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We’re joined by Anand Parekh, internal medicine physician and author of Prevention First: Policymaking for a Healthier America. We dive into the lessons of the COVID-19 pandemic, exploring the pivotal role of prevention in health policy. Anand discusses the urgent need for stronger public health leadership, effective crisis communication, and investment in community-based prevention programs. He also shares insights on bridging bipartisan divides to prioritize health care prevention for a healthier future.
Anand Parekh is an internal medicine physician and author of Prevention First: Policymaking for a Healthier America.
He discusses the KevinMD article, “Prevention is the key to saving lives: What the pandemic taught us.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Anand Parekh. He is an internal medicine physician and is the author of the book Prevention First: Policymaking for a Healthier America. There’s an excerpt from that book on KevinMD titled “Prevention Is the Key to Saving Lives: What the Pandemic Taught Us.” Anand, welcome to the show.
Anand Parekh: Kevin, great to be on with you.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Anand Parekh: Yeah, Kevin, you know, I’m in Washington, D.C. I work at a place called the Bipartisan Policy Center. So we are a think tank that tries to take the best ideas from both sides to promote health, security, and opportunity. I’m the chief medical advisor there, so I provide clinical and public health expertise. I must say that in an election year, it’s a bit lonely waving the bipartisan flag, but that’s really what we try to do. We try to ensure that both sides of the aisle in Congress work together, and health is the area that I focus on. In short, my career over the last 30 years has really evolved—I started with political science, moved to public health, then to medicine, public service, and now public policy. I’ve come full circle in the last 30 years and have focused my attention on improving the population’s health. What I’ve concluded, and it’s really what the excerpt is about, is that you need to focus on three things: prevention, primary care, and public health.
Kevin Pho: All right. Before I dive into that, I just want to ask about what you do from a bipartisan standpoint. We’re speaking on November 1st, just a few days before the election. This episode will be published sometime after that. So, when taking that bipartisan path and pulling ideas from both sides, how do you get those ideas to resonate in a Congress and an electorate that is so polarized today?
Anand Parekh: Yeah. It’s not easy. We try to identify issues in three ways. One, it’s got to be an issue that we think is incredibly important from a health perspective. Two, it has to be an issue we think both sides need to be educated on. And three, the issue needs to have some sort of policy or political window, meaning that someone cares about it. This could mean that both sides are setting appropriation levels, authorizing a health program, or that the administration is focused on an issue. We try to convene experts and get Republicans and Democrats in the same room, come up with policy recommendations, and send them to Congress on a wide variety of issues. Now, some issues are hyper-polarized, as you can imagine—think about reproductive health or gun violence—but there are many other issues, such as telehealth, rural health, behavioral health, and physician payment, where there are differences of opinion, but we can make traction. So, selecting issues where there is space for discussion and negotiation is key. That’s how we approach our work at the Bipartisan Policy Center.
Kevin Pho: Let’s talk about the excerpt from your book. It’s titled, “Prevention Is the Key to Saving Lives: What the Pandemic Taught Us.” For those who didn’t get a chance to read that excerpt, tell us what it’s about.
Anand Parekh: Yeah. The first edition of the book came out in 2019, and the second one was released just a couple of days ago. What happened in between was, of course, the COVID-19 pandemic. In the excerpt, I discuss the overarching takeaways and lessons learned from COVID. The two primary lessons are: first, that the majority of the approximately 1 million deaths in the United States were preventable if we had better built trust and confidence in the public to take the recommended public health interventions. Second, that if we had done nothing, millions more would have died, countering some revisionist claims that we did too much or shouldn’t have acted. I also delve into critical lessons learned, such as the importance of leadership, crisis communication, having adequate resources and tools—including a workforce and medical interventions—and understanding that public health actions have economic consequences that need to be mitigated in targeted ways. The excerpt highlights the importance of real-time data for situational awareness, among other lessons, because, as you know, Kevin, it’s not a question of if but when we face the next pandemic or public health emergency. We are already seeing signs, such as H5N1 influenza in various mammals. So, we must be prepared. The excerpt in the book focuses on that but then broadens the scope to address how we can make prevention the most important health policy priority in the United States, outlining ways to strengthen the public health system, primary care, and increase uptake of clinical preventive services.
