Vehicle crashes. Drowning. Smoking. Obesity. Inadequate obstetric and maternal care.
All are major public-health issues that Kelly Henning has spent much of her adult life trying to address. Henning, a medical doctor and epidemiologist, has led the Bloomberg Philanthropies Public Health Program since 2007. In her time with Bloomberg, she has traveled the globe to work with governments, neighborhoods and individuals to save millions of lives by reducing preventable deaths from these causes.
Previously, Henning was an assistant professor of infectious diseases and worked in hospital epidemiology at the University of Pennsylvania School of Medicine, where she had also completed her residency in internal medicine.
People often ask why she's drawn to public health. Earlier in her career, she did a lot of clinical, direct patient care work. But public health "is very special because, really, it's population health," she said. By putting effective policies in place, "you can make major changes for tens of thousands of people at a time."
A resident of Bryn Mawr, she spoke to us recently about her work, what the United States is doing to the health of other nations, and what each of us can do to be healthier.
Bloomberg Philanthropies was founded by Michael Bloomberg, three-time mayor of New York City and founder of Bloomberg LP, a global information and technology company. One of the focus areas for the philanthropy is public health. We have a group of programs addressing non-communicable diseases and injury prevention. The reason is, that's what is killing the most people in the world. And these areas are underfunded and under-recognized.
The first major program in the philanthropy was tobacco control. It is, in a sense, a flagship. It's the first. It's the largest. Tobacco is going to kill seven million people a year around the globe, and is on track to kill one billion people in this century if we don't do something about it. When Mike Bloomberg was mayor, he put into place a comprehensive indoor air law that prohibits smoking in indoor public places. That policy has now spread around the U.S. and around the world.
When it comes to non-communicable diseases, or NCDs, the big four are heart disease, cancer, diabetes and chronic lung disease. They represent more than 70 percent of deaths in the world. Low- and middle-income countries get a lot of health aid, but only 1 percent of that money is dedicated to NCDs. There's a big need to address these diseases that we've been seeing in the U.S. for quite some time.
Many people think NCDs are inevitable. But actually, what we're talking about is premature or early death. Deaths are occurring among people under age 70. We are talking about people at the peak of their productivity, their work life, their family life.
On the injury side, we support road safety. And we work on drowning prevention, which is an under-recognized killer, particularly of children.
We're a small team of about 12. We work in partnership with other organizations who then identify groups in low- and middle-income countries. We work in those countries because the burden is so great there.
The U.S. work is fairly recent, and it's centered at the Johns Hopkins Bloomberg School of Public Health, where we support a program called the Bloomberg American Health Initiative. It is a $300 million, 10-year program.
Life expectancy in the U.S. had been going up, but now it's leveled off. In 2015, we saw the first decline in more than two decades, and in 2016, the U.S. life expectancy declined to 78.7 years. This puts us 31st in the world behind both high- and middle-income countries. The initiative is looking at some leading concerns, including obesity, nutrition and diet. We're looking at the environment. We're looking at overdoses and addiction. We're also looking at adolescent health — the increasing group of adolescents who are experiencing social isolation and who are somewhat disconnected from community and society.
Another initiative is the global Partnership for Healthy Cities. Seventy percent of the world's population will be living in cities by 2030. This presents us with an opportunity to work with city governments to do more for the health of their citizens. Mayors of more than 50 cities around the world have committed to participate. Each city chooses one non-communicable disease or injury-related intervention, such as improving diet or reducing drunk driving. Our goal is to connect cities of all income levels so they can learn best practices from each other.
In the U.S., we have Philadelphia, Boston, San Francisco and Chicago. Elsewhere, cities are as diverse as- Ho Chi Minh City in Vietnam; Amman, Jordan; Melbourne; Montreal; London; Cape Town; Mumbai; and Shenzhen City, the seventh largest city in China.
The partnership across agencies in Philadelphia is only a year old, still in the implementation stage, but it is advanced work. The city is developing systems of monitoring pedestrians and bicyclists and overlaying that with other data to see how they can reduce crashes, but also increase physical activity.
In other words, are we exporting NCDs from rich countries to poor countries? In some ways, we are. Diet patterns have changed drastically. Consumption of processed food and sugary beverages in low- and middle-income countries has really increased. That's having an impact on obesity first, then cardiovascular disease, diabetes and cancer.
What can the U.S. learn from other places? Here's one example: Brazil has a program that's focused on whole foods and eating traditional diets. That type of intervention is one that other countries, including high-income countries, could be taking on.
As far as other countries learning from the U.S., the tobacco industry has been marketing very aggressively in lower-income countries. That's something the countries are really trying to push back against.
I should add that all of this — trying to improve the quality of people's lives, improve their health, and reduce premature deaths – is also a win-win for governments. They can have a population that's healthier and more productive and has lower health-care costs. That's especially important in poorer countries where they don't have as much money for their health-care system, so you want to prevent the diseases to try to improve health and keep costs down.
The tobacco industry has a long history of undermining public health. There is a global treaty that most countries have signed; among many tobacco control points, it clearly says that policy makers should not be talking to the industry or making policies that the industry suggests.
Overall, you try to work on policies that have been proven. And one of those is in the area of tobacco use. For example, we know that if you raise the price of tobacco products, you have lower use. It's been shown in many different settings, not just in the U.S., but around the world, in poor countries and rich countries. We also know that if you institute multiple policies — raising the price, having smoke-free public places, having hard-hitting advertising about the harms — you can really reduce smoking. In New York City, during Mike Bloomberg's time as mayor, these policies led to drastic reductions in smoking, contributing to a three-year increase in life-expectancy.
In terms of the food and beverage industry, there's been some work aimed at reducing the amount of sodium, or salt, in processed food. There has been some success, on a small scale. There is the possibility for doing more.
Lastly, about a third of preventable road crash deaths are passengers in vehicles. So the vehicle itself is very important. Vehicles sold in the U.S. are subject to lots of regulations that protect the occupants. Unfortunately, in lower- and middle-income countries, the new vehicles are sold without safety regulations in place. That's a place where the industry could do a lot more.
One of the most important things is to stop smoking. That's no surprise, but I really have to say it. Also, there is more and more recognition of the importance of diet in people's health. And activity. It now looks like any amount of increase in activity is helpful, although the more the better. It doesn't have to be hard-hitting competitive sports playing. Just walking can be good for your health.
Also, not drinking and driving. Not speeding. Not participating in cellphone use or any other form of distracted driving. Wearing a seat belt. In terms of drowning prevention, it's really important to have children who are not able to swim supervised very closely when they are near water. And it's important to fence in bodies of water — certainly swimming pools, and beyond.