Throughout the pandemic, I’ve been cognizant that I live in two worlds: In one, I have a bird’s-eye view of public health, and in the other, I look up from the trenches of emergency medicine. From up high, I see “all of us,” and from the front lines, I see “some of us.” I can’t avoid the reality of either. The divisions between “all of us” and “some of us” are impossible to ignore and sometimes hard to comprehend. A single phrase has allowed me some clarity: None of us, unless all of us.
This is a backbone of public health efforts, a pithy paradigm for the goals of our work. By identifying and addressing risk, disparities, and inequities of those most vulnerable or affected by an issue, the safety and wellness of each of us can improve overall. The only way to keep everyone safe is by intentionally safeguarding those who are most at risk.
Fill in the blank with any issue currently being debated in the health-care sector, and the mantra holds true.
None of us are protected from COVID-19, unless all of us are protected from COVID-19.
The delta variant was identified in December 2020; a year later, we are facing a new variant with global reach. There are nearly 800,000 people dead and 50 million sickened in the United States alone — and that’s before omicron has fully hit. In Philly, with more than 4,000 COVID-related deaths and nearly 200,000 infections, some continue to be dubious that COVID-19 is real or that the vaccine can be lifesaving, while others are getting their six-month booster shots and children over 5 years old get their first doses. Internationally, entire continents have minimal access to vaccines through no choice of their own.
The discrepancies and disparities in vaccine availability and uptake have allowed this tremendously efficient virus to exploit our collective weaknesses. We all bear responsibility. If you choose not to be vaccinated, you must commit to masking outside of your home and missing large gatherings. Governments and international agencies could take a lesson from Philly’s Ala Stanford, the acclaimed physician who brought vaccines to the Black community, to specifically take shots to the places where they are lacking.
None of us are safe from gun violence, unless all of us are safe from gun violence.
Philadelphia has experienced more than 520 deaths and 1,700 injuries from firearms so far this year, including nearly 200 children. It is a simplistic narrative to identify the problem of community gun violence only within the “redlines,” historically racially segregated neighborhoods that have been systematically disparaged through lack of political attention and capital investment. There is no part of our city and no age cohort of our community unscathed. Suicide continues to account for the majority of gun deaths nationally.
No matter where you fall on the right to bear arms, there can be no dispute that gun locks, safe storage, and regulated access to weapons are basic tenets that benefit all of us. It took a veto from Gov. Tom Wolf to strike down the concealed-carry bill, which had already passed through the Pennsylvania legislature. We can no longer overlook the critical role local and midterm elections play in setting Pennsylvania regulations.
None of us are untouched by the overdose crisis, unless all of us have access to lifesaving medications, equitable treatment options, and safe spaces.
Over the course of the first 12 months of the pandemic, we added more than 100,000 overdose deaths to the total national death toll. Based on early data, Philadelphia is on track to set another record in 2021. There is no way to know how many near-fatal overdoses were prevented with naloxone during that time.
But addiction comes with a stigma, which is just another way we depersonalize and distance ourselves from the loss and trauma that we all share. When our children step over used, open syringes on their way to the park, we can no longer remain resigned or decide drug use doesn’t affect us. The time has passed for empty indignation from our politicians and elected leaders, for judgment and bias to supersede science and evidence-based practice, and for anyone to try to look away. Philadelphia lost the chance to be the national leader on this front when New York City, a city with a third of Philadelphia’s overdose rate, opened America’s first legal safe injection site. Now, it’s time for accountability.
Nearly every city and state public-sector agency has received funding to address the twin overdose and opioid crises. Researchers continue to clamor for grants for addiction-related studies. Millions of dollars have been spent with few discernible improved outcomes — most important when it comes to lives lost. This cannot continue.
None of us can make choices about our own health, unless all of us can.
Last week, the Supreme Court heard arguments on whether to uphold a Mississippi law that bans abortions after 15 weeks of pregnancy. If the court does, the ruling would be at odds with the precedent of Roe v. Wade, the 1973 decision that established a constitutional right to abortion.
In a city with a higher maternal mortality rate than the national average (20 per 100,00 compared with 17.4 per 100,000), Philadelphia knows that pregnancy alone bears high risk to women. When you include racial disparities, mental health disorders, access to medical care, and history of substance use, it is abundantly clear that some women are more at risk of reproductive harm than others.
Listening to the Supreme Court debate — as Judge Amy Coney Barrett suggested adoption was an alternative to abortion — it became painfully clear that women are not considered equal and competent to make this medical decision for themselves in the eyes of some members of our highest court. Until all people are allowed to have the autonomy to make their own health-care decisions, no one will be truly free to do so. It’s now up to the Supreme Court to make the right decision to uphold the tenets of Roe.
While the pandemic persists through yet another holiday season — from Diwali to Thanksgiving to Hanukkah to Kwanzaa to Christmas to New Year’s Eve to La Befana — now is when we honor the things that matter the most and take stock of the time that has passed. It is when the light of our shared human experience can overcome the darkness of our division.
If we have learned anything these last nearly two years, it is that we are connected through our common vulnerabilities. The only way to move forward is to combine our strengths and work together. Unless all of us are in a position to thrive, none of us truly will.
Priya E. Mammen is an emergency physician and public health specialist. She is a fellow of the Lindy Institute of Urban Innovation and trustee of the College of Physicians of Philadelphia. She writes monthly for The Inquirer about the future of public health in Philly. @PEMammen