General’s Hospital

Deputy Surgeon General Boris D. Lushniak assists the Surgeon General in overseeing the operations of the U.S. Public Health Service Commissioned Corps. He also works to articulate to the public the best available scientific information on improving personal health and the health of the nation.

Assuming that the United States continues to implement the Patient Protection and Affordable Care Act (ACA), what do you see as the most beneficial aspects of the law from a public health perspective?

From a public health perspective, the Office of the Surgeon General has a focus on prevention of diseases and injuries. One provision of the ACA is the establishment of the National Prevention Council. The council is very unique in terms of its approach and the partnerships it builds, but it is only the first step in terms of really taking prevention seriously in this country. So with further implementation of the ACA, from my viewpoint, there is a strong need to emphasize the pathway we’re taking towards prevention.

Moving further, what changes could be made to strengthen the US healthcare system? Are there other countries we can look to as models?

Each country comes with different healthcare models. What we often get involved with is comparing healthcare systems in different nations, which is not a pathway that leads to fruition in terms of prevention. What we need to do in the US is take prevention seriously and put resources in support of prevention activities. The ACA, which puts an emphasis on prevention, also allows us to take paths forward to actually make it our national mission.

We know that while we’re number one in the world for healthcare expenditures, when it comes to the major indicators of public health, like infant mortality and years of longevity, we’re not number one. Do we want to achieve that? Yes, we’d love to achieve that, but it’s only going be achievable when we’re not putting an emphasis on both the healthcare system and on prevention activities.

Can the increased utilization of electronic medical records (EMR) be used for more comprehensive public health surveillance? What barriers, including patient privacy issues, need to be overcome?

I think the use of EMR will greatly change public health in the future. EMR will help us standardize how we keep our records and impact the accuracy of available health information. Right now, we’re kind of in the Middle Ages; we do surveillance by pen and paper techniques, sporadic surveys, or by looking at special data systems that are very complicated.

Although it takes a lot of resources to establish an EMR system, their benefits will outweigh their costs at some point. This will be through EMR’s standardization of information, the increased availability of information for surveillance of trends in diseases, and the ability to use EMRs to measure the impact of disease prevention.

The future is information technology (IT) and EMR oriented, and there will be new challenges as we go through this whole process. The patient privacy issue has to be taken very seriously – how do you allow this information to be accessible to those who need it without causing harm to patients by having too much accessible private information? There is a fine line between getting all the information you need and infringing on the person’s right for privacy. That’s going to have to be worked out in the policy and legal realms.

Do you think the controversial “soda ban” implemented in New York City is an effective policy? What other avenues could increase incentives for healthier consumer behavior?

In my view, because disease prevention is such an important mission, we have to consider various ways of achieving our goals. So is the answer legislation, regulation, education, or a combination of these? We want to make sure that we have the ability to use all of these techniques, so at the end of the day, the person freely makes the right choice.

The question is how do you get there? Is it a ban of large soda drinks? That’s a novel attempt and we’ll find out if it’s successful or not. Attempts like this have been made before, not necessarily by banning a product, but by increasing its cost or taxing it. For example, if you increase the cost of a pack of cigarettes, smoking goes down at least temporarily.

Personally, I think the approach New York City is using is innovative and takes a risk, and over time we’ll see if it is effective or not. But what it does certainly do, and this is important, is it makes people take notice: people talked about the issue. It induced in people an emotional reaction, and you know in public health, we need more thoughts, discussions, and emotional reactions.

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