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Over the years, as a physician, legislator, student and patient, I’ve developed the understanding that the concept of health is often viewed differently depending on the background, perspective, or even the situation of the individual.  These lenses of perspective usually fall into one of four categories: public health, population health, personal health, and political health.  Each lens shapes how we see health problems, discuss solutions, and at times, debate them.  Much like our vision, sometimes these lenses blur, but if we can understand which lens someone is looking through or which lens is most appropriate for the situation, our vision for the future of our health as an individual, community or state can become closer to 20/20.

Public Health: The Big Picture

Public health looks at the world through the wide-angle lens of community well-being.  It’s about clean water, vaccinations, safe food and controlling outbreaks before they spread. It’s the health department inspecting restaurants, tracking influenza and working to prevent opioid overdoses before they happen.

When viewed properly, the public health perspective aims to protect the greatest number of people.  During a pandemic for instance, it’s the public health experts who think about how to reduce transmission, distribute resources, and communicate risks.  While that’s an invaluable endeavor, public health works best when it respects that people live in real communities with real lives, not just as numbers on a chart.

In my interactions with public health officials or even in lectures or courses I have taken over the years related to public health or health administration, the big picture or a collectivist view is often at the forefront.  If one’s goal is to track, treat or advocate for communities, states or even nations, it’s certainly understandable that the big picture mindset is the predominant lens.

However, what I’ve learned, both in medicine and in public service, is that if one focuses too long or too much on the big picture, it’s easy to lose sight of the people inside it.  Numbers and charts can’t tell you about the single mom deciding whether to miss a day’s pay to take her child to the doctor, or the small business owner trying to keep up with new health rules while staying afloat.

Unfortunately, situational awareness of the individual can often get pushed aside for the public as a whole if one focuses solely through this public health lens.  In that respect, we often see a loss of trust in the system when an overarching mandate or public health initiative ignores the individual whose health situation isn’t suited to fit in the collectivist box.  Understanding this distinction and building that kind of trust from a public health perspective can save lives.

In the end, public health gives us the big picture and allows us to positively impact our communities and our state.  But that picture is clearest when it’s painted with respect for the freedom and dignity of every individual within it.

Population Health: A More Focused View

Population health narrows that wide-angle lens of public health. Instead of focusing on everyone at once, it zooms in on particular groups who may have unique needs or barriers to care.  Expectant mothers needing prenatal care, rural communities, or even minorities such as Native Americans like myself often have much more specific needs or challenges than the general public.

In Tennessee, one clear example is our rural physicians and medical practices. Their challenges differ dramatically from those faced in Nashville or Memphis.  A small-town doctor may be the only provider for miles, seeing everything from newborns to nursing home patients.  They often juggle business survival, staffing shortages and after-hours emergencies.  They do this all while trying to provide top-quality care with fewer resources.

When we talk about improving health in rural Tennessee, we’re really talking about population health and understanding what that specific population needs to thrive.  Sometimes that means supporting rural practices with telehealth technology or collaborative psychiatric care programs.  Other times, it means working on broadband access or transportation because health outcomes don’t just depend on doctors, but on the ability to reach them.

At the heart of population health is what is often referred to as the “social determinants of health.”  These are the non-medical factors that influence how people live and how healthy they can be.  These include things like housing, education, employment, transportation, income, food access and even community safety.  They’re the “everyday conditions” that determine whether someone can see a doctor, afford medication, or even get to an appointment.

Having life threatening asthma and severe allergies, I spent a good portion of my youth in hospitals.  In fact, my experience as a patient drove me towards the medical field.  Though I’m a tribal member of the Choctaw Nation, I was fortunate to grow up in Oklahoma City where I was in close proximity to an ER and a pulmonologist.  Other Native Americans throughout our country aren’t as fortunate as they are often faced with not only life-threatening challenges, but lack the means, the wherewithal, and access to care.  These social determinants of health within many tribal nations produce barriers which must be overcome to produce better outcomes for these patients.

Population health reminds us that improving health isn’t just about treating disease.  It’s about removing the barriers that prevent people from getting healthy in the first place.  It’s about seeing health as part of a larger picture that includes family, faith, work, and community.

When we recognize and address those barriers, we don’t just improve statistics. We improve lives.  That’s the essence of population health: understanding the needs of each community and working to address those barriers.

Personal Health: The Microscopic Picture

After looking through the broader lenses of public and population health, it’s important to zoom all the way in to personal health.  It is at the level of the individual where every statistic has a face and a story.  It’s about how one eats, sleeps, moves, handles stress and takes responsibility for one’s own well-being. As a physician, I’ve learned that even the best healthcare system can’t make someone healthy if they aren’t willing to make daily choices that support that goal.

