FXB at APHA 2023: Declining US Health: A population health emergency

Mary T Bassett

Plummeting Life Expectancy Rates for Americans Are a Public Health Emergency!

Stephen Bezruchka, MD, MPH, an acclaimed public health expert and author of Inequality Kills Us All, has convened a panel of experts, including FXB Director Mary T. Bassett, MD, MPH, to take on this crisis at the upcoming American Public Health Association annual meeting on November 12 in Atlanta.

Currently the citizens of more than 40 countries (including some poor ones) enjoy longer life spans than Americans. Our life expectancy, which peaked in 2014 at 78.9, has been in steady decline. A recent study showed that we have 11 million deceased Americans from 1980 to 2018 that would be alive if we had the mortality of other rich nations.  For every 2 Americans who died age 65 and under, one would have been alive if they had lived in Australia, Canada, Germany, Japan or Portugal.  This carnage is equivalent to two jumbo passenger jets crashing every day. An epidemic of chronic illness has also taken hold, with rates of heart disease, diabetes, liver disease, and obesity skyrocketing and impacting younger populations. Recently, the Washington Post spotlighted the alarming health decline in the U.S.

While Americans are quick to point to personal habits and lifestyle choices, research continues to show that record rates of inequality, a threadbare social safety net, high rates of stress, loneliness, and inadequate support for parents and children are all major culprits behind our failing health.

“The causes of our health emergency are political, and it’s time we address the systemic issues—poverty, inequality, racism, and the almost total abandonment of any program that would serve the public good—that are the root causes of the crisis,” says Stephen Bezruchka, MD, MPH, author of Inequality Kills Us All: COVID-19’s Health Lessons for the World (Routledge 2022), and professor emeritus at the University of Washington.

Bezruchka has convened a panel, “Declining US Health: A Population Health Emergency!,” which brings together some of the most respected public health experts to take on this crisis at the American Public Health Association (APHA) annual meeting on November 12 in Atlanta. Panelists (full bios below) include Steven Woolf, MD, MPH, lead author of the groundbreaking report, “U.S. Health in International Perspective: Shorter Lives, Poorer Health;” Donald Warne, MD, MPH, who hails from Pine Ridge Indian Reservation, which has the worst health outcomes in the nation; and Mary T. Bassett, MD, MPH, who as an New York City health commissioner reported on African American maternal mortality there being some ten times greater than for whites.

Bezruchka is heartened to see APHA acknowledging the health emergency by hosting his panel. “Public health institutions have been slow to recognize these alarming trends. By platforming this discussion, APHA has shown courage and leadership that other institutions can take inspiration from,” he says. He stresses that schools of public health and organizations tasked with safeguarding it must openly acknowledge our health emergency if we are to effectively intervene and guarantee health for generations to come.

The panel will discuss:

  • The real reasons why Americans are dying prematurely and why current approaches are inadequate to resolving the crisis;
  • How this crisis disproportionately impacts communities of color;
  • The crucial, yet grossly underrecognized difference, between health and health care;
  • Why public health education must change how they educate students and future policymakers;
  • The many pervasive myths about what creates health and how they lead to bad policy;
  • Setting clear goals for moving beyond the crisis and making the systemic changes required to reverse the current alarming trend.


Stephen Bezruchka, a graduate of Harvard, Johns Hopkins and Stanford universities, teaches courses in population health in the Departments of Health Systems and Population Health and of Global Health in the School of Public Health at the University of Washington. He worked clinically as a doctor for 35 years including three decades as an emergency physician.  He spent over 11 years in Nepal, writing the first trekking guide to that country, running a community health project a week’s walk from the road, training Nepali doctors in a remote district hospital and advancing concepts of population health. He serves on the board of directors of the Washington Physicians for Social Responsibility and works with its Economic Inequity Health Task Force.  His book: Inequality Kills Us All: COVID-19’s Health Lessons for the World is published by Routledge.

Mary T. Bassett, MD, MPH, is the Director of the François-Xavier Bagnoud (FXB) Center for Health and Human Rights at Harvard University and FXB Professor of the Practice of Health and Human Rights in the department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health. From December 1, 2021 to December 31, 2022 Dr. Bassett was on leave from Harvard and served as New York State’s Health Commissioner. Prior to that, she served as Commissioner of the New York City Department of Health and Mental Hygiene, Director for the Doris Duke Charitable Foundation’s African Health Initiative and Child Well-Being Prevention Program; and as Deputy Commissioner of Health Promotion and Disease Prevention at the New York City Department of Health and Mental Hygiene. Early in her career, Dr. Bassett served on the medical faculty at the University of Zimbabwe and went on to serve as Associate Director of Health Equity at the Rockefeller Foundation’s Southern Africa Office. After returning to the United States, she served on the faculty of Columbia University, including as Associate Professor of Clinical Epidemiology in the Mailman School of Public Health. Dr. Bassett received a B.A. in History and Science from Harvard University, an M.D. from Columbia University’s College of Physicians and Surgeons, and an M.P.H. from the University of Washington.

Sandro Galea, a physician, epidemiologist, and author, is Dean and Robert A. Knox Professor at Boston University School of Public Health. He previously held academic and leadership positions at Columbia University, the University of Michigan, and the New York Academy of Medicine. He has published extensively in the peer-reviewed literature, and is a regular contributor to a range of public media, about the social causes of health, mental health, and the consequences of trauma. He has been listed as one of the most widely cited scholars in the social sciences. He is past chair of the board of the Association of Schools and Programs of Public Health and past president of the Society for Epidemiologic Research and of the Interdisciplinary Association for Population Health Science. He is an elected member of the National Academy of Medicine. Galea has received several lifetime achievement awards. Galea holds a medical degree from the University of Toronto, graduate degrees from Harvard University and Columbia University, and an honorary doctorate from the University of Glasgow.

Donald Warne, MD, MPH, joined the Johns Hopkins Center for Indigenous Health as Co-Director on September 1, 2022. He is an acclaimed physician, one of the world’s preeminent scholars in Indigenous health, health education, policy and equity as well as a member of the Oglala Lakota tribe from Pine Ridge, South Dakota. Dr. Warne will also serve as Johns Hopkins University’s new Provost Fellow for Indigenous Health Policy. Warne comes from a long line of traditional healers and medicine men, and is a celebrated researcher of chronic health inequities. He is also an educational leader who created the first Indigenous health-focused Master of Public Health and PhD programs in the U.S. or Canada at the North Dakota State University and the University of North Dakota, respectively. Warne previously served at the University of North Dakota as professor of Family and Community Medicine and associate dean of diversity, equity, and inclusion, as well as director of the Indians Into Medicine and Public Health programs at the University of North Dakota School of Medicine and Health Sciences.

Steven Woolf, MD, MPH, is with Virginia Commonwealth University, where he is Professor of Family Medicine and Population Health, Director Emeritus of the Center on Society and Health, and the C. Kenneth and Dianne Wright Distinguished Chair in Population Health and Health Equity. His career has focused on raising public awareness about the social, economic, and environmental conditions that shape health outcomes and perpetuate health inequities. He has written extensively about the U.S. health disadvantage relative to other high-income countries and chaired the National Academy of Medicine committee that produced the 2013 report, U.S. Health in International Perspective:  Shorter Lives Poorer Health.


Lorna Garano