Health or Safety ?

Health or Safety

When the Chronicle ran the fourth installment of its series "Out of Control,"examining the risks to pedestrians and bicyclists in our region, it prompted a spirited conversation on the Facebook page of Critical Mass Houston, a group that organizes a monthly bike ride for cyclists of all skill levels.

Some of the comments got heated circling around the observation of Maggi Gunnels, acting regional administrator for the National Highway Traffic Safety Administration. She was quoted as saying: "This really is a crisis. A public health crisis."

The term "public health" is what drove it off the rails. Public health isn't sexy. And it's often misconstrued.

A subset of health

On April 23, 2017, Dr. Georges Benjamin, executive director of the American Public Health Association (APHA), walked onto the stage at the March for Science in Washington, D.C. A bunch of heavyweights were there.

Bill Nye the Science Guy. Denis Hayes, one of the founders of Earth Day. Questlove provided the musical backdrop, and Thomas Dolby dusted off his '80s hit, "She Blinded Me with Science." NASA's Nancy Grace Roman, a.k.a. "Mother Hubble," wowed the audience simply with a smile and a wave.

Dr. Benjamin had no flashy fireworks, no huge name recognition, no musical accompaniment. Even as he stepped to the podium, there was rain on his glasses.

But the crowd was his. "We represent thousands of public health professionals who practice science every day to keep people healthy and safe in our community."

This group knew the work of public health advocates improves their lives in almost any area imaginable. Many people don't.

During the exchange on Facebook at Critical Mass Houston, one person responded to a post that attempted to explain the range of topics under the public health rubric, writing: "You are conflating public safety with public health. 2 different things. That's why we have the Department of Public Safety and Texas Department of State Health Services. This is a public safety issue."

That's right, and wrong. It is indeed a public safety issue, but that makes it a public health issue. Safety is a subset of health.

Catherine Troisi, associate professor at UTHealth School of Public Health, serves on the board of the APHA. I asked her what "public health" really means and why it's sometimes confusing. "Public health has two main goals: prevent disease and promote health. The Institute of Medicine defined public health in 1988 as 'what we as a society do collectively to assure the conditions in which people can be healthy,'" she said. "The public health system includes not just health departments but transportation, hospitals, city planning, schools, law enforcement, etc. etc. — in fact, it's hard to find something that's not part of the public health system. All have a role to play in protecting the health of a community through either preventing disease or promoting health."

Troisi continued: "I think that there's a lot of misconceptions about what public health is. Part of the reason is that we refer to hospitals such as Ben Taub that treat people who don't have insurance as public health hospitals or "public" health hospitals where "public" modifies "hospitals," not "health." One survey found 47 percent of people thought that public health was government-provided health care for the poor. We also talk about what doctors and nurses and hospitals do as 'health care' but it's really medical care. Medical care treats the individual using stethoscopes, thermometers and more advanced diagnostic tools, but the individual is the focus. Public health practitioners use their tools (demography, epidemiology, vital statistics) to look at long- and short-term trends across populations and communities are their 'patient.'"

Susan Polan, associate executive director for public affairs and advocacy at the APHA, puts it this way. "Public health is like an invisible umbrella that is protecting you, your family, your community from harm 24 hours a day, seven days a week."

Specific to the "Out of Control" installment, Dr. Benjamin told me: "Pedestrian and cyclist deaths are preventable. To address this public health concern, many communities are adopting Complete Streets policies that help make our roadways safer for all who use them. Under a Complete Streets approach, communities retrofit poorly designed roads by adding sidewalks and bicycle lanes, reducing crossing distances and installing crosswalks and better bus stops. This helps make walking and biking safer and more inviting for users of all ages and abilities. This approach also helps reduce traffic speed and points of conflict — two big causes of costly crashes."

A question of language

But if the experts are agreed, the average person on the street may not see it the same way. Why not? I believe it comes down to word usage. So, let's imagine we are at almost every high school speech ever given. It starts like this: "Merriam-Webster defines health as ... "

1. a: the condition of being sound in body, mind or spirit
b: the general condition of the body

2. a: a condition in which someone of something is thriving or doing well: well-being
b: general condition or state

And here we should see the distinction between health and medical care. Health is all about wellness; medical care is often a response for when health is absent.

Distinctions can get blurred when words are used to mean different things, especially in such close proximity, like "public health" and "health care."

"We've tried to come up with a better term, and some people talk about 'population health' or 'community health,' " Troisi told me, "but I think we need a different term — just not sure what it is."

CHRONICLE INVESTIGATION: Out of Control

Regardless of how the language wars play out, the work of public health advocates continues. Water standards, education improvements and student support, epidemiology, contagious-disease prevention and response, criminal justice reform — these are a few of the many areas they address to build and support systems and policies that make it easier for people to choose to be healthy. Polan says it works because they connect cause and outcome. "The goal of public health is to keep people well. To do that, we move upstream to the things we know will make a difference, like creating seat belt laws, supporting vaccines, reducing emissions so we have clean air."

If you're on a bike, here's what upstream might look like: bike helmets, dedicated lanes, thoughtfully designed intersections, drivers who are trained to respect riders and a justice system that holds drivers accountable.

There are public health professionals working toward those goals right now, because they know a crisis when they see one.

Even if some folks don't recognize the name.

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Joe Center is a photographer and writer based in Houston.