Much like being born with asthma was beyond my control, other conditions from genetic disorders to birth defects are out of the individual’s control. Yet, one can modify a lifestyle, be compliant with one’s medications, or take measures to improve one’s path to wellness.  There isn’t a government program, medical technology or doctor that is going to care about your health more than you do.

Personal health is rooted in personal responsibility and advocacy at the individual or family level.  I probably took that to the extreme as my own health struggles drove me towards medicine.  I wanted to understand the human body and use that knowledge to help myself and others like me.

Because of my asthma, I once aspired to become a pulmonologist.  Ironically, medical school quickly taught me that I couldn’t spend a career in a pulmonologist’s office.  The lingering and overwhelming odor of cigarette smoke triggered my asthma. Even as a legislator, that sensitivity followed me.  During my first year as a state representative, I had to request an office change because I was near a vent where smokers congregated.

Those experiences taught me something fundamental about personal health: no one can fully understand or manage another person’s unique health challenges. It’s this individualistic focus of looking through the lens of personal health that sometimes clashes with the more collectivist lenses of public or population health.  When laws or mandates intended to improve public health, outcomes infringe upon the personal liberty and health choices of an individual; therein lies the root of many health-policy related conflicts.

Perhaps the highest profile conflict between personal health and public or population health has been the Affordable Care Act (ACA).  In an attempt to increase health insurance coverage on a macro-scale, the ACA required many individuals who were healthy, self-insured and proactive about their health to pay for others’ insurance through higher premiums or taxes.  More recently we saw similar friction during the COVID-19 pandemic when emergency use authorization (EUA) vaccine mandates were forced on young and healthy individuals in which COVID-19 posed very little risk.

The lens of personal health reminds us that we are our own best advocate and when we take personal responsibility, our outcomes naturally improve.  But if we ignore the bigger picture, even our best individualistic endeavors can be negatively impacted by the broader forces of public or population health. Understanding this relationship and working towards a positive balance can help us all achieve better wellness.

Political Health: A Myopic View

Myopia in layman’s terms is nearsightedness.  It’s the inability or difficulty in seeing things that aren’t close to you.  In politics, people often have a selective vision or confirmation bias towards only focusing on or seeing what they would like to see.  There is a blind spot for differing opinions, points of view or perspectives.  Such is the lens of political health and how our political beliefs shape our opinions, decisions and laws related to health.

A clear example came during the COVID-19 pandemic.  When vaccines were being developed under the Trump Administration, many Democratic leaders publicly questioned their safety, expressing doubts about whether they could be trusted.  Yet, when the administration changed, so did the rhetoric.  The very same vaccines were suddenly touted as essential and beyond reproach.  That shift wasn’t about science changing overnight; it was about political myopia.  The view of the same medical intervention changed, not because of data, but because of who occupied the Oval Office.

From a legislative standpoint at the federal, state, and local levels, we see politically driven legislation filed or presented all the time and across all different scopes of issues.  Health is not immune to these biases or pressures.  We also see the myopia of political health arise when a politically neutral health legislation becomes overshadowed by skepticism because of the known ideology of the bill sponsor.  As chairman of the House Health Committee, I often have to decipher the merits of the proposed policy when such conditions arise.

A healthy approach to “political health” is about recognizing those blind spots and understanding that our political convictions can distort how we interpret science, medicine and policy.  If our vision is clouded by partisanship, we risk missing the real goal: improving the well-being of the people we serve.  As lawmakers, we have to constantly ask ourselves whether our positions are grounded in evidence and principle, or simply in the comfort of our own politics.

Just as a good eye doctor prescribes lenses to correct blurry vision, when dealing with the health of individuals, a population or the public as a whole, outcomes are better when we all can adjust our focus.  Political myopia may never be fully cured, but it can be corrected with humility, open dialogue and a willingness to place patients at the forefront.

Seeing Clearly Through All Four Lenses

Health, like vision, requires clarity and balance.  Much like the parable of the elephant and the blind men in which each man draws a different conclusion based on their experience, each of these four lenses of health offers a valuable but incomplete view on its own.

Public health reminds us that we’re part of something larger. Clean water, safe food, and strong communities benefit everyone. Population health helps us see the unique challenges faced by different groups, whether it’s rural physicians, expectant mothers, or Native American communities.  Personal health brings the focus back to the individual where responsibility, discipline, and daily choices determine outcomes more than any policy ever could.  And political health challenges us to keep our perspective honest and our motives pure, ensuring that our decisions serve people, not parties.

Most everyone needs corrective lenses for better vision. Understanding and recognizing the perspective of each lens while employing self and situational awareness can allow us to see the complexity of health with a clearer picture.  The challenge for every citizen, clinician or policy maker is to resist the temptation of simply seeing the issue through a singular lens.  For it is when we put the patient at the center of the picture, focus each lens appropriately, and act with wisdom and compassion then we can build a healthier Tennessee and a stronger nation.