The Public’s Health is Increasingly Being Undermined by Shortsightedness, Greed, and Environmental Destruction

Dirk J. Spruyt, M.D., M.P.H.

Born in San Francisco, Dirk Spruyt is a WW II U.S. Navy veteran. His premedical education was at Swarthmore College. Following graduation from medical school, he had a rotating internship and one year of general surgical residency at the Mary Hitchcock Hospital, Hanover, NH. After one year of rural general practice in Warren, NH, he entered the Harvard School of Public Health where he received training in Public Health, becoming board certified in Public Health and earning membership in the Delta Omega Honors Society. His subsequent varied career is described in his essay.

As a public health physician, I have defined a community, however otherwise defined by others, as my “patient”. In Cortland, N.Y. it was the county. In Ethiopia it was the villages served by the newly launched health centers. As a member of the faculty at the University of North Carolina School of Public Health, it was the variety of settings health administrators were preparing to oversee. At the North Carolina Division of Health, it was the chronic disease programs in county health departments. Since then my outlook has broadened to include the whole world, the interrelationships between humans, and the biosphere projected through the next century.

I came to the U. of R. School of Medicine and Dentistry with two principal interests. One was ecology and the other preventive medicine. The thought of including a strong preventive component to family practice waned as I observed how busy general practitioners were. This led me to public health and being the head of a county health department when polio was being conquered by the Sabin vaccine. Our programs were to control communicable diseases, bolster the health of mothers and children, and enforce sanitation codes. The relationship of life styles and environmental contaminants to chronic diseases was not to be a health department thrust until near the end of my career when I helped North Carolina’s health departments focus on changing personal habits as a means of reducing common chronic diseases.

Evaluating the impact of the new community health center program in Ethiopia was a six year experience including observing a centuries’ old shifting balance between crops, weather and the subsisting population. During a year of famine, the central government understood better than we (USAID) the long term consequences of rescuing a population the land could not support. This imbalance is being experienced in many parts of the world today, aggravated by civil wars and environmental collapse. Industrial societies are not immune as our present infrastructure depends on non-renewable resources, petroleum being a prime example.

Nuclear arms and their overkill capacity continue to put in jeopardy all that Medicine and Public Health has accomplished in the past several centuries. Attempting to enlist the involvement of physicians as a restraining group through Physicians for Social Responsibility made me aware of how tenaciously we resist change. As we cause environmental imbalances and collapse, the atomic weaponry and environmental degradation will increasingly compete as the more important threat to our survival as a species. One may ask, “Is this a public health concern?” To me it is a challenge for each of us, in our professions and for us as participants in unsustainable life patterns.

I came to medicine with an interest in ecology and prevention. My career in public health has facilitated a journey which began by providing medical care to individuals, their families (and cows) in rural New Hampshire. My perspective has broadened over time, now being concerned that local decisions are cognizant of global changes/trends of which we are a part. Centuries ago the Chinese understood, “If you do not change the direction you are going, you will end up where you are headed”. Where we are headed does not appear to be a healthy place. Changing direction may still be an option.