The executive director of the American Public Health Association breaks down food deserts, environmental racism, prostate cancer and the growing risks of marijuana on community health.
Georges C. Benjamin, MD has spent decades at the intersection of medicine, policy and public advocacy. As executive director of the American Public Health Association since 2002, he has become one of the most recognized voices in the country on the forces shaping community health. A former military physician, emergency medicine chief and Maryland health secretary, Benjamin brings a ground-level clarity to conversations that often get lost in policy language. In a conversation with Munson Steed on Health IQ, he pulled no punches.
When we think about the American Public Health Association, what should some of the first thoughts be as it relates to the organization?
We have been around since 1872. We were founded when medicine and doctors understood that there were things that occurred outside the doctor’s office that influenced your health. What you eat, where you work, the quality of your housing, whether you had money to pay your bills, the environment in which you lived, the exposures that you had. And they began to say, if we could fix those things, then we could prevent bad health from happening in the first place. It was not just physicians involved. It was physicians, lawyers and a whole range of public interest people as well.
When you think of public health, what are the three things you would like our community to understand immediately?
The first thing is that public health is for everybody. It often gets characterized as just being for poor people, but it is for everybody. It is making sure the water is safe to drink, the air is safe to breathe and the food is safe to eat, and that you are safe in the environment in which you live.
The second thing is that public health practitioners are focused on your health. There is really no other motive. That is what they get up in the morning to do. They are public servants, just like the people who run the ambulances.
The third thing is that every community has a public health department. It is staffed by people from your community, your neighbors, your friends, who are professionally trained in what they do. They think about the community’s health versus primarily individual health.
When we think of public health, I want to mention food scarcity, HIV and communal diseases, and environmental living conditions. Can you speak to those?
Food deserts tend to be in communities where there is always a little corner store. It serves food at a higher price than you can get at the big grocery stores. It often does not have access to fresh fruits and vegetables because they do not have the chillers, and they make their margins on high-fat, high-salt, low-nutritious foods, sometimes selling alcohol and tobacco. When you have been working two shifts, six or seven days a week, and you get home at 11:30 at night and you are hungry, those donuts look good. Food deserts exist in our communities because the economics have not worked to bring in full-service grocery stores that are open during the hours working people can actually get there.
On the environment, far too often, people dump their trash in communities where the land is not valued, and quite often that is where communities of color live. When I was commissioner of health, in Washington, D.C., trash haulers would cross the 14th Street Bridge and go right into the impoverished part of town, into Wards 7 and 8, instead of left into Georgetown. One of the public health interventions we did was put police officers on the bridge to stop and arrest the illegal haulers.
Growing up in Chicago, when they built the Dan Ryan Expressway, they built it right through the Black community. The projects were right there next to it, which meant our folks were exposed to all the vehicle emissions from a very busy expressway. It bifurcated our community and exposed us to environmental pollutants. That causes higher rates of asthma, higher infant mortality, smaller babies and more trouble with pregnancy. We were also still using leaded gas, and a lot of folks were exposed to lead both from burning fossil fuels and from what got into the environment.
On infectious diseases, HIV-AIDS started primarily in communities of men who had sex with men, but none of those diseases stay in one community. When I was in Washington, D.C., we were beginning to see more African American gay men getting HIV-AIDS, and it was transitioning into the heterosexual community, particularly affecting women and substance-abusing individuals sharing needles.
Why should we be active in supporting organizations like yours and advocate for better public health?
Because we are on the front end of the effort to make sure people are healthy. We are the ones telling folks we need to address things like income inequality, because there is a direct correlation between low income and lower health. The reverse is also true. People with higher income have better health. Poor housing dramatically impacts communities of color. We live in communities that were redlined years ago and allowed to decompose. Our potholes are the last to get filled. Contractors charge more to fix things. When disasters strike, like Hurricane Katrina, we still have people of color living under blue tarps because they did not have insurance or it was too expensive.
If you were going to give a speech to Black men over 50 about their health and testing, what should they understand?
We want to be strong for our significant others and our families, but you cannot be there if you are not healthy. Bad news does not get better with time. You have to get that digital rectal exam, a colonoscopy, oral cancer screening. As you get older, particularly if you are not at ideal body weight, you are at higher risk for heart disease, lung disease and kidney disease. Communities of color have disproportionately higher rates of chronic disease. What we are seeing more of, because people are just not paying attention, is prostate cancer, particularly in Black men. We get it younger and in a much more aggressive stage than others.
What are the public health impacts of smoking in any form, including vaping and marijuana?
Tobacco has to be promoted because of its soothing effect. Physicians actually used to promote tobacco use. Then we learned it causes chronic obstructive pulmonary disease, lung cancer, low-weight babies, cardiovascular disease and heart attacks. The tobacco industry still promotes this deadly addiction. Most people start as teens. Flavors are a big part of that. Menthol specifically had a cooling effect, and the industry targeted communities of color through it. Tobacco is the only product that, when used as intended, kills.
Then vaping hit. While it can be used as a tool to reduce combustible tobacco use, far too often people end up with dual use. They also put other things in the vaping tool beyond nicotine, including drugs laced with heroin, cocaine or fentanyl, and you do not know what is in it.
Marijuana is a growing public health concern. If you smoke it, you have all the same physiological problems as with tobacco. We are also beginning to see effects on the brain. The federal government has not allowed much research on it because it is a controlled substance, yet we have aggressively grown a marijuana industry for business purposes. We are seeing more car accidents, more falls and more people getting hit because they are walking while impaired. I agree with decriminalization, and there are likely some medical indications for THC under proper conditions, but we really do not understand the long-term impacts. Science is a quest for truth. It is not the end-all. I will tell you what I know today, and if I learn more, I am eager to correct myself and tell you what I know better when I have more information.