On HIV, Prevention, and Public Health

It is with some regret for our regular readership that I announce I am not yet done beating the drum regarding the U.S. failure to allocate adequate resources to prevention and public health. 

Harold Pollack, a professor at Chicago, is doing a bang-up job guest-blogging over at Ezra's shop, and has a terrific post regarding the abject failure of HIV policy in the U.S.

He notes:

AIDS has already killed more Americans than the combined total of combat deaths in World War I, World War II, Korea, and Vietnam.  Despite treatment advances, the deaths keep coming.  In 2006, the most recent year with good records, we lost 14,627 of our fellow citizens to this terrible disease.

[ . . . ]

Our continuing failure to execute public health interventions was . . . lethal.  Public health is almost always treated as the disfavored stepchild of the biomedical enterprise. In AIDS, this has brought especially tragic results ....

Though our readership is no doubt tired of hearing me fulminate on this issue, I will continue to do so because this failure is directly tied to our failures to produce the kind of health that we are capable of producing.  The well-intentioned movements to reform our health care nonsystem and universalize access are not about health per se, they are about health care.  Though health and health care are obviously related, they are not equivalent, and there is robust evidence warning of the dangers of thinking that faciliating access will substantially improve population health.  Pollack's analysis of HIV policy fits neatly into this conceptual frame. 

(To repeat the caveat I issue every time I discuss this concept, I fully support universalizing access, and the moral case for doing so is persuasive, in my view.  But it does not follow therefrom that we are justified in believing that fulfilling our moral obligations here will also produce improved population health.  What are we justified in believing will improve population health? Public health and prevention activities, as well as policy directed to the SDOH).

Pollack writes more about the HIV story in TNR.  I do not endorse all of his perspectives, but his focus on the "deteriorated public health system" is right on, in my view.