As Philadelphia’s recently appointed Health Commissioner, Thomas Farley (MD, MPH) sets policy for the Department of Public Health, working with other human-services agencies to promote and protect the health of all Philadelphians. A physician trained in pediatrics and epidemiology, Farley has dedicated much of his career to public health, with posts at Tulane University School of Public Health and Tropical Medicine, the Centers for Disease Control's Epidemic Intelligence Service, the Louisiana Office of Public Health, and the Public Good Projects, a nonprofit that uses media communications to combat health problems.
His book Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for 8 Million Lives describes his challenges and triumphs as the health commissioner for New York City, where he pushed for progressive public health policies such as smoke-free parks, caps on portion sizes of sugary drinks, and numerous restrictions around tobacco sales. Prior to his address at this year’s graduation exercises, we talked with Farley about how health professionals can adopt a public health mindset, his advice to new graduates, and his plans to make Philadelphia a healthier city.
There was a time when many public health professionals were physicians first – like you. Today they come from many backgrounds. How has that diversity changed the field?
Public health asks, “How do we create a context for people’s lives so that they’re more likely to stay healthy and less likely to get sick?” And the actions you take to do that are rarely the actions that a doctor takes. For the most part, the medical model is that the patient gets sick, they go to the doctor, and the doctor prescribes a cure. The public health model is much more focused on what we can do so that fewer people get sick in the first place. It’s a very different approach. Temple’s College of Public Health has quite a diverse array of professional specialties. When people who specialize in public health or in the allied health professions – communication science or physical therapy, for example – assume leadership roles, they can promote health and prevent disease to groups and populations.
How might practitioners in the allied health professions inform their work by seeing it through a lens of public health, as they do here at Temple?
One of my heroes, the epidemiologist Geoffrey Rose, said, in effect, “People think they are sick and are made well, but it is more nearly the opposite: People are well and are made sick.” That public health mindset should inform the actions of everyone in health. It’s thinking about how the environment around us has an impact on our health, rather than thinking about just the person.
What are some of the greatest opportunities and challenges for today’s public health professionals?
Because medicine is such a dominant field in our society, public health is not well understood. So we always have to explain and be advocates for the public health focus on prevention. There are opportunities to do big things, but we have to be very good at articulating the value we provide. Part of the reason public health is not well understood is that many of the solutions it provides operate at an infrastructural level that people don’t think about much.
How do you help people understand how they fit into the bigger picture?
I think showing people results can be very helpful. For instance, back in the 1830s in Philadelphia, we had epidemics of cholera that killed about 1,000 people per year. That’s the equivalent of killing about 19,000 people per year today. It’s because of public health that we don’t have this awful disease here anymore. Cholera hasn’t disappeared from the face of the earth; it just doesn’t happen here in Philadelphia because we have a good water and sewage system. Smoking rates in Philadelphia are far too high – they are about 20 percent. But in 1962 they were over 40 percent. It’s because of public health efforts that those rates have decreased by half, and we’re having great declines in lung cancer rates because of that. Practitioners need to articulate that and spread the gospel to others.
What are your priorities as Philadelphia’s health commissioner?
There are three things I feel we need to do in the health department in general. One is to do a good job providing the services we’ve provided for many years – everything from inspecting restaurants to making sure children are immunized to investigating outbreaks of infectious diseases. Second, we need to respond to new public health crises that arise. Right now one of those is the opioid crisis. And the third thing is to create a more health-promoting city. For example, we have smoke-free parks here in Philadelphia; we want to expand the places that are smoke-free. That’s just one behavior, but there are other areas, too, such as ensuring access to healthy food.
What are some ways Temple’s College of Public Health contributes to achieving those priorities?
Academic institutions are always key partners for us in government. One important way they assist us is to provide our future workforce. Our agency’s assets are our people. The better trained and the more capable they are, the more effective we’re going to be. The second way universities can help is in generating ideas. We are pressed in government to respond to the crisis of the moment and often don’t have time to think about larger questions. We value specialists in advising us when we have a tough problem. For example, Scott Burris is somebody at Temple whom I’ve contacted in the past because he’s worked in HIV and in substance use. He’s had a chance to think about things that the rest of us don’t have time to.
What wisdom would you like to offer our graduates as they embark on their careers?
Most of the professions that you are preparing for didn’t exist 150 years ago. That’s a very good thing. There are many ways to help people. That’s happened because the medical system in this country is growing by leaps and bounds – it’s now approaching 20 percent of the economy. But that growth cannot go on indefinitely, so it’s incumbent upon all of us who work in the health field to think about how we can be as effective and as efficient as possible. We all need to recognize the value of what we do as part of the health system but also think about how we can promote wellness rather than continue to divert resources into a system focused on treating the sick.