Visionary Leadership, Visionary Goals: NPHW@25

On May 25, 1961, President John F. Kennedy announced before a special session of Congress that it was the goal of the United States of America to land a man on the moon and bring him safely home within the decade. At the time, many felt this was an unrealistic goal because much of the technical science and math were unknown. But we were in a space race and the Soviet Union was way ahead of the United States in both experience and space science, having been successful in both sending up the first space satellites and the first man and woman to orbit the earth. There were numerous challenges that the United States needed to overcome beyond the science if we were going to achieve this: the extraordinary cost ($25 billion, or $125 billion in today’s costs) and the need to marshal and focus public support and political will. It was indeed an ambitious goal, some might even say unrealistic. But what it really was, was visionary—leadership at its best.

Kennedy believed strongly in the capacity of the US science community, in particular the newly created National Aeronautics and Space Administration, which already had this idea but as a longer term goal. The president trusted that his scientists could accomplish this if he championed the effort, convincing Congress to provide the funding and the political support. He understood that essential to this was having focus and building public support. So Kennedy set a visionary goal, got the money, and rallied the public. In one of his most famous speeches, at Rice University, he stated, “We choose to go to the moon. . . .We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard.” On July 20, 1969, the United States successfully landed humans on the moon and returned the astronauts safely to earth.

HEALTHIEST NATION

Eyal and Sjöstrand remind us in this issue of AJPH of the importance of thinking carefully about setting goals in public health (p. 480). They explore the concept of “unrealistic goals” and debate the pros and cons of setting them. In this exploration, they review public heath efforts that have been successful in achieving their goal and many that have not. In many cases the goals seemed unrealistic to begin with. They debate whether setting an ambitious goal is useful in motivating action or undermining the credibility of public health.

One could argue that many of these goals were visionary, were clearly hard to do but not unrealistic in general concept. In many cases, the goals were not met because the resources, political will, and public support to achieve them were lacking. Imagine if we were serious about universal health coverage, or eliminating polio, or zero preventable deaths from childhood tuberculosis. In these cases we actually have the science but lack the funding and political will. Suppose we as a society decided that health equity was an important human right and a priority requiring all of our efforts to address. We actually have the knowledge about what causes many health inequities but have failed to act decisively.

A visionary goal requires visionary leadership to achieve it. Visionary leaders create a visionary goal and then lead others to achieve it. But that is the first step: achieving it requires the leader to focus, build public and political support, and acquire the resources to make it happen. The American Public Health Association (APHA) believes that the United States does not get the best value for our health care dollar, spending almost twice as much as the other industrialized nations yet remaining at the bottom in a variety of health measures, including mortality. The culprit is not lack of knowledge; it is misplaced funding and low levels of public support and political will. That is why we have set a visionary goal of being the healthiest nation in one generation. Our metrics are those of our nation designated by the US Department of Health and Human Services, currently Healthy People 2020.

These metrics are mostly achievable and in some cases are stretched metrics requiring extra efforts to achieve them. But in terms of the overall goal of being the healthiest nation in a generation, I would argue it is both visionary and achievable with visionary leadership. The United States could decide to fix our fractured health care system, focus more on prevention, address the social determents of health with intention, and once and for all achieve universal health care coverage. If we did this we could make it happen. It does, however, require a Herculean effort equivalent to the moon shot to make this happen—an effort that builds the support and resources to make health a shared value. At the APHA we get up every morning to provide the visionary leadership to make this happen.

NPHW@25

April 2020 marks the 25th anniversary of President William J. Clinton’s formal designation of National Public Health Week. The first full week in April is a time for the public health community to measure our successes, adjust goals, set new ones, and build public support for public health. This year’s theme, “NPHW@25: Looking Back, Moving Forward,” is designed to stimulate visionary thinking that is informed by the past. It is an important celebratory, educational, and planning activity that brings together the more than one million public health practitioners, policymakers, the media, and the general public in efforts to improve the public’s health. During this special anniversary week, the public health community will consider many health goals; people another 25 years from now will assess whether they were achieved and, if not, question their realism.

As we set these goals, we should carefully consider the perspectives that Eyal and Sjöstrand have given us in this issue of the AJPH. At the APHA we have set a public health equivalent to Kennedy’s goal to go to the moon. We do want our next generation to become the healthiest, not by other nation’s populations getting sicker but by deploying the best of our resources and knowledge. NPHW@25 is an opportunity for the public health community to provide the visionary leadership to achieve this most realistic goal.