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Murray: Good afternoon. I'm so glad to be invited to this family affair. All graduations
are really family events. The family of your faculty and staff members and fellow students,
and most important, the families that got you this far.
So let me just say a few words to your families, especially those members of your families
who are not public health professionals. Yes, in fact, it is a difficult thing to explain
to many Americans what exactly is public health. To me, public health is everything. There
is nothing that happens in this nation, nothing that you do from the moment you wake up, to
the moment you fall asleep at night, that is not part and parcel of public health. We
are an interdisciplinary field. Among the graduates today are public health educators,
lawyers, epidemiologists, historians, statisticians, health managers, nurses, engineers, physicians,
psychologists -- you can go on and on and on. Some of the graduates today came to us
as young people seeking to improve the world. Many came to this school as mature professionals
still committed to changing the world. Another thing that families wonder about,
they may not say it today, but they are thinking this is, what about jobs, what about status,
is my investment in this student going to pay off ever? Some of these graduates already
work in public health. Some of them work in governmental public health. Those people and
their families know the trials and tribulations of government workers. This is a difficult
time for our nation and many of them, like so many of my fellow workers in local public
health departments, some 18,000 of them in the past year, understand cutbacks and layoffs
and furlough days. In fact, let me announce here publically for Fox News, I am on a furlough
day. But those of us in governmental public health
are really privileged to work closely with the people we serve in the communities that
we live in. The programs that we run in local health departments and state health department,
the surveillance we maintain, the decisions we make, impact the lives of people in their
communities every single day. Most of the graduates will find themselves outside of
government; some will actually go on and still be students next year -- that's a good things,
parents, don't despair, that's a good thing. Some will join institutions as researchers
and faculty members. Most of them will find their way into a wide variety of organizations
in roles; and many of those organizations they work for will not even realize that they're
public health organizations. Ours is a field that's woven into the soul
of this country. It was 150 years ago this year, that the American Civil War began -- an
event that may sound like a dry, boring fact, but is an event that led to the abolition
of slavery in this country -- a dry, historical fact that I take personally. One hundred and
twenty-five (125) years ago this year, in Chicago, the hay market demonstrations occurred;
and that demonstration and police riot, which resulted in workers of unions being hung in
trials later, contributed probably more to improving the health of Americans than any
other single event, because it fought for the 8-hour work day. It's been 100 years since
just a short distance from this building, the Triangle Shirtwaist fire occurred, where
over 100 mostly immigrants, mostly women, died because the bosses locked them in the
factories. Lessons for history are real. It's only a few years ago that we took Wal-Mart
to court for locking their workers in on third shift.
There's a saying in public health made famous by another institution that, when public health
works, we're invisible. Refuse to be invisible. Refuse to be invisible, because we were able
to double the life expectancy of this nation between 1850 and 1950. It didn't happen by
public health staying invisible. If you look at CDC's 10 greatest public health achievements,
that didn't happen by us being invisible. The decrease in morbidity and mortality for
occupational diseases didn't happen because of cohort studies; they happened because public
health people joined with workers of this country to fight for workers' rights, and
to change the way work takes place in this country. When we pat ourselves on the back
for healthier foods and safer water, that didn't happen because of only what went on
in the bench research; it had been because we were a part of social movements that fought
to make the food healthy and safe. The improvement in women and children's health
didn't happen because women and children are nice; it happened because it was part and
parcel of social movements over decades to eliminate slums, to make sure that we could
clean up the running sewage in our cities, and to join in what seems to be a never-ending
fight to make sure that women in this country have the right to control ourselves and our
bodies. Refuse to be invisible. We need to lend our strength and our science to broad
social movements whose goal it is to make things better -- that's what it means to improve
the health of the people. In recent decades, public health has forgotten
too often its history. We're focused on how little we're appreciated, how few resources
we have. We talk about networking with the broad community. When that becomes an excuse
for not fighting the cutbacks, we do ourselves and our field a disservice. There is no question
that the cutbacks in public health in the past 30 years, and the cutbacks that are going
on right now as we speak, destroy the seed stock of our field. Refuse to be invisible.
