Why Public Health Gets Left Behind with Michael Stein, MD
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What is public health and why does it matter compared to individual health care?
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You're listening to the Nocturnous Conversations. I'm Emily Silverman. Many of the people listening to this show are clinicians. We see patients one by one in the office or in the hospital room. But there's a different way of thinking about care, a broader way, which is focused on populations, neighborhoods, communities, even entire nations. This is the field of public health, where something simple like a tax on sugary beverages or a law about speed limits can have enormous implications for the health of all of us. And yet we spend forty times more money on health care than we do on public health in the United States. Today's guest, Dr. Michael Stein, has written a book that explores this asymmetry and how we focus our resources and offers some explanations for why that might be and for how we can harmonize these two seemingly very different worlds.
Michael is a primary care physician, chair of health policy at the Boston University School of Public Health, and the author of several books, including Me vs. Us, A Health Divided, which was a finalist for the 2022 Association of Publishers Pros Book Award. In my conversation with Michael, he offers a definition for what public health is, discusses the public health interventions that have been the most successful across time, and explores the way that language and rhetoric shape how we perceive the efforts of those working in public health. But first, I asked Michael to read an excerpt from his book, Me vs. Us, A Health Divided. Here's Michael.
I have a friend who runs a hospital. She tells me about a patient who trips on a pothole, falls, and breaks his hip. The ambulance brings him to my friend's hospital. The doctors in the emergency room make sure that he, his heart and lungs, will be able to tolerate surgery. They take him to the operating room. They put a twenty thousand dollars piece of metal in his hip. They sew him up. They make sure he doesn't get pneumonia or a blood clot or a wound infection during his recovery period. They get him up and moving. They arrange for home services to keep him safe and ambulatory. They do all this expensive and expert medical and surgical work, and my friend asks me in exasperation, Now who's going to fix the pothole?
Does my hospital team have to go do that too? There has been a one sided, indefatigable investment in health care. Health care and health are very different things. The pothole question sits at the intersection. Who is looking after public health? My friend's job is health care, she reminds me.
I am sitting here with Doctor Michael Stein. Thank you so much for being here today.
Thanks so much for having me, Emily.
So, Michael, you are a primary care doctor. But you also have a role in public health. Tell us a little bit about how you got interested in the public health aspect of health.
Yeah, I have been a primary care doctor for multiple decades. I started and ran an HIV program and did that for twenty years, which takes one into the realm of Politics and work outside of a hospital. I have been a clinical researcher for most of my career. At a certain point, about six years ago, I decided to move from the medical world to the public health world. There are very different academic worlds, and they're actually very different intellectual worlds, as I've tried to write about in this book. And that happened when I took a job at the Boston University School of. public health directing chairing a health policy department. So I still see patients, but most of my work these days is around health policy and helping junior people smarter than I to develop new health policies.
And what moved you to make that transition to public health?
I think it was a change in time of life.
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Chapters
3 chapters
1
What is public health and why does it matter compared to individual health care?
0:00–17:33
2
How does Michael Stein’s personal journey lead him from primary care to public‑health policy?
17:33–48:07
3
What are the three Ps (Population, Prevention, Policy) that define public‑health action?
48:07–49:30