American Public Health Association executive director Georges Benjamin spoke with Health Affairs deputy editor Parmeeth Atwal at the APHA annual meeting earlier this month in Boston about the meeting’s human rights theme, the association’s “Get Ready” program, and the future direction of public health.

Atwal: I note that in this month’s issue of the American Journal of Public Health that you have excerpted Jonathan Mann’s 1996-1997 piece on health and human rights in which he laid out the first principles of this new subfield that he helped develop. Health as a human right has historically been a principle for which APHA has advocated. Why has APHA chosen public health and human rights as the theme of its annual meeting this year?

Benjamin: Well, I think as we began looking at a lot of things that are going on around the world, it became clear to us that we needed to reinvigorate that effort. And what APHA is pretty good at is reinvigorating the knowledge base of our members. We thought it was important for them to think of health and human rights as broadly as possible. We have always had an international human rights committee, and we’ve always had sessions on human rights, but by making it a holistic discussion at the meeting, it brings everybody into the discussion. So we get to talk about it from health care access, a woman’s right to choose, the science around genetics and cloning, and a whole range of important scientific, ethical, public health issues we thought were important. And quite frankly, we felt we needed to talk about the war.

Atwal: The theme of last year’s meeting seemed a particularly astute choice — directly responsive to the call from policymakers at all levels for greater accountability for perceived increases in public health-related expenditures in recent years. What does it say, going from that seemingly politically adroit choice, to public health and human rights this year, which seems to sort of harken back?

Benjamin: Well, it harkens backward but also forward…. We still have 47-48 million Americans without health insurance, so we’ve not yet espoused or put into practice as a nation health as a fundamental human right. Making sure everybody has equal access is certainly a first step.

Now we have a war which we went into based on things that we now know to be absolutely not true. The human implications behind conflict — particularly wars — will be with us for generations, and there are huge human rights abuses in any kind of conflict. So I think the theme…will reenergize us to begin looking at public health as a peace movement again.

Atwal: You mentioned in your remarks at the opening session of the meeting that one of the key challenges going forward for APHA is this need to reach out to core stakeholders. You also mentioned that often the public health community has the “echo chamber” problem and ends up talking to itself. How do you propose that APHA should reach out to the public in general and to policymakers?

Benjamin: We want to change the paradigm so that we are spending more time in a proactive manner educating policymakers before they make policy — so that we craft a process by which we become information bearers on an ongoing basis in timely ways, so that policy doesn’t get made in haste and without the information needed.

The second thing is to begin to work much more aggressively with business. I think we have to stop viewing business as the dark forces and figure out ways where we agree with them and work in those areas in which we agree. . . . My experience is when you get two people on opposite poles of an issue and you find the areas where they can agree, you often find that they agree on more and more over time. There is some give-and-take which brings people to a more collaborative effort, and there are many opportunities to work with business. I think business people are very powerful advocates in public health and can be so if we can better educate them on what our needs are, how they benefit, et cetera.

And then there is the community effort, which I think is the most powerful of all,… will, we believe, allow APHA to be the trusted voice for the public in public health. Now, certainly, various agencies of the Public Health Service want to be that as well, but we’re the nongovernmental voice, and we think that that’s an important voice for public health. We don’t have the constraints that government has, in many ways, but the average citizen does not know who we are. So we would like to make ourselves visible, trusted, and knowledgeable and engage the public differently than we’ve engaged them in the past. We don’t want to simply put out press releases and say, “You should do this” — we want to really get people in the communities more engaged with the American Public Health Association.

A few years ago, at the D.C. meeting, we had town forums on environmental justice. We brought in people from the community to be part of those forums, as part of the audience, and really tried to engage the public in discussions around environmental justice. We can do that around a range of public health issues. The power of engaging the public, of course, is that the public will go to their legislators and talk about public health issues and insist that those issues are addressed. Now we obviously have a perspective on how they should be addressed, but even if we got them addressed our way, the real importance here is the dialogue.

Atwal: Is the “Get Ready” campaign an example of that? Is that more geared towards the public and engaging the public, or is that something more geared towards the policy community directly?

