Innovating for a Healthier Public.

Innovation is the process of generating new ideas and creating value through new approaches or products. “Innovation,” wrote Roberta Ness, “is the engine of scientific progress.” I agree, and would argue that we would be missing a tremendous opportunity if we did not actively think about how we may embrace innovative approaches in advancing the goals of public health. This push for innovative approaches is perhaps lent further urgency by our living in Boston— the premier hub of health-related innovation in the world.

A note today, therefore, about innovative strategies that may lend synergy to the goals of public health, commenting on three fronts: the role of biological and pharmaceutical approaches, almost inescapable in the Boston context; the role of less typical innovative technological approaches to the improvement of population health; and the approaches to public health efforts that rely very little on technology, but rather rest on novel approaches to the improvement of the social, cultural, and economic conditions that shape health.

First, on biology. Take by way of example the development of Tenofovir disoproxil/emtricitabine (Truvada). Truvada is on the cutting edge of HIV prevention. In one study of all adult Kaiser Permanente San Francisco members evaluated for preexposure prophylaxis between July 2012 and February 2015, there were no new HIV infections among Truvada users. This makes Truvada an exciting, potentially game-changing drug focused on prevention. Take as another example the adoption of metformin for possible use in cancer prevention. Diabetic post-menopausal women aged 50–79 years old have been shown to have a 45 percent greater risk of dying from invasive cancer than women without diabetes. Research from the Women’s Health Initiative has suggested, however, that over the long term, women managing their diabetes with metformin have a lower risk of getting cancer than other diabetic women. Other studies have shown equally encouraging results, suggesting that metformin, designed for treatment, can be leveraged for disease prevention. The examples of drugs like metformin and Truvada are just two cases where pharmaceutical innovations are creating the conditions for a healthier future in ways that are compatible with a prevention focus. There is more to encourage us in this area. The use of biotechnology and genomics in vaccine development, and the continued refinement of rapid diagnostic tests (RDTs), are helping to move the needle on both primary and secondary prevention, including, coming back to the starting example, the potential of RDTs to make a tremendous difference in the fight against malaria if broadly utilized.

Second, on other technology. Let us start small. One of the most useful developments in the history of health technology is also one of the most basic—the mosquito net. The use of mosquito netting has dramatically lowered the prevalence of malaria in Africa; the disease used to be the number one killer of refugees on the continent but is now the fifth. The mosquito net, simple but effective, represents in many ways the perfect marriage of innovation and disease prevention. Now let us jump ahead and consider more contemporary innovation in a host of industries, beyond just the pharmaceutical or biological world, that contribute to improving population health. In green energy, for example, the construction of ever larger offshore wind turbines means cleaner air and all the attendant health benefits of a less polluted environment, including longer life expectancy. In architecture and urban design, we see schools being built with an eye towards improving the physical and mental health of students, and the layout of cities modified to improve pedestrian well-being. Cars have also been upgraded in the interest of safeguarding health. The widespread use of seat belts, a triumph of public health, is now one safety measure among many, including blind spot sensors, collision warning systems, and automatic breaking. According to a 2015 National Highway Traffic Safety Administration report, vehicle safety technologies, combined with safety standards, have saved more than 613,000 lives between 1960 and 2012. Finally, technological innovation stands to make a difference in preventing gun deaths. The introduction of fingerprint-locking “smart guns” suggests a way that technology can mitigate the lethality of firearms. Amidst the contentiousness of the gun debate, smart guns are an area of possible compromise. A recent study found that close to 60 percent of Americans would be open to buying a smart or childproof gun.

Third, on innovation that may shape the conditions that make people healthy. There is little question that changing these conditions has to be at the core of the mission of public health. We have witnessed recently several spectacular efforts at innovative approaches to this end that have failed, including, for example, efforts to change soda packaging norms in New York. But for every such effort, we have seen other highly successful efforts. New York City successfully banned trans-fats, substantially reducing saturated fat content in meals consumed in the city. Recently, the mayor of Philadelphia proposed a budget that includes a new soda tax. While this measure is not being cast as a public health effort, its net effect will be the reduction of sugary soda consumption, and by consequence an improvement in population health. Take another example: the Vision Zero program. The program aims to reduce urban traffic injuries and has shown thus far a reduction in pedestrian fatalities in the first two years of the program (see Figure 1 below). These programs are indeed innovations. They take something that we thought could not be done (can trans-fats be banned? Will consumers not just leave New York City and go eat in New Jersey?) and show that it can be. Efforts to increase the minimum wage make a bold statement and represent attempts to restructure our economic context, indeed adding value. A recent analysis shows that raising the minimum wage to $15/hour could have averted between 2,800 and 5,500 deaths in New York City alone between 2008 and 2012, representing a 4 percent to 8 percent of preventable deaths during that period.

Innovative approaches stand to improve population health in a broad variety of ways, ranging from what we may typically think of as innovative—the discovery of new molecular or genetic targeting approaches—to creative approaches that shape our social, economic, and political context to an equally dramatic, but perhaps far less sung, effect. Importantly, many innovative approaches that may promote health do not necessarily arise from the pursuit of a population health goal, but can equally well lend themselves to the improvement of population health. This, to my mind, agitates for public health’s active engagement in partnerships across different sectors, and an openness to an “any means necessary” approach to creating a healthier world.

I hope everyone has a terrific week. Until next week.

Warm regards,

Sandro

Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Twitter: @sandrogalea

Acknowledgement: I am grateful to Eric DelGizzo for his contributions to this Dean’s Note.

Previous Dean’s Notes are archived at: https://www.bu.edu/sph/tag/deans-note/