Commencement Speaker Paul Grogan Calls for a ‘Rebranding’ of Public Health.
In more than a decade at the helm of the Boston Foundation, Paul Grogan has worked to reverse the outdated view that large philanthropies should be benign benefactors toiling behind polite veils of privacy.
Paul Grogan
Under his leadership, the venerable non-profit has actively embraced a strategy of sponsoring research into critical ways it can leverage its $850 million in assets to do the most good. It’s a muscular brand of philanthropy that eagerly puts the foundation’s money where its mouth is — and often speaks loudly to advocate change.
“We also try to marshal influence and move public opinion,” said Grogan, who will deliver the 2012 BUSPH Commencement Address on May 19. “We promote our ideas in the press and work in a non-partisan way in the public policy dimension. Trying to do all of those things in concert, we have found a powerful way to make change.”
The foundation manages nearly 900 charitable funds that reach into nearly every aspect of community life. It actively supports research into education reform, supports changes to charter schools, pushes for government accountability, and plays an increasingly vocal role in the sausage grinder of Massachusetts lawmaking.
Beginning in 2007, the Boston Foundation raised the ire of thousands of union members across the state by pushing for changes in the generous health insurance plans given to many municipal workers. Armed with foundation-sponsored research that uncovered about $100 million in savings, the State Legislature overwhelmingly passed a reform measure in 2011 that Gov. Deval Patrick quickly signed into law.
Grogan has set his sights on public health as a long-neglected area of potential civic change. He believes that public health’s mission of helping great numbers of people stay healthy can be an important driver of lower health care costs.
“People are coming aware that the trajectory that we’re on in terms of current medical costs is completely unsustainable, ” Grogan said. “It’s an exciting time, particularly in Massachusetts, because the success in access to medical care has created some new space for this discussion and this conversation is growing.”
Q: How do the aims of the Boston Foundation dovetail with those of public health?
“It’s a major priority at the Boston Foundation and it represents a little bit of a shift for us. The Boston Foundation has been deeply involved in health care issues for the whole life of the foundation, which goes back to 1915. But most of that health work has been about access to medical care, particularly for disadvantaged and vulnerable populations. The Boston Foundation was a major force in the ’60s and ’70s in the development of the neighborhood health center system in the city.
“A couple of years ago we began a strategic review of our priorities overall across the foundation. When we looked at health and did some research and formed a partnership with NEHI [New England Healthcare Institute], we realized that we needed to shift our priorities from access to medical care to wellness, prevention and public health.”
Q: What did some of that research reveal?
“Massachusetts has made a lot of progress on access to medical care. We lead the nation in terms of our health care. We’ve made substantial progress. There’s so much evidence now that focusing exclusively on medical care is bankrupting the country. And in certain fundamental ways we are not getting healthier. In important benchmarks like lifespan, infant mortality, rise of chronic preventable diseases like diabetes – we are lagging other developed societies around the world despite the fact that we’re spending far more on health care than they are on a per capita basis.
“We looked at a lot of research that shows whether we are healthy depends far more on things like behavior, environment and socioeconomic status than it does on access to medical care — although who would deny that if you need medical attention you want to be able to get it.
“It’s just very clear that we’ve gotten ourselves into a very deep hole with the combination of health care being ruinously expensive and in some ways not terribly effective. We believe the whole society needs to be placing much greater emphasis on prevention and public health, exercise, good nutrition – particularly for children and especially for children in the inner city.”
Q: How was that advocacy affected by what you learned in the studies from NEHI and other groups?
“In our own grant making we’re supporting something called the ‘Healthy People, Healthy Economy’ initiative which does focus on exercise and nutrition in the inner city. We’re working very closely with the Boston Public Schools to restore daily vigorous physical activity to all school children. We’re working on bringing farmers’ markets to inner city neighborhoods. And we’re working on a policy level to do a number of things.
“We’re quite appalled that Massachusetts is one of handful of states that still offers a sales tax exemption to soda and candy, which are major culprits in childhood obesity and the rise of these preventable chronic disease. The idea that we’re treating these as food and exempting them from taxes is ridiculous, so we’ve filed legislation to repeal that exemption.
“We’re also backing legislation that was filed by [State] Representative Jeffrey Sanchez from Jamaica Plain, who is the chairman of the Public Health Committee in the Legislature, to require vigorous physical activity as a part of every school day across Massachusetts.
“We believe that the public sector should be investing far more in public health than it does. The mismatch between what we’re spending on and what matters couldn’t be greater. Not only are we not increasing our investment in public health, but it’s frequently been on the chopping block. And when times get tough, public health is often one of the first things to be cut.
“We’ve just got to create an urgency and a sense of priority for public health across the country. We really think it needs to be rebranded and remarketed to the public so that it’s not so vulnerable when the budget squeezes come.
“It’s ironic that in order to keep funding medical care, the government is cutting a lot of things that are arguably more important to our health like parks and recreation, like public health, like public higher education. If we can move people up the education ladder, all the evidence suggests that they tend to take better care of themselves.
“We need to drastically shift our own priorities and hopefully encourage a broader understanding of what needs to be done.
Q: Going back to your earlier point, how do you envision the rebranding of public health, and what effect do you hope that will have on the field?
“I don’t think public health has a good image. When people hear the term public health, I think they think of something going on in developing societies that really don’t have any type of sophisticated medical care. There’s something about the term that’s sort of off-putting and doesn’t speak to people. I think we need a broad campaign to reacquaint the public and the leadership with some of the staggering accomplishments of public health. Those things have has a huge impact of some things that the medical establishment likes to take credit for, like the increase in average lifespan and so forth.
“Public health is sort of the Rodney Dangerfield of public policy. It gets no respect. If you want to know what’s wrong with American health care, go to any university and compare the endowments of their medical school with the endowments of their public health school, and you’ll find a staggering difference.
“I don’t want to demonize the medical establishment – some of my best friends are doctors – but there’s no question that the medical profession has been very successful as defining itself as the central factor in health and, frankly, virtually monopolizing the resources that we put into health. The medical profession has enormous power and prestige that the public health field really does not have. There has to be some rebalancing of scales here because the health care cost issue is really the big culprit in the financial problems afflicting the country. If we do not moderate the growth in health care costs, we’re toast. We will simply lack the resources to invest in a better tomorrow.
“Health care costs have become like a Pac-Man consuming everything in its path.
“When you look at how this country was built, with key public investments like the land grant universities, or the GI Bill – there are lots of examples of things that were done – we’re putting the public sector in the position of not being able to make those kinds of investments any more because of health care costs.”
Q: Where will that image change come from?
“We’re an example of an ally that the public health field can attract but the public health field itself has to take more responsibility for rebranding itself and forging that connection for people because I don’t believe that you can moderate health care coats without a much greater effort in public health, wellness and prevention I don’t think it can be done. The payment reform stuff that’s happening is important and that can make a contribution, but I don’t think we’ll get there without a vastly increased emphasis in public health.
Q: Should that greater emphasis be at all levels — local, state and federal — or should the direction for the change come from the federal government?
“The way the country changes is often from the bottom up — from localities and states — just as Massachusetts has done with access to medical care. I think it will be driven primarily by a wave of experimentation that kinds of makes its way up the political good chain. Louis Brandeis called the states the laboratories of democracy and I think there’s a profound truth to that. So we believe that what we’re doing is very important because it’s part of a necessary ferment of experimentation and change that hopefully will lead to a broader shift in priorities.”
Submitted by Michael Saunders msaunder@bu.edu