I reject the notion, coming out of Atlanta lately, that we can only focus on the winnable
battles, battles that we can make measureable progress on in four years. That's not how
we improve the health of the nation. Dare to thing about the real issues, the real problems,
however complicated they are. Refuse to be forced into a narrow technocratic response
to one health problem or another. This nation has just experienced a worldwide pandemic
for flu, H1N1 remember that? Now, we lucked out there everybody, we were really lucky.
But what did we do in public health? Cover your cough, wash your hands, and if you're
sick, stay home -- right? And if you were a progressive health department, you did it
in 30 languages. Where was the real public health message there. How do we expect people
to stay home from work when they don't have sick days. A real preparation for flu pandemic
would be to legislate that every worker in this country have protected sick days, paid
sick days. We know what we're supposed to do. We know
that the health of people is determined by -- not influenced by, not colored -- determined
by the social conditions in which we live. This is why social/political/economic inequalities
lead directly to health inequities. Ours is a field that encompasses both an individual
focus, which clinical medicine often claims as its own, and a population focus. But as
a physician who was trained in public health, I'm here to tell you that these are two sides
of the same coin, that you can't have one without the other; that it's critical in public
health to understand how individuals think and work and make decisions, just as its critical
for my clinical colleagues to understand what makes communities and populations healthy,
and they're not always exactly the same. Individual decisions and work is important, but we also
have to address broader issues -- jobs, safe secure well paying jobs with dignity -- that
is the first brick that you need for a healthy community and a healthy nation. Still today,
14 workers go to work every day and die on the job.
What happens to a community when 20, 30 or 40% of its young men have never worked? Welcome
to my block. The question of jobs and economy impacts all of us. We live in a nation where
the growing gap in wealth is the worst that it's been since 1920. We have the same level
of inequity as China. From the end of WWII through the 1970s, we saw different period
of history: The gaps narrowed, the health and equalities narrowed, the poor actually
got richer; but starting in the late-'70s, we've seen a widening of those inequities.
So for the past 26 years, the bottom fifth of our population's income has increased by
about $8.00 a year, $200 over 26 years; the top one-tenth of 1% saw its income grow by
some $6 million. We live in a nation where the top 5% of the households account for 63%
of the wealth; and the bottom 80% accounts for only 13% of the wealth.
Jobs, income and wealth, housing and neighborhoods -- it's not just that housing can exacerbate
asthma or that the built environment can interfere with a healthy lifestyle, housing is a major
mechanism of wealth accumulation in the United States. This recent and still continuing foreclosure
crisis has wiped out more family wealth among blacks and Latinos than anything else in our
history. You're here today getting degrees, and if
I could change just one sector of our society, it would be education. The people in this
country who build prisons, know how many cells to build, based on how many third graders
can't read. This is probably the greatest violence we do against our youth -- failing
to teach them how to read. In some communities in Chicago, it's been estimated that for every
100 black boys that start kindergarten, only 3 will receive a Bachelor's degree by the
age of 25. Where is our voice as public health professionals
that says: When they cut the education budget, you will kill more people; when they increase
the increase the class size to 45, you will create more smokers, you will increase obesity,
you will have more diabetics, people will get sicker and they die younger -- that is
what we need to be saying. Public health knows that a sustainable food
system is critical to the health of the country. Actually, the largest single public health
legislation that Congress looks at every year is the agricultural bill, and that's what
we should be teaching in our policy classes, not simply how the CDC is funded.
And let me remind you, even though we are often posed in opposition to medical care,
that medical care is a social determinant of health; who gets medical care, when they
get it, and what kind they get is determined by social and political conditions. We live
in a country that has passed a major piece of legislation last year; but still 22 million
Americans, if everything works perfectly, will remain underinsured. And if you're an
immigrant without documents, even though we hire you to work in our homes and businesses,
even though you'll pay taxes, even though you continue as previous immigrants have done
to enrich our nation, you will be prohibited from participating in this great medical reform.
