Health Advice



It's not just coronavirus: America repeatedly fails at public health

Noam N. Levey, Los Angeles Times on

Published in Health & Fitness

WASHINGTON -- As the coronavirus outbreak swept the country, President Donald Trump for months promised high-tech solutions just over the horizon: thousands of new ventilators, miracle drugs and vaccines developed at "warp speed."

He has shown decidedly less enthusiasm for simpler steps such mask-wearing and social distancing. That has frustrated public health officials, who are now pleading with Americans to make a few small changes in their behaviors to help control the widening pandemic.

But if the president's disdain for masks may be extreme, his impulse to look for the latest and greatest medical intervention reflects a strong tradition in American health care that has long put a premium on new drugs, bigger medical systems and more technology, often at the expense of public health initiatives that other nations have shown to be more effective at lower cost.

"We are much more willing to put money toward treating something than preventing it," said Dr. Richard Besser, the former acting director of the U.S. Centers for Disease Control and Prevention who now heads the Robert Wood Johnson Foundation.

It is a mindset that helps explain the nation's more than $3.6 trillion annual health care tab, by far the highest in the world.

It also accounts for some of America's struggles with the current pandemic, which is exploding across the country, threatening to claim tens of thousands of additional lives, even as it fades in Europe and other wealthy nations.


Similarly, the long-standing American resistance to public health measures hampers efforts to restrain diabetes, heart disease and other chronic illnesses that are driving hundreds of billions of dollars of medical spending.

"Public health is a quintessential public action," said Dr. David Blumenthal, president of the New York-based Commonwealth Fund, which studies health systems in the U.S. and abroad. "It must be done by people working together on behalf of themselves and others. In a fiercely independent culture, that is very hard to undertake."

America spends more than $237 billion a year on medical care for people with diabetes, for example, much of it to control a disease that can be prevented or managed with simple interventions like eating more healthful foods.

Just the tab for prescription drugs to control the disease topped $85 billion in 2017, according to research by the American Diabetes Assn.


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