(Gabriella Cullen | Contributing Photographer)

Sandro Galea, the new Dean of Public Health, gave a talk titled “Why health? Reimagining what we think about when we think about health” to a full audience at Graham Chapel on Wednesday, January 29th.

In his talk, Galea placed equity at the center of public health and argued that addressing these complex challenges requires an interdisciplinary approach. He also recommended ways for the U.S. to improve its poor health status, such as a “health-and-life” balance and a spending prioritization on “prevention” rather than “cure.”

After acknowledging the rapidly shifting landscape of modern health, Galea first described the most important part of health and highlighted humanity’s progress over the past 200 years in bettering human health.

“The capacity to live a full, rich life: that is what health is about,” Galea said. “For most of [humanity’s] ~75,000 years, [health] has been terrible, like really, really bad … In 1940 most of the world had life expectancies still in the 50s, maybe 60s. Now, we get most of the world’s life expectancies in the 70s, 80s.”

However, according to Galea, the U.S. still has a ways to go, especially in regards to equity.

“It is important that we recognize that our priorities in health should be driven by an effort to create space for all of us humans to live full, rich lives … that drives what we prioritize in health,” Galea said. “There should be no conversation about health without equity at the heart of the conversation.”

Galea incorporated visuals throughout his talk, comparing life expectancies between populations and highlighting health inequities. Galea called these inequities “health gaps,” and considered them unacceptable.

“Why is it okay that if you’re born in Nigeria, you can expect to have 25 years fewer of life than if you were born, say, in Japan,” Galea said. “Why is it okay that we have about a six or seven year difference in life expectancy, by birth, across U.S. states? It’s just not okay.”

The dean also highlighted health gaps driven by racial or income differences, demonstrating the impact of societal discrepancies on health. Galea, who said the “problems of some of us are the problems of all of us,” thus called public health a multidisciplinary field.

Professor Tim McBride, the first Associate Dean in the Brown School public health program, emphasized the transdisciplinary nature of public health when interviewed after the talk.

“So we believe that solving the really difficult public health problems would require all the disciplines working together in a vision from the start,” McBride said. “I hope [Galea] takes it to the next level, involving [Olin] Business School, engineering, arts and sciences, medicine … other schools as well [as the Brown and medical schools].”

The COVID-19 pandemic, as well as some COVID-era policies, exacerbated certain social inequities, illustrating what Galea called scientists’ and health experts’ struggle to both communicate and balance health with life.

“Right from the beginning of COVID, we knew something pretty straightforward, that COVID-19 was a disease of people who are older,” Galea said. “An approach that balanced health and living might have [taken that] into account and said … there is socio-economic achievement of children, how do we ensure [their] lives go on? [Instead,] we shut down schools and [thus] created even more gaps between children in more affluent, and less affluent schools.”

Barton Hamilton, a business school professor who attended the talk, told Student Life that the health-work balance Galea advocates for is an important but uncommon concept in public health. 

“Recognizing that there’s trade-offs between things that might maximize health [but] also may have unintended consequences [is important], like keeping children home during COVID,” Hamilton said. “I like what he said about ‘maybe we need to think about some uncomfortable questions that we don’t normally like to think about.’”

During his talk, Galea continued to hone in on the inequitable impacts of COVID-19 policies, calling the work-from-home recommendations a “collective decision to protect those who can afford to work from home.” At one point, he directly challenged the audience.

“Did you work from home at least part of the time during COVID?” Galea asked. “Raise your hand if, while you worked from home during COVID, you never, ever [had] anything delivered to you. If you did get something delivered to you, ask yourself why it was okay that, while you were protecting yourself, people who made less money than you put themselves at risk to deliver stuff to you. Unless we can ask those questions … we are not thinking deeply about health.” 

However, Galea said that while COVID-19 “set our health achievement back a decade” and affected the U.S. heavily and inequitably, it has not caused all of the U.S.’s poor health statistics.

“The U.S. has lost nearly two decades of progress in life expectancy, we are essentially where other high income countries were two decades ago,” Galea said. “Even subtracting out COVID, our life expectancy takes a plunge.” 

The poorest 80% of Americans have “fallen way behind on all dimensions of heart disease,” Galea said. He also stated that the U.S. has an extremely high maternal mortality rate. Even just accounting for the top 1% of each country, the U.S. is still twice as worse than fellow countries. 

Galea explained that this was not due to a lack of spending: we spend more on health as a percentage of GDP than any other country. Galea called this a “spend more, get less” situation.

“The bottom line is, our mismatch between our spending and our outcome is because we keep spending on curing ourselves when we’re sick,” Galea said. “[But] that’s not what we care about; we actually care about being healthy. But that’s not what we spend on.”

Galea asserted that the U.S. should spend more on the causes of good health, rather than so heavily focusing on curing bad health. As he put it, more emphasis on prevention than cure.

“We keep forgetting that healthcare is a part of health, but so is our smoking, drinking, sexual activity, places we live, education, our job status, our family supports, our income, [etc.]” Galea said. “All of that is also a part of health, and there is an enormous mismatch [in our spending] because we spend only on the cure part.”

Throughout the talk, Galea repeatedly emphasized the complexity of these issues, with “no low hanging fruit.” He highlighted universities’ ability to address public health challenges due to their multidisciplinary nature.

“Our job … is to work together across all aspects of society, from medicine to social work to humanities to the arts to engineering, to create a world that engenders health,” Galea said. “I think our job together, working as a university that leads the way for how the world thinks about health, is to … create a world that is really healthier for all.”

WashU has a diverse nine schools, making it perfect for harnessing Galea’s multidisciplinary approach to public health. With the new School of Public Health set to launch soon with Dean Galea at the helm, one senior in attendance at Galea’s talk, Jada Lee, only wished the program had started sooner.

“I think, overall, I’m excited about the public health program at WashU,” Lee said. “I really wish it was earlier so I could’ve been more a part of it!”