Be afraid of that cheesesteak, very afraid: Can we bring public health into the 2008 campaign?

I’m not telling tales out of school to reveal the obvious: It’s hard to get any oxygen behind public health in the presidential campaign. The “health reform” debate seems almost entirely to revolve around the financing and delivery of health services. There are many crucial issues here–not least the fight for universal coverage. Yet broader issues of population health are getting short shrift. This is too bad, because medical care is not–and perhaps never has been–the major driver of improved life and health.

Upon hearing Tim Russert’s tragic news, an acquaintance emailed that everyone who can afford it should have an advanced heart scan. I’m not convinced. The track record of shot-in-the-dark imaging isn’t good. It leads to many unnecessary, costly, and sometimes dangerous interventions whereby some surgeon cracks open your chest with too little reason.

What we really should do is much harder. We must adopt more healthy lives and help our family, friends, and neighbors do the same. That’s pretty counter-cultural these days. We live in a toxic society and economy that discourages proper nutrition, exercise, and other forms of healthy living. We see this most dramatically among children, too many of whom marinate in a pop culture dominated by McDonald’s and video entertainment. High-calorie food is cheap and tasty. We can sit on our butts and TiVo 150 channels of HD-TV while texting our friends. My daughters attend a public junior high school in the Chicago southland. If you wait by the front door, an astonishing number of overweight kids come running out at the end of every school day.

We must change that, but it won’t be easy. Food is a basic part of our lives and the way we relate to other people. A reliable source of pleasure. food provides an opportunity to relieve stress, pass the time, comfort ourselves, care for other people, remember loved ones, honor family and religious traditions.

Tim Russert’s mega-seller Big Russ and me has a poignant chapter, simply titled “Food.” It describes how the Russert family gloried in hot dogs, steak, chicken soup (“Jewish penicillin”), fruits and vegetables, too. “You gotta eat,” Big Russ taught his children, as my parents taught me with many of the same foods. We must teach our children something a bit different: You gotta eat better food, in smaller portions.

We must talk about this at every dinner table. The conversation belongs on the campaign trail, as well. It’s much easier to get people excited about ensuring broad access to high-tech surgery and heart scans than it is to drum up interest in less glamorous, more difficult preventive measures that are often more reliable and cost-effective. For the cogniscenti, Bob Schoeni, Jim House, George Kaplan, and I just co-edited a brilliant academic tome on this subject.

Without diminishing the need for improved medical care and universal coverage, we must look beyond these issues to other public policies that promote health, and to the personal choices we make every day to care for our bodies and minds that no one else can make for us.

Reporters have been ribbing Barack Obama over his apparent reluctance to eat fatty foods. Michelle Malkin asserts that anyone afraid of a cheesesteak isn’t ready for Bin Laden. In his apparent fastidiousness, Obama realizes something the reporters don’t. The campaign may look like a sprint, but he wants to stick around for what promises to be an exhilarating long-distance run. Me too.

You can see more on this, and a corny title ripoff from Woody Guthrie at