Econ 050: public health activism

Associate professor Jochen Mierau’s background is in economics, but as a founding member of the Aletta Jacobs School of Public Health, he is applying his expertise to a new discipline. Health outcomes vary from one nation to the next, but zooming in on the level of neighbourhoods can shed light on best practices that can be applied on a city or regional level.

Mierau says that public health is not a spectator sport, and in our conversation about the increasingly interdisciplinary nature of this academic field, in honour of the school’s namesake, he talks about how health care interventions effectively amount to a form of activism.

Who is Aletta Jacobs, the woman the school of public health is named after?

Jochen Mierau: I think for multiple reasons Aletta Jacobs is a good example after which we are proud to name the school of public health. The first is that she was the first female medicine student in the Netherlands and also one of the first female doctors thereby, and not only that, but she was very engaged in public health, especially in the women’s health movement. She had early thoughts about contraception as a way to counter poverty. On top of that, she was also very active in the suffragette movement and a pivotal force in realizing universal suffrage in the Netherlands and outside of the Netherlands. And I think as a school of public health, we strive for health of the public as such. So I think her outreach towards the public and actually making many people a little healthier instead of making the few a lot healthier is I think very exemplary for what we do, and I think is also a nice way to connect to the history of the university. She went to the university of Groningen, so I think it’s nice to connect to that history and to have her as a name.

Is public health inherently activist?

Mierau: Well I think that public health by definition is not a spectator sport. So it’s a field that’s intensely connected to the world around you, and if we look around, there’s different ways schools of public health engage with their environment. So some schools of public health, let’s say the big private schools of public health, they’re very research oriented and oriented towards the inside. And we see the more publicly funded schools of public health, like those in the United States, are very engaged with the community around them and really play as kind of a knowledge pipeline to the stakeholders around them and help them in reaching their goals of making the people around them healthier.

What are the biggest regional or national differences in north Europe when it comes to public health and medical systems in general?

Mierau: So I think that one unique thing we have in the northern Netherlands is that we have this border with Germany, which gives us kind of a natural experiment. We have two societies that are culturally and genetically, historically very similar, yet have quite different healthcare systems, but face essentially the same challenges. So we see this demographic transition, where now we have a disproportionately large part of society that’s 60 or 60-plus, we have this transition towards chronic diseases that could have been prevented. Those things are playing out on both sides of the border, but there are systems on both sides that give different tools to intervene in them. It teaches us something about what the value is of our system, and we can only learn about that by looking and cross-border comparisons. So I think from a public health context, it’s always important to work together with other regions to understand what do we have because it’s kind of a general truth, and what do we have because of the institutions that we have and that we can also alter?

On how income levels are not always an indicator of a neighbourhood’s health:

Mierau: We see that there’s massive numbers of neighbourhoods that are supposedly quite poor but where people don’t have massively higher health care costs. And simultaneously, there’s relatively rich neighbourhoods where people are actually quite unhealthy. And this is a pattern that we keep on seeing now in research. We’re really focused on the average comparison, but actually within say groups of so-called low socioeconomic status, a massive number of people are actually very healthy. And I think the question we should start focusing on is not why are poor people on average unhealthy, but why are poor people healthy in the first place? And there’s quite a lot of us again “poor people” who are really healthy and what can we learn from them in terms of interventions that can maybe make an entire group healthier? At the same time, there’s a lot of rich people where we have loads of theories why they should be healthy, and they’re really unhealthy. They drink too much, they’re lonely, I don’t know what. Supposedly, they have all the skills to be healthy, but they’re not. So what’s going on there?

On the emerging benefits of centralising medical care centres:

Mierau: So what’s happening now is that the specialist care is actually coming closer to the patients again, because now we see a number of primary care centres where cardiologists go to that centre. This is a very planned treatment. You know we always have to differentiate between acute care when you just have to go there and plannable care. This cardiologist goes to that primary care centre, talks to you about your condition once every half year and it’s fine, and saves you the visit you would have had to that other regional hospital that maybe doesn’t exist anymore but now the specialist comes to you. So over time now we see this concentration of the big acute care centres where you have to stay overnight and what not. But on the other hand we also see that the primary care has also increased in scale so that not on the GP you know the GP is a bit further away but other specialist maybe is even coming closer and they are kind of new movements which I think are really interesting, and I think can also sustain high quality care in rural areas much better than trying to keep alive all hospitals just because we need a hospital.