Chiaki Sato

The distinguished U.S. Supreme Court Justice Oliver Wendell Holmes, Jr. asserted that government by the people should include a way to promote the common welfare through “public health.” In the 1905 opinion Jacobson v. Commonwealth of Massachusetts he wrote, “It is no part of the function of a court or a jury to determine which one of two modes was likely to be the most effective for the protection of the public against disease. That was for the legislative department to determine in the light of all the information it had or could obtain.” In his view the government by the people through their chosen representatives could participate in promoting public health better than a court or jury.

Like other countries the United States has fought with problems of insufficient access, increasing cost, and inadequate quality of medical care. Challenges for the twenty-first century include providing more access to health insurance while controlling healthcare costs and enhancing the quality of care. These are not easy tasks. In my view the best way to address these problems is to increase federal and state leadership in disease prevention. This proposal may be surprising to many readers. It is a plan, however, that is both attractive and more feasible than previous efforts and it will bring credit to the United States.

Here are some reasons why. U.S. health expenditure per capita is now over $6000 a year, the highest figure for an OECD member state. Chronic diseases are especially problematic, accounting for about 75% of these health care costs. In fact, the cost of chronic illnesses such as cardiovascular disease, obesity, cancer, diabetes, and arthritis is so huge that it is a burden on the U.S. economic system. The U.S. is now on track to face the dire situation predicted by the CDC in 2003 when it warned, “If current policies and conditions hold true, by the year 2011, our nation will be spending over $2.8 trillion on health care”. The challenge of preventing disease could be met with new leadership from the federal and state government in the form of effective surveillance and education. The idea for all this is not a new, but was established by the CDC in 2003.

In my opinion the most important thing that government can do for disease prevention is change people’s minds and health consciousness, an effort that amounts to creating a “New Culture of Health.” Much more governmental leadership in disease prevention is needed to motivate people in U.S. to lead a healthier life style. The great efforts of the CDC would work better if complemented by people’s buy-in. Despite the CDC’s efforts at disease prevention and health care, the U.S. population has enjoyed little success in these arenas. This does not mean that the CDC’s idea is wrong, but it needs to be complemented by another instrument: a “New Culture of Health.”

This would be a culture in which people consciously strive to prevent disease and achieve better health. It is an effort that must be made by ordinary people, but it will require governmental leadership.

For example, the “car culture” and the “internet culture,” both of which have drastically changed the U.S. and the world, could not have been created without leadership from both the government and the private sector. In addition to private initiatives, the role of government at both the federal and state level must be recognized as playing a major role in making these new cultures come into existence. Federal and state authorities should create a vision that encourages people to be conscious of their health and of disease prevention.

As a Scholar in the McDonnell International Scholars Academy at Washington University, I have desire to contribute to this change in culture by creating a hub of useful information for better public health. This has taken the form of the “McDonnell Academy Global Medicine Lounge” (http://www.medicinelounge.com/). The Medicine Lounge is an initiative by Ryotaro Kato and me to create an innovative website that addresses global healthcare issues. It is our medium to: 1) challenge governments to think about better health care, 2) provide a hub of information for people from across the world, and 3) provide a model of collaboration to scholars from around the world. In our view a key for creating the “New Culture of Health” is to coordinate a broad spectrum of government and university efforts. This is an effort to lead the quest for effective disease prevention in a global society.

To date there is no established model for fostering better health through effective disease prevention in the U.S. However, the people could do a great deal with the right governmental leadership to reach the goal of changing the culture of health. We all need to find a way to participate in this.