Kevin Pho: You mentioned public health, and like you, I’m an internal medicine physician. I do primary care in my exam room. I see that trust in our public health institutions is at an all-time low, and I believe it worsened during the pandemic. What are you seeing from a Washington, D.C. standpoint? Are you also seeing trust in our public health institutions at a low? If so, why do you think that is?
Anand Parekh: Yeah, I am seeing that, and I think it’s unfortunate. We’re also witnessing the politicization of issues that were traditionally bipartisan. Public health had often been nonpartisan. When we discussed public health related to emergency preparedness, it was always bipartisan. Vaccinations were also traditionally bipartisan. Now, we’re seeing spillover effects from COVID affecting flu vaccine uptake and how parents perceive the importance of childhood vaccinations. It’s concerning. I tell both sides of the aisle that public health is fundamentally about “kitchen table” issues. COVID reframed public health, and that’s why trust eroded. But public health at its core is about keeping communities safe, ensuring that harmful substances stay out of communities, infectious diseases are managed, chronic disease prevention is prioritized, and our roads, food, air, and water are safe. Public health allows us to live our daily lives safely, even though it is taken for granted and rarely celebrated. We need to communicate that public health is a crucial part of our nation’s infrastructure, supporting lives in every community. If we can shift the focus back to what public health truly encompasses—not just vaccine or mask mandates—I believe we can rebuild trust.
Kevin Pho: One thing that damaged trust in public health was the rapidly changing science during the pandemic. It seemed like every week or month there was new guidance. You mentioned crisis communication. In terms of regaining trust in public health, are there communication mistakes or failures that you think public health institutions can improve on moving forward?
Anand Parekh: Yes, absolutely. Crisis communication, especially when you’re learning as the crisis unfolds, is critical. We need to acknowledge that science changes, but we must act based on the best available science and communicate that clearly. During the pandemic, we could have done better. For example, the messaging around masks evolved from no masks to cloth-based masks, then to surgical masks, and finally to N95 and higher-quality masks as the most effective. While some of this was learned as we went along, we needed to communicate to the public that “this is what we know now, and as soon as we know more, we’ll share it.” Being honest with the public about what is known at the moment and that it may change is vital. It’s essential to communicate that and ensure a two-way dialogue between public health leaders and the public. These are areas where we fell short, and we need to do better next time.
Kevin Pho: You talk to both sides of the political aisle. For those who have lost trust in our public health institutions, do you think they can be persuaded to trust them again? Given how polarized our society is, is there any historical precedent for regaining lost trust?
Anand Parekh: I hope so, and we have to. The stakes are too high. If you look at critical health indicators in the United States, we are falling behind. Even before the pandemic, we saw stagnation in life expectancy. Our post-pandemic recovery compared to other OECD countries has been slower, and we face significant disparities—racial, gender, and geographic. Achieving our societal goals, whether economic, national security, or other objectives, requires a healthier nation. Public health, like medicine, contributes to individual and population health. So, we have no choice but to rebuild trust with empathy and continuous communication to shore up confidence in vaccinations and the work of local health departments. Public health was the primary reason life expectancy increased from 47 to 77 years in the 20th century, thanks to advancements like vaccines, antibiotics, and preventive measures. Reminding the public of these successes and what public health can achieve in the future is essential.
Kevin Pho: One of the areas you mentioned is prevention. As a primary care physician, that’s what I focus on every day. What do you think are the biggest obstacles to realizing your vision of “prevention first”?