We cannot have a healthcare system that refuses to cover people that are here without documents.
We live in a nation with a broken medical care system. As a physician, I will tell you
quite simply and plainly, we need to start to fix it by adapting a single payor system
for financing. So how did this come to pass, how did we end
up here? One of the real historical contributions that we, as a nation, has made to the world
is our understanding and value that we put on the individual. This is very different
than many old cultures in Europe and many cultures elsewhere in the world, where the
emphasis is always on the group, and I want to value and call out that important contribution.
But there's a belief sweeping our land, it's almost like a mythology that's spreading out
like bad air, that raises this notion of the individual to the level of an icon, almost
like a religion, as though the only way America survive was by the individual. There are no
individual frontiersmen -- they died. Americans don't really believe that when you really
ask them. On the banks of the Mississippi, they're not sitting there as individuals;
they're coming together in communities and churches and families, sandbagging and trying
to make sure that the old and the young are taken care of.
American's are peculiar. We all believe that we're all middle class, and we all have faith
that we're going to win the lottery -- and Mailman graduates know that that's statistically
impossible. But it's this magical thinking that says, I'm an individual, all I need is
me, my husband and my kids, we can face the world. This magical thinking that says, government
is useless, collective action is futile, and it logically follows then that public health
is useless. This notion that we try to brainwash the population -- don't try to solve that
problem, it's too complicated, it's too big, it's too expensive.
We've retreated, public health professionals, from our core mission -- keeping people healthy
-- to safer areas -- vital records, communicable disease registries, laboratory services, environmental
chemistry, categorical medical care where the medical system doesn't want to be bothered.
We have a paternalistic component to our history. We issue commandments from the pulpit -- eat
five fruits and vegetable a day, brush your teeth, don't smoke. We effectively cut ourselves
off from our base of support. During my youth in the '60s, a period when
there was great social upheaval and progress was made -- the poor got richer, the ignorant
were educated, and the gaps between Americans were narrower. Our cry was: What do you want
-- freedom; when do you want it -- now! Not, what do you want -- evidence-based interventions;
when do you want it -- after peer review. Public health is synonymous with social justice,
and we need leadership from you. Social justice and public health argue that collectively,
through our planned collective action, we can change things that are wrong, we can make
things right that improves health. By tying ourselves and our careers to social justice
movers of today, we can make progress, like we have in past decades. You know what needs
to be done. You know that medical care is not going to improve the health of people
by itself; and that the social and political circumstances really determine how far we're
able to go. You understand that every policy that we have in this country is a policy about
health. You know that in order to really make progress, we have to improve the daily conditions
that people live in, the circumstances in which people are born, grow, live, work and
age. That means supporting the rights of workers to organize and fighting for basic democracy.
You know that only by tackling inequitable distribution of power, money and resources,
can we really address the things that divide Americans -- class, gender, racism. You know,
because you're good graduates of this school, that we have to measure, understand, study
and survey the problem, and in the interventions that we put in place, the policy changes we
make to make sure that we're going in the right direction.
Graduates, we need you to join us, because you know in your heart, that it's just not
right that your life expectancy be determined by the class of your parents, or where you
work, or how much money you make. It's never been right that your survival from high blood
pressure or diabetes or cancer, be determined by the color of your skin or the gender that
you have. We must stand up as public health professionals and fight against the diseases
plaguing our nation -- racism, war against workers, hatred, bigotry, foreign wars.
The Reverend Dr. Martin Luther King said: Rarely, do we find men willing to engage in
hard, solid thinking. There is almost a universal quest for easy answers and half-baked solutions.
Nothing pains some people more than having to think.
Graduates, you know how to think, you know what must be done -- refuse to be invisible.
Join us, and let's just do it. Thank you.