Where’s Dr. Crumbine When We Need Him?
Dr. Samuel J. Crumbine
Until just recently, I had never heard of Dr. Samuel J. Crumbine (1862-1954). Wikipedia says Crumbine was a pioneer in public health who campaigned against the common drinking cup, the common towel and spitting in public in order to prevent the spread of tuberculosis and other germs. Crumbine was trying to educate the public about shared health concerns as epidemiological methods were in their infancy:
“I began to realize, as I never had before, how much the health of each of us depends on the health of all of us.”
According to the WHO (the World Health Organization, not the band), the U.S. spends a higher portion of its gross domestic product on health care than any other country but ranks 37th out of 191 countries, according to its performance. Among Americans ages 20 and older, 71.6% are overweight, 39.8% are obese. One in five still smoke. Nearly 2 million will be diagnosed with cancer this year. We take more than $425 billion in prescription drugs and spend $3.5 trillion on health expenditures. We are not by any measure well. We spend so much money on health but we are not healthy. Why?
University of Utah Health surveyed 150 attendees at the annual conference of the Association of American Medical Colleges in Seattle Nov. 11-15 and asked them to tell us what really shapes medical care. Of those surveyed, 81% stated that their patients are interested in guiding their own health care. However, 62% said their patients were not empowered or able to do so. Social and economic factors were the greatest things influencing an individual’s health. People want to be responsible for guiding their own health care but do not have the means to do so.
When asked, “What has the greatest potential to impact a community’s health?”, the highest percentage response was “Health-care systems working with community organizations.” A vast portion of the country’s health problems are problems that could be avoided with education and social programs helping people to gain control of their own health care.
Our country is going through a health crisis like never before. COVID-19 has taken many lives. How much is our country’s already-declining health a contributing factor in negative outcomes?
A recent report published in JAMA (Journal of American Medical Association) studied the comorbidities and outcomes of 5,700 COVID-19 patients admitted to 12 Northwell Health system hospitals in New York City, Long Island, and Westchester County. The study included all sequentially hospitalized patients from March 1 to April 4, 2020. The most common comorbidities were hypertension (56.6%), obesity (41.7%), and diabetes (33.8%). Similar studies were performed with similar outcomes in the Wuhan region of China as well. And the greater the number of comorbidities, the worse the outcome. These are cases when chronic conditions have now become acute.
Kate Hauf working out on a rowing machine…
... and on a treadmill.
Are these comorbidities preventable? How do you prevent hypertension? Obesity? Diabetes? You maintain a healthy diet, get an appropriate amount of exercise, and manage stress. We know that these comorbidities present worse outcomes, so we should be doing our best to reduce these factors. Most of the research and funding is focused on a pharmaceutical intervention. The last thing Americans need is to take more drugs, especially when diet and exercise is proven to be effective. We need to stop the willful ignorance of our own poor health. It’s been proved that people will eat more if they do not know the calories of a certain food. They will purposefully disregard caloric information or nutrient content so they can downplay the probability that their favorite meal is high-calorie and nutrient-poor. We need to stop the ignorance and take control of our own individual health so that we can become healthy as a whole.
As Dr. Crumbine said, “In the long run, lasting victories are won by telling people the truth.” He also said, “We suffer from disease through ignorance. We may escape through knowledge.” (My man had some great quotes.) Crumbine’s most famous quote was “Don’t spit on the sidewalk.” (I guess they can’t all be winners.) He also invented the flyswatter.
Suppose we are faced with another novel virus and subsequent pandemic in the future? We need to be much better prepared for the next pandemic than we were for this one. It starts with yourself. Reducing your own comorbidities may help you combat the next virus, which will in turn lead to better outcomes for everyone else.
Crumbine knew that educating the people would be the most impactful thing for public health. Increasing the health of each of us individually will increase the health of us collectively. There is zero downside to getting healthy as a nation. A healthier workforce is a more productive workforce, and a productive workforce builds a stronger economy.
The cost of health care is built into every product and service offered in America, and that per-capita cost is higher than that of any other nation in the world. A reduction in health-care cost would mean the cost of American products would become more competitive.
A healthy population also means increased savings rates. You’ll be more concerned with your future financial needs if you expect to live longer. The bridge between health and the economy is education.
The U.S. needs to educate its citizens about these issues or we will repeat the same mistakes and face the same poor outcomes when COVID-19 or something like it appears in the future. We don’t want to live through what The Who also said, “And the world looks just the same, and history ain’t changed. ’Cause the banners, they all flown in the next war.” (That’s the band, not the World Health Organization.)