Anand Parekh: There are many obstacles. We discussed the politicization of public health. When it comes to clinical preventive services—such as immunizations, cancer screenings, cardiovascular screenings, and substance use and mental health counseling—these are evidence-based and generally free of charge due to the Affordable Care Act. Yet, the uptake of these services is low, and the pandemic worsened this. It’s vital to help the public catch up on these services. We recently launched a nationwide campaign with AHIP and 20 member organizations to remind the public of the importance of clinical preventive services, which are at no cost. The second obstacle is broader and relates to primary care, which you and I practice. Fifty years ago, about half of all physicians were primary care clinicians. Now, it’s down to about 10 to 20 percent. Primary care must be the foundation of any health care system. It’s the one resource consistently associated with better health outcomes, improved care, and lower costs. However, primary care is in crisis due to workforce shortages and reimbursement issues. I discuss this in my book and the excerpt, emphasizing the need to bolster primary care, which also serves as a vital connector to public health.
Kevin Pho: Let’s break down two points. First, the low uptake of preventive health services like cancer screenings—why is that? Is it public resistance, or are they not as accessible as they should be? What are some reasons for this low uptake?
Anand Parekh: There are barriers on both the patient and provider sides. On the patient side, it’s often an issue of education—understanding the importance of these services can be confusing, given the dozens of preventive services available. Communication plays a crucial role. Additionally, social barriers like transportation can prevent patients from accessing these services. On the provider side, it’s less about education and more about the overwhelming number of things providers must manage. With quality metrics driving value-based health care, clinical preventive services haven’t always been prioritized. We need to ensure these are emphasized, and work with providers to design workflows, support team-based care, and integrate these services into practice. Elevating the importance of preventive services through quality measures and incentives will help providers facilitate access and provide these services to patients.
Kevin Pho: The second point is shoring up our primary care system. We’ve talked about this for decades, and various medical societies have tried to address it. What will it really take to move the needle? Is it just about money, willpower, or the division among clinicians? What’s needed to make significant progress?
Anand Parekh: You’re right; this has been a topic of discussion for decades. One key aspect I discuss in the book is the idea that “if you don’t measure it, it doesn’t matter.” Currently, federal health insurance programs like Medicare and Medicaid don’t track primary care spending. In the U.S., it’s estimated that only about six cents of every health care dollar—six percent of our $4.5 trillion health care expenditure—goes to primary care. This is half of what other OECD countries spend, and those countries have better health outcomes. Nineteen states now track and set targets for primary care spending. We’ve been advocating for federal-level tracking and target-setting to shift resources upstream into primary care. Additionally, moving away from fee-for-service to hybrid payment models with capitated payments is essential. These models allow primary care providers to do activities they aren’t reimbursed for in a fee-for-service system. Workforce issues are also critical—there’s still a stigma in medical education against choosing primary care. We need to tackle that stigma, address loan repayment concerns, and highlight the importance of primary care, both in terms of prestige and financial viability.
Kevin Pho: Does the urgency of bolstering primary care resonate with both sides of the political aisle?
Anand Parekh: Yes, it does. One positive development is the re-establishment of the Congressional Primary Care Caucus. There are now four members—two Democrats and two Republicans in the House—championing primary care. Senators Whitehouse and Cassidy have also introduced bills like the “Primary Care for All Act” to support primary care payments. We’re seeing bipartisan support, and thankfully, primary care has not been politicized like public health. Maintaining that bipartisan focus is crucial to advancing primary care initiatives.
Kevin Pho: We’re talking to Anand Parekh, an internal medicine physician and author of Prevention First: Policymaking for a Healthier America. Anand, we’ll end with some take-home messages for the KevinMD audience.
Anand Parekh: I want to thank you and your audience—clinicians and everyone working hard to take care of patients and keep Americans healthy. We need to support our colleagues, especially those in primary care, encourage the uptake of clinical preventive services, and defend our public health colleagues who are facing challenges. All of this will help keep our patients healthy. Prevention must be our nation’s health policy priority, and I hope this resonates with clinicians. We need to ensure policymakers understand this as well.
Kevin Pho: Thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Anand Parekh: Thanks so much.
