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In the Lead: Sylvia Mathews Burwell on Global Public Health


In recognition of World Health Day earlier this month, we sat down with IWF Washington DC Member Sylvia Mathews Burwell for a conversation on current public health issues.

Throughout her career, she has held senior roles relating to global public health. She served as Secretary of Health and Human Services in the administration of US President Barack Obama, and as the COO for the Bill and Melinda Gates Foundation.

She is currently the President of American University in Washington DC.

World Health Day 2018 occurred earlier this month with the theme “Universal Health Coverage: Everyone, Everywhere.” That seems like a daunting task. What actions need to be taken to move the needle on this? Is there anything individuals can do to make a meaningful difference?

Happy World Health Day to everyone!

While I’ve had the privilege to work on health care in an international context, I spent a lot of my time at HHS focusing on moving the needle on health coverage in the domestic context. Some of the domestic lessons around affordability, quality and access apply to our world’s broader efforts to help more people get health coverage.

First, people need to be able to access health coverage in the first place – whether through a public program, private coverage, or a combination of the two. In the United States, more than 150 million people get coverage through their employer, 59 million in Medicare and about 74 million through Medicaid (with some overlap between those last two). And by the time the Affordable Care Act passed, somewhere between 45 and 50 million Americans had no coverage. Here in the United States, on access, between 2010 and the first quarter of 2017, the rate of the uninsured in our country feel from 16 percent to 8.8 percent – an historic reduction, and the largest decline since the launch of Medicare and Medicaid.

Second, health coverage can’t just be accessible, it has to also be affordable for the people in that nation. On affordability, since the Affordable Care Act passed, the rate of health care premium growth has slowed, and many more Americans have been able to afford coverage in the individual market through subsidies or their state’s expansion of Medicaid.

Finally, to move the needle on universal coverage, health coverage that is accessible and affordable must also translate to quality care. For example, in the United States, before the Affordable Care Act, most health plans in the individual market didn’t cover maternity care, a third didn’t cover mental health, and almost one in ten didn’t cover prescription drugs. Also those with pre-existing conditions could not get coverage. Too many Americans found out the coverage they thought they had access to, and that they thoughts was affordable didn’t actually provide them much coverage at all. Changes in our nation’s laws (the Affordable Care Act) guaranteed that coverage and thereby care throughout the nation could move to higher quality.

Fortunately, everyone can play a role in helping more people gain health coverage. You can start by learning about the substance of health care so you help folks move beyond rhetoric on the topic. You can volunteer with an advocacy group, contact your member of Congress and state representative, or you can write a letter to the editor or an op-ed. Make your voice heard, because every person has a chance to be a part of this progress. It can even be as simple as, the next time you hop into a Lyft or an Uber, making sure your driver knows when Open Enrollment is for the Health Insurance Marketplace – because everyone deserves access to affordable, quality coverage, and we all have a role to play in making a positive, lasting impact.

What do you currently feel is the greatest threat to global public health?

The challenge of global public health is that you never face just one threat at a time. For example, this is the 100th anniversary of the Spanish flu, which killed up to 50 million people and infected a third of the world’s population at the time. There have also been reports of Lassa in Nigeria and yellow fever in Brazil.

Above all of these, though, the overall state of our global health security is the most important thing we need to monitor. It covers both the developing and developed world at the same time, and in our globalized world, we need to consider both simultaneously. A global health security infrastructure that focuses on early detection, prevention, and response at the site of an outbreak can help us fight against Ebola and Zika as well as longer-term threats like antibiotic resistance.

Burwell with President Obama and Ebola Researcher Nancy Sullivan

These are serious threats. The Ebola outbreak claimed 11,000 lives – including 8 percent of all the doctors, nurses and midwives in Liberia, and 7 percent and 1 percent of the health care workforce in Sierra Leone and Guinea, respectively. And the reduction in health care workers meant that an estimated 10,600 lives were lost in these three countries to other diseases like HIV, tuberculosis, and malaria. As to Zika, more than 42,000 people tested positive for Zika in the United States and territories. And Anti-microbial resistance leaves 2 million every year in the United States who are infected with bacteria that are resistant to antibiotics. At least 23,000 people die in the U.S. every year as a direct result of those infections.

These threats are all daunting, but they’re not all the same. Some come and go, like outbreaks of Ebola or Zika, and some are long-term threats, like antimicrobial resistance, where the greatest risk is in the out-years. It’s hard to make the upfront investment in prevention, but prevention is the backbone of an effective global health system.

Burwell with Bill and Melinda Gates during a Gates Foundation visit to Africa

The ideal global health security system empowers us to be prepared both for crisis and for managing the day-to-day. When we build that kind of system, not only will we be prepared to work on problems like Zika or Ebola, but we can make important progress on reproductive health, fighting malaria, and increasing the rate of vaccination. Stronger global health security would protect the developing world as well as developed countries, and that includes the United States

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In the Lead: Sylvia Mathews Burwell on Global Public Health
In the Lead: Sylvia Mathews Burwell on Global Public Health
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