Q&A: 'People need convincing there's something you can do about climate change'

Since 2002, Dr. Georges Benjamin has served as executive director of the American Public Health Association. An internist, he previously served as secretary of the Maryland Department of Health and Mental Hygiene. Before that, he served as chief of emergency medicine at Walter Reed Army Medical Center. Benjamin has made the Modern Healthcare list of the 100 Most Influential People in Healthcare nine times, the list of the 50 Most Influential Physician Executives and Leaders six times, and the list of the Top 25 Minority Executives in Healthcare twice. His association is hosting its annual meeting Oct. 31 through Nov. 4 in Chicago. Modern Healthcare reporter Andis Robeznieks recently spoke with Benjamin about social determinants of health and his organization's approach to reducing gun violence and addressing climate change. This is an edited transcript.

MH: What has you the most excited about this year's APHA annual meeting?

Benjamin: The theme is getting lots of people to think about their role in health, even though they may not primarily do health or healthcare. That includes the people who pick up your trash every day and the people who check your water system. We're going to be talking about a range of activities, including making sure you get health insurance.

One of our opening session speakers is Ed Begley, a well-known advocate on climate change. We also will have Freeman Hrabowski, president of the University of Maryland at Baltimore County, a strong advocate of education, particularly for minorities, in science and technology. We'll also have the health officers from Chicago, the city of Baltimore, and St. Louis County. All of those three urban settings have had significant issues around violence and poverty.

MH: What are social determinants of health and what is your organization doing in that area?

Benjamin: I trained in internal medicine, but most of my time I practiced emergency medicine. So I was always fixing injuries. But only 10% of what actually makes us healthy is based on the work that I used to do. The things that make you healthy are whether you exercise, what you eat, and whether you have access to affordable, safe foods. Your doctor may say you need to go out and exercise more, and that's a great prescription. But if you're in a community with no sidewalks and where it's not safe to walk at night, you're not going to be able to walk. So the absence of the ability to walk safely is a social determinant that influences your health.

Let's say I tell you to eat a healthy meal. But if you live in a community without any grocery stores, it's pretty difficult for you to make safe and affordable meals for your family. If you live in a community where, tragically, there are no healthcare providers, and the transportation systems aren't well-developed so you can't get to a physician easily, when you fall and injure yourself, you're much more likely not to do well because of the distance you have to commute to get to that healthcare provider. Those are things that have a much greater influence on whether or not we're going to be healthy than many other things.

MH: What is your organization's approach to reducing gun violence?

Benjamin: We know through multidisciplinary collaboration you can reduce the likelihood of being injured or killed with your firearms. It's not about taking firearms away, specifically. It's about looking at the data and finding ways to make the firearms safer and make the community safer for people with their firearms.

We've been very successful in bringing down death and disability from cars. We made cars much safer with airbags, seat belts and laws against driving while intoxicated. Through community action, we set up systems where bars could help you get a ride home, and we promoted the idea of a designated driver.

Today, we're working on texting and driving. We've also made the roads themselves safer. We changed the way people behaved and the environment so that it was much safer. We can do the exact same thing for firearms.

MH: What is your organization doing on the issues of mental health and opioid abuse?

Benjamin: We're very concerned about people who are depressed and we are concerned about substance abuse. Because physicians don't prescribe opiates as well as they ought to, we have more people becoming addicted to opioid drugs.

We all have medicines we don't use. We don't clean our medicine cabinets often enough to get rid of them. At the meeting, we're going to talk about how you get rid of those medicines safely so they don't end up in the hands of kids. People can get addicted, and sometimes that serves as the gateway for more serious drug addiction. So we're talking about ways we can interrupt that pathway so that people can be safer.

MH: What about climate change as a public health issue?

Benjamin: Climate change is a big one for us. Climate change will dramatically affect our health in a variety of ways. No. 1, more intense, severe and frequent intense storms put us at significant risk. We also know that as the world warms up, we're much more likely to see things like dengue fever or malaria because the ecosystem changes. And we have to be very concerned about the loss of infrastructure in storms. We've seen tornadoes go through communities, and you lose a hospital. That health infrastructure isn't easy to replace.

We know that climate change is manmade, and there are some things that we can do to reduce it and reverse it.

MH: Are there people who still need convincing in the public health community?

Benjamin: There are people who need convincing that there's something you can do about climate change. When you're worrying about making sure that all the kids in your community get vaccinated, that the water is safe to drink, that your restaurants are safe to serve food to patrons, and you have a limited budget, trying to get this issue of climate change on your agenda sometimes is a little tougher. One of the things we will be doing is getting people more engaged. I think the solution is giving people action steps that they can do to make a difference.

MH: What are important public health issues that haven't appeared on people's radar screens?

Benjamin: We've got prescription drug costs. It's great that the Affordable Care Act is there, but we still have people who want to cut the public health and prevention dollars in the law.

We'll be talking about advocacy efforts to train people, to engage their policymakers, to encourage them to make further investments in public health funding.

MH: How do you keep the momentum going after a meeting like this?

Benjamin: We reach back out to our members, send them e-mails every day, contact them through social media. We've done webinars on climate change, firearm-related violence and racism in health. It doesn't just end when the meeting ends.