糖心vlog

鈥淭hey took away our thank yous!鈥� My friend, a primary care physician, was furious. Administrators had programmed her clinic鈥檚 electronic health record system to hide every message from patients that read, 鈥淭hank you.鈥� My friend protested, explaining that these short expressions of gratitude were meaningful to her. Not only did the administrators refuse to budge, but a few days later, they announced triumphantly to her practice group that they had reduced the number of incoming messages by a few percentage points.

Alas, the case of the disappearing thank you is not limited to clinical medicine. In health policy, where the news about gaps in coverage, care, and equity are ever present, there is little time and space for appreciation of what has been accomplished.

Recent headlines have highlighted the millions of children losing , the cost of health insurance, and the rates of cardiovascular disease. These are all important stories, but they are rarely balanced by positive coverage of policy efforts. Several months ago, The New York Times reported that , representing $3.9 trillion in savings for the federal government compared with previous spending projections. Numerous laws and regulations, including the Affordable Care Act, contributed to this success, but other media have barely covered this story, and few individuals in the US are aware of it or understand its importance.

Similarly, there is scant attention paid to important public health work occurring every day, from efforts to establish comprehensive , to investigations that uncover the cause of , to coordinated efforts to improve . A decade-long in my hometown of Baltimore, Maryland, has brought infant mortality to record lows while reducing racial disparities, but it would be hard to find someone outside Baltimore who has heard of this successful program.

Good news is hard to find these days. In a world dominated by social media, headlines with negative terms . With trust in government at , there is a large appetite for narratives that color public officials as corrupt or incompetent.

What are the consequences when the public does not learn about programs and policies that have advanced health and saved lives? Without ongoing and widespread reporting of successful initiatives, it becomes easier to undo them. An example in which a vital and successful program has largely gone unnoticed by the US public and is now at risk is the program. This public health program is estimated to have saved more than over the last 20 years. Experts recently called PEPFAR 鈥渁s close to a 鈥榩erfect鈥� model of health care delivery and goodwill from the US towards international health concerns developed to date.鈥�¹ Yet according to a from the Bipartisan Policy Center, 52% of individuals in the US had never heard of PEPFAR, another 17% said 鈥淚 know the name, but nothing about it,鈥� and another 16% said, 鈥淚 know at least something about it, but I鈥檓 not very familiar with it.鈥� Just 15% understood PEPFAR well.

Into this information vacuum have stepped some conservative politicians who claim that the PEPFAR program promotes abortion. As a result of this discord, Congress to reauthorize the program on time, leaving a cloud over its future.

Political battles over foundational policies for and are looming. Without appreciating the in the number of individuals in the US without health insurance or the many thousands of lives saved through , will signature achievements for the health of individuals in the US continue? Just a few years ago, in 2017, over the Affordable Care Act facilitated efforts that in repealing the landmark law.

A failure to appreciate past victories can also jeopardize efforts to tackle the health challenges of the future. in government and public officials, from national political parties to local agencies, is declining. Lower levels of trust were associated with worse outcomes during the COVID-19 pandemic.² It is not a stretch to see that a trust deficit the ability to respond effectively to long-term threats such as climate change.

Reminding people of the effectiveness of yesterday鈥檚 smart policy decisions can rebuild confidence and faith that action taken today to protect future generations will make a difference. The progress made in clean air and water should be ballast for efforts to reduce carbon emissions. The effectiveness of efforts to redesign certain health care payment models should encourage more ambitious attempts to control costs and improve health outcomes.

Remembering past success can have a near-term effect on the people working every day to protect health and save lives. Just like my clinician friend who smiles whenever she receives a 鈥渢hank you,鈥� many in health policy and public health may need appreciation as fuel to keep going.

The last few years have been brutal for those working in health agencies at every level, with widespread harassment, firings, and even violence.³ It is a natural inclination when faced with such attacks to limit exposure by retreating into silence. But it is far better for agencies to start talking about the invisible work of food safety, tobacco control, and other bread-and-butter efforts that make communities healthier. Efforts to reinforce the foundational capabilities of public health are drawing support in states across the political spectrum and even leading to new investments in infrastructure.⁴ Now would be a good time to celebrate the frontline workers whose commitment to health has made a difference for their communities.

Of course, it is possible to overdo a 鈥渢hank you.鈥� It can be tempting to overstate the value of previous efforts, and in the process, unintentionally reduce the urgency of action today. The message of 鈥淚 appreciate you鈥� should never become 鈥淢ission accomplished.鈥�

Rather the goal should be to strike a more sustainable balance between the past, present, and future. All bad news all of the time does not constitute a nutritious information diet. Remembering and even celebrating past triumphs can provide sustenance for the difficult work of advancing equity and protecting health.

After all, as my clinician friend told me, it only takes a moment to read a thank you, but that moment can nurture the strength and resolve to move forward. In 2024, let us give her鈥攁nd all of us鈥攂ack our thank yous.

Published: January 11, 2024. doi:10.1001/jamahealthforum.2024.0001

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Sharfstein J. JAMA Health Forum.

Corresponding Author: Joshua Sharfstein, MD, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205 (joshua.sharfstein@jhu.edu).

Conflict of Interest Disclosures: None reported.