Benjamin: The “Get Ready” campaign is primarily targeted at the public. Now there was certainly a professional component and a policy component, because you have to have that comprehensiveness to make it work. But our idea is that . . . particularly after Katrina,…we wanted communities to become resilient; we wanted people to become self-empowered….This is knowing what’s going on in your community, engaging in the political processes, engaging in the discussions. If we have a flu pandemic, we want the public to be able to engage in a discussion around their schools and whether their schools close or not, and who’s at home. . . . Particularly — you saw in Katrina, low-income communities obviously were not engaged as part of the disaster preparedness efforts. We want to change that, and we are focusing on flu because we think it’s narrow and it’s something that’s contemporary. . . . But once the model is in place, it can be shared much more broadly…, and we can talk about chronic disease, and reducing diabetes, and improving public health infrastructure, and yes, even universal health care. And we see this as building an engine and a communications tool mechanism to engage communities effectively. It also means we have to work with state and local health departments; we have to work with the organized components of government.

Atwal: As part of the evidence-based policy push at last year’s meeting, reinvigorating the public health research agenda seemed a priority. You also noted earlier APHA’s goal of informing the policy formulation process in a timely way. Yet it seems the public health research agenda has been so underresourced for so long, that you might have a chicken-and-egg problem. Where does the public health research agenda fit in?

Benjamin: We are actively working on the research agenda through a variety of mechanisms. First of all, we have been involved with CDC [the Centers for Disease Control and Prevention], and they’re creating the national research agenda. We are a part of the workgroups that have worked on that, and we hope that CDC will be able to unveil that research agenda soon. This is a recent agenda which is targeted to prevention research, public health services research.

The second thing is we’ve been working through Research America, of which we’re a member, to again encourage Congress to continue to adequately fund core research in a variety of ways — basic biomedical research.

And then the third thing we’ve done is we’ve worked with the Campaign for Public Health, a 501(c)4 advocacy group working to increase dramatically the CDC budget. CDC’s budget is around 7–8 billion dollars. There was a professional judgment number put out there several years ago by Dr. Julie Gerberding [head of the CDC] which puts it in the 15-16 billion dollar range, and basically the question was asked of Dr. Gerberding, “If you had the money to fund what we know works, and to fully fund the programs that you have now, what would you do?” And that’s . . . the number that came out to. That’s several years old now . . . but we’ve been working to try to get Congress to focus on that. Of course, as you know, we’ve been fighting a real rear-guard action in terms of trying to stop Congress from cutting the CDC budget. In the last budget cycle, which, as you know, has not been completed yet . . . they cut so many things that we went to the Congress and said, “You need to increase the domestic pie; the pie is too small,” and Congress, at least the Senate side, increased the domestic pie by about 7 billion dollars. This allowed us to in effect maintain public health programs I think at 2005 budget level. So basically we’re asking for level funding. We’re also beginning to talk to foundations about crafting effective strategies and programs for public health research — particularly protocol systems research.

Atwal: Any foundations in particular you’d care to name?

Benjamin: Not yet.

Atwal: OK. To close, in light of the landmark election, what is the take-away message policymakers should have going forward about the interaction between public health and human rights?

Benjamin: This election, I believe, is about the neglect of domestic policy in addition to the real concerns about the war in Iraq. And I believe this election is about a wrong-headed social policy. . . . So what I hope policymakers hear from this is that we need to pay attention to the social determinants of health. There are some basic building blocks that we have not yet done in this country. One is universal health care. Another is dealing with poverty; and another is dealing with a range of injustices that we have still, that impact on health — the whole issue of health inequities that we have in this country that still are a national disgrace — complex, but still a national disgrace. We have the tools and resources in this country to do all of that. I’ve argued that this is a nation that spends money for what it wants to . . . even if we have to borrow it — not that I’m encouraging anyone to mortgage our future, but what I am encouraging them to do is pay themselves first. Spend the money on the basic building blocks of domestic policy first to make sure our kids are healthy, make sure our kids are well educated, make sure they’re well fed. If they take from this election . . . those core tenets and move with them, I think we will be a healthy society.

Atwal: Thank you for taking the time to speak with me today.

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