Jay Butler Reflects on ASTHO’s 75th Anniversary
In advance of ASTHO’s 75th anniversary year, which kicked off this week with a symposium on public health challenges and opportunities, we spoke with Jay Butler, MD, ASTHO president, and director and chief medical officer of the Division of Public Health and Alaska Department of Health and Social Services, about lessons learned as a public health leader, what he considers the most important public health achievements over the past 75 years, and which public health issues he believes will be a priority in the coming 75 years.
What are the most important lessons you’ve learned during your career as a public health leader?
One of the most important lessons I’ve learned as a state health official is that you have very few enemies. The person who angers you today may end up your best supporter tomorrow. This is particularly true in the political environment in which we exist. Sometimes people need to beat you up a little in public, but don’t take it personally. There are critical conversations that still need to be had with those people, and it’s important to have those conversations.
Your 2017 ASTHO President’s Challenge centers around public health approaches to preventing substance misuse and addictions. How do you believe public health leaders can work with the new administration to address this pressing issue?
As we address the challenges of substance misuse and addictions, one of the advantages we have is that this issue is recognized as important on both sides of the aisle. It is my hope that some of the efforts started in the previous administration will be carried forward by the current administration, and there is every indication that this will be the case.
What do you think have been the biggest public health achievements over the past 75 years?
The first thing that comes to mind is small pox eradication. We should not forget that this was a disease that killed millions every year. Small pox was the first global infectious disease to be eradicated from the human population, and while it is not eradicated from the planet earth entirely, there is no natural infection occurring in humans and hasn’t been for decades.
Another very important point of progress over the past 75 years was recognizing the health effects of tobacco smoke. The first Surgeon General’s Report on Smoking and Health in 1964 really laid the groundwork for some of the important health improvements in chronic disease we’ve seen over the past few decades, such as declines in heart disease mortality and declines in cancer.
Similarly, the 2016 Surgeon General’s Report on Alcohol, Drugs, and Health raises the hope that we will see a comparable type of progress in the prevention of alcohol and drug abuse. Moving forward, however, one thing we should keep in mind is that the changes we saw following the Surgeon General’s report in 1964 did not happen overnight. The improvements occurred over a period of several years, in which we saw declines in tobacco smoking and subsequent declines in health-related effects. With that said, we need to mount a concerted effort for more rapid progress in addressing the health effects of alcohol and drug misuse so that we don’t have to wait for decades to see gains in health.
What do you hope will be some of the biggest public health achievements 75 years from now?
First of all, as we move through the 21st century, it is my hope that we do not lose ground on the critical achievements we have already made in infectious disease control, as well as in addressing chronic diseases such as heart disease and cancer. I also hope that we will begin to eradicate health disparities, so that the progress we have made for many parts of the population will extend to everyone, regardless of socioeconomic status, educational attainment, racial/ethnic background, or sexual orientation. I hope that 75 years from now everyone can enjoy optimal health. I also hope that we will see progress in approaches to substance use disorders and addictions, as well as mental health issues.
I have a vision that 75 years from now we will regard substance use disorders and addictions as a whole multitude of diseases for which we have very specific mechanisms to treat as well as prevent. This is not unlike cancer, which we now know consists of over 300 different diseases, whereas not too long ago—maybe 100 to 150 years ago—we generally thought of it as one disease. These are some of the challenges we face moving forward, and my hope for public health over the next 75 years.