Pained: Uncomfortable Conversations about the Public's Health

A POLITICAL PROVOCATION FROM A PAIR OF PHYSICIANS WRITING OUTSIDE THEIR LANEAmericans care about their health. Americans pay lots of money in hopes of maintaining their health. So why are Americans so unhealthy? The reason is simple: as a country, the United States overinvests in medical care at the expense of the social, economic, and cultural forces that produce health. The rise of medicine as a cornerstone of American life and culture has coincided with a social and political devaluation of factors demonstrated to mean more to our vitality than anything else -- influences like where we live, work, and play; livable wages that create opportunity for healthy living; and gender and racial equity. In Pained, physicians Michael Stein and Sandro Galea push the conversation around American health where it belongs: toward matters of class, money, and culture. Across more than 50 essays and data illustrations, Pained casts a light on how the structural components of everyday life -- like school, housing, police, even cell phones -- ultimately determine who gets to be healthy in today's America. In doing so, it makes a case for reframing our political discourse in less myopic, more effectual terms.Accessible and surprising, political but not partisan, Pained is the urgent, uncomfortable conversation that American needs in this challenging moment. It will delight and infuriate readers of all political stripes.

Table of Contents:
Contents Acknowledgments Dedication Preface Section 1. THINKING DIFFERENTLY 1. Creating Health is Like Winning at Soccer 2. The Illusion of Clinical Success 3. Can We Reverse Course on Health? 4. A Party Trick 5. Treating Laura 6. Water Quality Violations 7. The Immigrant Experience in Hurricane Season Section 2. THE PERSONAL IS POLITICAL 8. Denying Climate Change is Denying Health 9. Public Health and a President's Racism 10. The Census and Public Health 11. When We Talk About Public Health 12. The Two Degree Solution 13. The Partisan Divide Over a Soda Tax Section 3. COUNTERINTUITIVE 14. What Kills Our Kids? 15. What Data Do We Need for Health? 16. We Cannot Have It All 17. The Microbiome and the Public's Health 18. Immigrants and Private Insurance: Pay More, Use Less 19. Dying Young in the USA Section 4. A SURE ARGUMENT 20. Vaccines and Conspiracies 21. Health Systems and Public Health Thinking 22. Misconceptions about Veterans and Health 23. Immigration and the Health of the Public 24. Out of School, Out of Luck 25. Pseudoscience and Abortion Policy Section 5. FOLLOW THE MONEY 26. Income Inequality and Our Health 27. Can CEOs Save the Health of Americans? 28. The Health of the Poorest 50% 29. Can We Promote Public Health and Generate Return on Our Investment? 30. The Poor People's Campaign 31. Spending Too Much On the Wrong Things 32. Clarifying Medical Bankruptcy 33. High Pay Gets Higher, Low Pay Gets Lower Section 6. DARK THOUGHTS 34. The Story We Are Not Talking About Enough 35. Names Matter in the Opioid Epidemic 36. Pain Drain 37. Violence is a Public Health Issue 38. Mental Health and Mortality 39. Three Notes on the Opioid Crisis 40. Invest in Health, Not Death 41. Direct-to-Docs Opioid Marketing 42. Firearm Legislation Linked with Fewer Fatal Police Shootings Section 7. THE FUNDAMENTALS 43. Housing and the Public's Health 44. Food Justice 45. Guns and Suicide 46. The Smoking Gap 47. Maybe the End of HIV 48. Homelessness 49. Documenting Delays in EMS Wait Times 50. Particular Particulates Section 8. WILL TECHNOLOGY SAVE US? 51. Should Black Boxes Be Welcome in Medicine? 52. The New Elderly Surveillance State 53. Good App Hunting 54. In Social Media We Trust 55. Racial Equity in Kidney Transplants 56. Air Quality Standards Have Room to Improve Section 9. WHAT NOBODY WANTS TO TALK ABOUT 57. Broken Justice and the Public's Health 58. The Promise of Palliative Care 59. Making Aging Healthier 60. The Downside of Drinking 61. How Far Do Women Have to Travel to Get an Abortion? 62. Planning for End-of-Life Section 10. MAKING THINGS BETTER 63. Volunteering for the Health of the Public 64. Mental Health on Campus 65. Healthy Homes 66. Toward a Muscular Public Health 67. Zero Tolerance for Preventable Deaths 68. Police and the Public's Health 69. Making Strides Towards Zero 70. Cancer Survival Is (Mostly) Improving Sources

About the Author :
MICHAEL STEIN is Professor and Chair of Health Law, Policy and Management of the School of Public Health at Boston University. He is primary care doctor and has been a leader in general medicine and substance use research and policy for two decades. He is Executive Editor of Public Health Post, a popular website on matters of population health. He is the author of six novels and two works of non-fiction. He has been interviewed by Terry Gross on NPR's Fresh Air and has been included in Best American Essays Notables. SANDRO GALEA is Robert A. Knox Professor and Dean of the School of Public Health at Boston University. He is a past president of the Society for Epidemiologic Research and of the Interdisciplinary Society for Population Health Science, chair of the board of the Association of Schools and Programs of Public Health, and is an elected member of the National Academy of Medicine.

Review :
"In these pithy essays, Michael Stein and Sandro Galea convincingly show that American health depends less on medical care than on the state of our jobs, families, social networks, and environment. Recommended for anyone with an interest in public health." -- Sandeep Jauhar, author of Heart: A History "A stellar essay will inform, captivate, and motivate the reader to action. In this respect, Sandro Galea and Michael Stein contribute not one, but more than 50 essays illustrating in their compelling fashion how healthy people represent more than just the integrity of their DNA and the quality of their medical care. In Pained, Galea and Stein underscore at once the magnitude of the challenges, the public nature of the solutions, and their daunting prospects. Fortunately, the public health community is accustomed to daunting challenges, and this book will serve as an important resource for development of the strategies required." -- Michael McGinnis, National Academy of Medicine