opinion | The primary election is over: Let’s talk about public health

Eric Lupher is is president of the Citizens Research Council of Michigan

Everyone has a policy issue they believe should be at the center of political campaigns. Jobs, schools, roads and health care seem to be the usual contenders, but let us propose an alternative that state and local leaders should be talking about:

Public health.

A report released today by the Citizens Research Council of Michigan looks at public health in Michigan. Much like infrastructure and public safety, public health benefits entire communities and has generally been a responsibility of state and local governments. The report finds that Michigan has failed to invest in these vital services, and ranks near the bottom among states in per-capita state funding for public health.

Many have an incomplete understanding of what is meant by “public health.” It does not refer to publicly financed health insurance.

Public health is the science of protecting and improving the health of people and their communities. Rather than simply treating illnesses or injuries when they occur, public health seeks to prevent them from happening in the first place. While medicine works to help people one at a time, public health works upstream to help entire populations. Moreover, public health relies on the understanding that health is not merely the absence of disease, but rather a state of complete physical, mental, and social well-being.

Average life expectancy has more than doubled since the mid-1800s (from 39 years to 79). While medical care looks to many like the obvious hero, around 80 percent of this improvement is due instead to improvements in public health – better nutrition and food safety, water treatment, sewage and garbage management, control of infectious diseases, injury prevention, and improved social conditions (like housing and neighborhood quality), as well as improvements in the public’s knowledge and understanding of health (e.g. the risks of smoking and benefits of healthy diet). All of these things fall under the umbrella of public health.

As the saying goes, an ounce of prevention is worth a pound of cure. The economic (and human) cost of stopping epidemics and preventing environmental catastrophes is lower than the cost of treating diseases and cleaning up messes once they’ve occurred. Successful investment in public health requires long-term planning and broad collaboration, factors hindered by the tendency of state policymakers toward short-term thinking and partisanship.  

Like infrastructure and other services that Michigan has neglected, the bill for underfunding public health is coming due. Contaminants like PFAS, lead, 1,4-dioxane, and cyanotoxins (from harmful algal blooms) continue to threaten drinking water safety. Outbreaks of diseases like Hepatitis A (the worst in the U.S.), influenza, and measles have afflicted many Michiganders, and emerging disease threats like SARS, MERS, Ebola, and Zika, among others, provide reminders of how the public’s health can be imperiled by infectious diseases.

Michigan has experienced natural disasters in the form of tornadoes and flooding, as well as man-made disasters like the water emergency in Flint. Thankfully, we have not had to deal with  an attack with a bioterrorism agent (e.g., anthrax, smallpox, or tularemia) or chemical weapon, which would require an equally swift public health emergency response. In each case, risk can be mitigated by advance planning.

Our neglect of public health also is evident in the wellbeing of Michigan’s citizens. Michigan has higher than average rates of infant mortality, smoking, and obesity. Prevalence of multiple chronic diseases also exceed national averages. Moreover, evidence suggests that gaps in health and well-being are increasing among the state’s diverse citizenry.  

Pure Michigan is about more than the beautiful scenery found in abundance throughout our state. It is about having the governmental apparatus in place to protect our citizens from harm and treat them if they are harmed. It is about fostering and preserving an environment (natural and built, physical and social) that considers prevention and addresses the root causes of poor health.

Our desire to be competitive is boosted by an investment in public health, for it is a critical ingredient that precedes both educational success and workforce performance.

Some may question if Michigan can afford to invest in public health as it struggles to fund roads and schools; given the manifest, multitudinous threats to public health facing Michigan, it seems just as reasonable to ask if Michigan can afford not to.

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Janet Olszewski
Tue, 08/21/2018 - 9:25am

Thank you to CRC for highlighting this critical issue! Our statutory basis for public health in Michigan was a model for the country when it was revised in 1978. Its continual updates provide a strong legal basis for the protection of the public’s health in our state. At the time of the Public Health Code revision project our decentralized system of local health responsibilities supported by a strong state infrastructure was also a model for the country. Alas, like roads and education we have allowed our investment in public health to wither and as CRC points out there are significant consequnces. So while we may still have tthe statutory outline we need we do not have the capacity to meet 21st century public health. issues. It is time for citizens and policy makers to recognize the central role a strong public health system plays in supporting a vibrant economically strong Michigan.

Kevin Grand
Tue, 08/21/2018 - 12:15pm

I think that Mr. Lupher is placing way to much effectiveness on the current "public health" apparatus here in America.

From their mysteriously collective silence on the introduction of diseases that were foreign or were at least under controlled here in America, to their requiring the compulsory usage of vaccines whose efficacy is questionable at best (why else would Big Pharma need state and federal laws shielding them from lawsuits), America's "public health" apparatus has got an image problem that it needs to remedy FIRST before there is any talk for more money to be spent on it.






Wed, 08/22/2018 - 6:59am

What a charming mix of xenophobia and anti vax dogma.
You could add a hint of protecting our precious bodily fluids as a garnish.

Kevin Grand
Wed, 08/22/2018 - 8:00pm


Better throw in a comparison to Adolf Hitler, or better yet the Anti-Christ if you're gunning to show me up.

That'll display for all to see what a handle you have on the facts as it relates to this op piece.

Wed, 08/22/2018 - 1:02pm

They need federal protection because otherwise, people would be suing them for things like hair loss, erectile disfunction, random itchiness and toenail fungus. If you're injured by a vaccine, you *can* get compensated, but it's a binding-arbitration process and limited to known side effects -- allergic reactions, etc.

Kevin Grand
Wed, 08/22/2018 - 8:04pm

Sounds exactly like typical side effects they were warning people about on the last drug ad I saw on TV this afternoon.

How ironic that the "treatment" is far worse that the malady?

Tue, 08/21/2018 - 12:48pm

Another Bridge version of the economic dilemma; Unlimited needs and wants and Limited means and resources. Right there with the environment, poor people, education, crime, abandoned dogs and cats, litter, ugly sweaters on and on. Please stop letting people do these pieces without also providing specifics of how they'd solve it AND PAY FOR THEIR SOLUTION!!!! Otherwise this is just useless whining!

Michigan Observer
Tue, 08/21/2018 - 2:48pm

Three cheers for Matt. Well done.