October 24, 2018

VoteAs we get close to the mid-term elections I keep thinking about how interconnected public health and politics have become. We simply cannot separate those two areas of concern these days no matter how hard we may try.

In that context, I read with interest an editorial in the New York Times by Dr. Danielle Ofri of Bellevue Hospital entitled “Doctors Should Tell Their Patients to Vote”. In that article Dr. Ofri recalls for us the groundbreaking discoveries of Dr. Rudolf Virchow in 1848, who identified the poor environment in Upper Silesia as the social conditions (“poor sanitation, terrible working conditions [in the mines], inadequate housing, meager education and unhealthy diet”) that were promulgating the typhus epidemic in that area. Dr. Virchow concluded that the causes of the epidemic were without “any doubt… the poverty and underdevelopment of Upper Silesia.” He even concluded that the prescription for the solution to this health problem should be “free and unlimited democracy.”

As Dr. Ofri comments, this is not a standard prescription that most physicians deliver to their patients, and yet maybe in these times it is a prescription that is needed and necessary. In my blog posts throughout my year as president of NHMS I have so often been commenting on issues of health and wellness that are intertwined with political concerns. 

Take for example the issue of the impact of firearms on public health, which will be the subject on my talk at the NHMS Annual Scientific Conference, November 9-11, in New Castle, NH. This is not an issue that clearly can be separated from politics, nor can a solution be found that is not rooted in a major change in the politics of the legislators in charge of our state and federal governments. Similarly, the issue of the Affordable Care Act and the protection of people with pre-existing conditions being able to afford health insurance cannot be separated from the political parties in power. We also cannot separate environmental protections from toxins released as a result of relaxation or elimination of former EPA standards that were put in place to protect the health of us all.

Dr. Ofri emphasized how similar the concerns expressed by Dr. Virchow 170 years ago are to the concerns facing us today. She recalled the words of caution expressed by Dr. Virchow, and she, too, expressed concern that "the creep of religion into state affairs, the outsize power of the wealthy and the autocratic impulses of government feel unsettlingly contemporary.”  Dr. Ofri’s conclusion is that doctors should pull out their prescription pads and encourage their patients to register and to vote. I wonder as well whether that kind of social prescription is a necessary one in this unsettled time.  Indeed, as Dr. Ofri concludes, that is one prescription that does not need “prior authorization".

As always, I would appreciate your comments on this and other issues affecting public health and society, and the interconnections between them. I can be reached at lenkorn.md@gmail.com.

Regards,

Len Korn, MD

NHMS President