On Aug. 23, Director Rochelle Walensky called for a paradigm shift in the manner the Centers for Disease Control and Prevention (CDC) do their work.
“In these pandemic moments, we found ourselves having to talk to a broader audience,” she said. “We didn’t have to convince the scientific audience — we had to convince the American people.”
This shift is critical if the efforts of the CDC are to fully understand, address and combat the challenges undermining the health of the American people. Moreover, this shift is timely given the near historic drops in life expectancy in the United States reported by the National Center for Health Statistics reported a week after Walensky’s statement.
Literature is replete with scientific knowledge on the ways infectious agents, such as viruses, evolve to create disease in humans. Evidence suggests ecological factors, including climate change and deforestation, enable bacteria to transform their genetic structure to the point that such pathogens cause us to become sick when they enter our systems.
Other novel pathogens, such as SARS-CoV-2, the virus which causes COVID-19, may have been enabled by zoogenic transfer as humans increasingly interact with infected animals. The virus that causes monkeypox was transferred from rodents to chimpanzees to humans. HIV followed a similar pattern. These biological transfers are common and our ability to contain these diseases in humans has been advanced by the development of medical treatments and of vaccines.
This is the good news.
The bad news is the spread of infectious diseases is incumbent on human behavior. Risk-inducing health behaviors, such as being unvaccinated or engaging in unprotected sex, are predicated on the social and structural conditions that shape people’s actions and emotions.
If we are to emerge from this likely new era of pandemics without losing millions of more lives, we must continue to develop the biomedical strategies that help us to combat pathogens while forging strategies that address the psychological, social and structural factors that cause humans to infect each other.
This will require nonbiomedical actions. We must uncouple losing wages for missing work because of illness, we must facilitate childhood vaccinations by easing the burdens on families who must travel long distances to doctors because none are available nearby and we must address the undiagnosed or untreated depression that catalyzes risk-taking with one’s health.
In short, suboptimal work conditions, lack of access to health care and mental health challenges fuel infectious disease.
Implementing a biopsychosocial paradigm (versus a purely biomedical one) in prevention and care isn’t an innovative concept. Hippocrates, considered the father of Western medicine, recognized treatment and healing were directed by attitude and environmental factors.
In 1977, George Engel advanced the notion of a biopsychosocial paradigm, stating, “To provide a basis for understanding the determinants of diseases and arriving at rationale treatments and patterns of health care, a medical model must also take into account the patient, the social context in which he lives and the complementary system devised by society to deal with the disruptive effects of illness.”
This approach to health care also underscores the Affordable Care Act.
“Take two aspirin and call me in the morning” is the ethos that has shaped our responses to the pandemics of the past four decades. For those of us who came of age during the height of AIDS, such rigid, noncreative responses simply aren’t enough. We know activism and psychological health need to sit alongside medicine to address the social inequities that fuel HIV. Dr. Anthony Fauci understood that, too, and joined forces with groups such as ACT UP to ensure the lives of people are considered in our battle against pathogens.
I have heard too many say the COVID-19 virus has outsmarted us. How is that possible? This virus has no brain, no nervous system and no emotions. It proliferates and infects us because we, as human beings, are making faulty decisions. Many of our leading health institutions ignore that humans serve as vectors of disease, driven by emotions, not by logic and reason.
Those of us in the fields of public health and public health psychology understand and implement these concepts in our work. We recognize racism as a social determinant that leads to heightened health disparities for Black and brown populations. We recognize a vaccine won’t eradicate COVID-19. And we know AIDS continues to take the lives of many underserved populations of color. HIV continues to disproportionately infect young gay men predominantly in states such as Florida, where LGBTQ identities are under siege. No pharmaceutical or medical procedures can combat these social conditions.
If we are to control outbreaks, we must focus on people. In doing so, our approaches must marry the biomedical with psychological, behavioral, social and structural. Public health must have equal representation in our decision-making bodies and in the extramurally funded research National Institutes of Health programs that we taxpayers continue to support.
Perry N. Halkitis is dean and Hunterdon Professor of Public Health and Health Equity at the School of Public Health, Rutgers University.