If you've got your health, the cliche goes, you've got just about everything. If you've got public health duties, you're responsible for just about everything from mosquitoes (West Nile carriers) to hygiene (wash your hands for as long as it takes to sing "Happy Birthday" twice). Dr. Jonathan Fielding heads L.A. County's Department of Public Health, which is bigger than some states' health departments. A pediatrician by training and the head of the county's health programs since 1998, Fielding is such a believer that he and his wife, Karin, turned savvy investments into a $50-million gift last year to UCLA's School of Public Health. Here he takes the temperature of the medical and political aspects of his work.
To the public, "public health" may sound outdated. Do we still need the department?
Clean water, pure foods, safe and effective drugs, substandard housing, occupational safety — those are public health triumphs from the late 19th and early 20th centuries, but we're now finding them in other forms. Water — whether it's drought or fracking or what's seeping into the aquifers. We've never had a time of more food recalls. What toxins don't we know about? People are not aware [of the risks]. It's a core public health responsibility, to let people know what we know and what we don't know.
Maybe "public health" needs a new name?
People say to me, "Oh, you must be providing a lot of indigent care." We are, but it's not the only thing we do. Maybe it could be [called] the health protector department?
C. Everett Koop was our best known U.S. surgeon general. He was high profile to say the least — he even wore the uniform.
Maybe a uniform would be helpful! Chick Koop was amazing. He was a truth-teller at a time when ideology was trumping common sense and knowledge.
What are L.A. public health achievements?
In the county, we're down to 13.1% of adults who smoke. The incredible progress in cardiovascular disease, stroke, lung cancer — a 60% decline in cardiovascular disease, a 40-plus percent difference in stroke. 2006 is the first time we got beyond 80 years life expectancy in L.A. [With restaurant grading], we've shown a 13% reduction in hospitalization for food-borne [related] illness compared to surrounding counties. We inspect multi-unit housing. We're the first public health agency in the country to have an agreement with the FBI; we have [public health] people at the Joint Regional Intelligence Center here. We're a national model for preparations for terrorism.
A West Hollywood man recently died of bacterial meningitis, making a total of four such deaths in L.A. County over five months. It's not an unusual number, but some have used the word "outbreak."
We were on it the same day and made sure people who were exposed to [the victim] had prophylactic antibiotics. There were statements made that this could be the new AIDS, that this was somehow a coverup. Unfortunately, that resonated with some in the gay community because of the terrible history of HIV. We did not have an increase in [meningitis] cases, we had no "outbreak" based on the usual criteria. The CDC has very clear [outbreak] criteria: three related cases within three months and a rate of at least 10 [cases] per 100,000. We weren't there.
We have to be careful because the words we use don't always mean the same to the public as they do to us. "Outbreak" is one. "Plague" — that's certainly another; people have this notion of the Black Death in history. Certainly "epidemic" is one.
Science can be slow, but the public wants information now. How does that affect your work?
It's a question of whether it's a public need or a public demand. Social media has positives and negatives. There's no way in real time that we can respond to misinformation because we have to verify what's actually happening.
There was a report on social media of a gonorrhea superbug. It turns out that there was a naturopathic physician who claimed this was happening. It was not true, but it got picked up quickly. A lot of people don't ever hear the correction, so they're living with the myth. All it takes is the "send" key.
New York and Mayor Michael Bloomberg have been hammered for imposing "nanny state" rules on big sodas, trans fats and the like.
We have to make sure when we're abridging individual freedom that there's a real strong reason for it. Tobacco [restrictions], for example — we've made huge progress. It makes sense, when you can empower consumers. You need to be not authoritarian but authoritative.
Public health is [altered] often by successive redefinitions of the unacceptable. Think about tobacco. I wrote an editorial about 20 years ago about banning smoking in public places. They almost didn't print it. They said it was so outrageous it would never happen. Look at it now.
What about guns as a public health issue?
It's definitely a public health issue. African American males in L.A. County live on average 18 years fewer than an Asian Pacific Islander female. Some of that is the high rate of homicide. There are estimates of 300 million guns [in the U.S.]. If you're starting from that, where do you go?