LETTER FROM THE CHAIR
Dear Colleagues,
Recently, I returned from a trip to the Baltic Sea that included visits to St. Petersberg, Copenhagen, and Stockholm. All three cities presented opportunities to think about structural change and human health. St. Petersberg, the city of the Russian czars, is a place where it is hard to avoid thinking about structural change. People there experienced transitions from imperial monarchy, to communist revolution, to resistance to Hitler’s armies (600,000 died in a 3-year siege), to Soviet hegemony over Eastern Europe, to Glaznost/Perestroika, to dissolution of the Soviet Union, to emergence of a new hybrid economy run by the “oligarchs.” Failure to plan an effective transition from a state run to a market economy left the country vulnerable to corrupt self-interested manipulators who stepped into the breach and snatched opportunity from a population that might have benefited from new opportunities. Their experience suggests that change you can believe in requires meticulous attention to implementation.
On the other end of the Baltic, in the City of Copenhagen, people live in a social democracy, i.e. a free market economic system that is married to a social welfare system. Based on principles that come from both traditions, the Danes recently overhauled their health system. Their new approach offers ideas that could help us move forward as we try to make our health system work in the 21st century. For example, 70 percent of the contacts between patients and clinicians happen asynchronously. Much medical care is delivered through communication only, so that clinicians have more time for the people who are most sick. Planned and proactive management of chronic conditions such as asthma is reducing hospitalization rates. Many Danish innovations are worth considering.
As we enter the home stretch before the APHA Annual Meeting, we face a possible shift in the balance of political power. Financial hardship and new legal structures such as health insurance mandates are frightening some people into hoping that new candidates will do better. Manipulators are hard at work taking advantage of this. Some are spreading bold lies and hate in an effort to change the balance of political power again. If this occurs, we may be at another pivotal point in U.S. history having lost an opportunity to push adjust ahead with the limited structural changes that were achieved. Many simple acts can contribute to a better outcome. Canvassing, calls, and monetary collections are a few. Since Pennsylvania is a swing state, the case for involvement here is compelling. I encourage you to be involved and do whatever you can over the next two months. I look forward to seeing you in Denver.
Sincerely,
Mona Sarfaty, MD, MPH
Chair, Medical Care Section