Sandro Galea

“Galea (Well), dean of the Boston University School of Public Health, offers a revelatory new conception of public health and disease prevention in this trenchant study of systemic inequity. In the first two sections, Galea argues that maintaining health requires more than just medical care; people must also invest in their communities in ways that prevent sickness in the first place. Primarily, this involves lifting people out of poverty and repairing the social harms that remain a legacy of Jim Crow legislation. He examines failures in public health based on such metrics as life expectancy, addiction, mental health, and noncommunicable diseases, exploring how food deserts, low wages, and homelessness ensure that some communities are less healthy than others. The last two sections focus on solutions, including concrete actions (invest in housing and safe transportation, for example) and a realigning of values in America toward a more just society that will minimize the damage of future public health crises. Galea powerfully demonstrates how inequities are detrimental to public health on a grand scale, affecting everyone: “As long as any part of our world remains vulnerable to poor health, we live, collectively, beneath a sword of Damocles,” he writes. Policy makers, take note. (Nov.)”

“The Covid-19 pandemic is not a one-off catastrophe. An epidemiologist presents a cogent argument for a fundamental refocusing of resources on “the foundational forces that shape health.”

In this passionate and instructive book, Galea, dean of the Boston University School of Public Health, writes that Covid emerged because we have long neglected basic preventative measures. “We invest vast amounts of money in healthcare,” he writes, “but comparatively little in health.” Readers looking to learn how governments (mainly the U.S.) mishandled the pandemic have a flood of books to choose from, but Galea has bigger issues to raise. Better medical care will not stop the next epidemic, he warns. We must structure a world “that is resilient to contagions.” He begins by describing the current state of world health, where progress has been spectacular. Global life expectancy has more than doubled since 1900. Malnutrition, poverty, and child mortality have dropped. However, as the author stresses repeatedly, medical progress contributed far less to the current situation than better food, clean water, hygiene, education, and prosperity. That’s the good news. More problematic is that money is a powerful determinant of health; those who have it live longer. Galea begins the bad news by pointing out the misleading statistic that Covid-19 kills less than 1% of those infected; that applies to young people in good health. For those over 60, it kills 6%, for diabetics, over 7%, and those with heart disease, over 10%. It also kills more Blacks than Whites, more poor than middle-class people, and more people without health insurance. The author is clearly not just interested in Covid. He attacks racism, sexism, and poverty in equal measure, making a plea for compassion toward stigmatized conditions such as obesity and addiction. He consistently urges the U.S. government, which has spared no expense and effort to defeat the pandemic, to do the same for social injustice.

An oft-ignored but fully convincing argument that “we cannot prevent the next pandemic without creating a healthy world.”
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“In The Contagion Next Time, Sandro Galea calls for improving public health—including the public’s understanding of public health—following the revelations brought about by Covid-19.

The book’s overriding question is of how to best prepare for health emergencies in the future. It looks beyond vaccines and medical care to focus on the political, environmental, and economic factors that contributed to the Covid-19 crisis. Using scientific data and historical anecdotes, it demonstrates that health involves more than medicine. For instance: life expectancy has been linked to socioeconomic and social changes, and these same factors contributed to Covid-19’s devastating impact, during which low income and Black families were more vulnerable.

These analyses are sobering in their implications. Racial inequalities and climate change are factored in for how they impact public health, too, resulting in a balanced perspective. The book also acknowledges positive outcomes in the world’s response to Covid-19; it notes that trends lead to skewed perceptions, as with media overemphasis on violent crime at the expense of reportage on chronic conditions that led to far more casualties, such as kidney and heart diseases.

Galea’s reasoned, thoughtful approach mixes idealism and practicality. To effect positive change, the book calls for empathy, shared responsibility, and looking past immediate crises to focus on their underlying causes. This work
concludes with a warning about learning the right lessons for the next major health crisis—as with the Delta variant.

Not just a medical but a social prescription for change, The Contagion Next Time is a researched, passionate call for collective action for the common good.

HO LIN (November / December 2021)”

“Reflecting on the COVID-19 catastrophe, public health expert Galea believes the path to preventing future pandemics requires a “restructuring” of society that ardently promotes health for all. Health is influenced by many nonmedical forces political, economic, environmental, and social. Spending massive amounts of money on medical treatment is not sufficient to advance the overall health of society and individuals. Unless health inequalities, economic hardship, and racial injustice are effectively addressed, the world will remain seriously susceptible to pandemics. Fortifying health and constructing an improved world requires compassion, justice, humility, and a reaffirmation of the importance of science. Galea points to the many missteps occurring throughout the pandemic and the damage done by mistrust and scapegoating. He considers concepts of vulnerability, uncertainty, and “collective sacrifice.” Even in a post-COVID-19 world, other dangerous viral contagions will lurk in a tropical forest being razed, a wet market, perhaps even a laboratory. Galea offers a basic blueprint to help society better prepare for viral onslaughts. He wisely surmises, “We are all attempting to navigate life in the same fog—none of us know nearly enough.”

— Tony Miksanek”

“ The Contagion Next Time is a book whose very premise may have you wanting to skip ahead to the end. Written by Sandro Galea, MD, PhD, a physician, epidemiologist, and dean and Robert A. Knox Professor at the Boston University School of Public Health, the book offers a four-part treatise on what it will take to prevent the next global health catastrophe.

Galea begins by sharply detailing the complex and entrenched social, racial, economic, and political problems that have persistently produced this country’s exorbitant, broken, and inequitable healthcare system. Of course, COVID-19 has served to even more clearly bring these complex problems to the surface, which have long obstructed our ability to achieve the “common good” of health.

In the first three sections, Galea’s elegant and scholarly prose provides compelling evidence that more “contagion” — whether infectious or not — awaits our unprepared nation. That he’s capable of compressing what would typically take a year-long seminar to cover into fewer than 200 pages is a great lesson for teachers everywhere. It also makes these sections rich sources of detail for the subjects that are germane to you, personally or professionally.

On initial read, the foundational “forces” that Galea identifies may not seem to be directly related to health. These include:
- Multigenerational poverty, with its scarcity of stable housing, food insecurity, foreclosed educations, and absence of sanitation and clean water to drink;
- Racial injustice, putting lives in peril while relying on criminal justice solutions for social and economic problems;
-Economic inequities, deepening the divides between the rich and the poor
-Partisan politics and political extremism; and
-The primary pursuit of money (especially in healthcare, for the purposes of this book), frequently eclipsing the common good.

Nonetheless, these sections clearly illustrate how these forces can destabilize and sometimes ruin our societal institutions, as well as any chance for preventing disease. If left unaddressed, Galea makes a compelling forecast that the “contagion next time” will set the stage for an even more massive disaster than COVID-19.

However, it’s the book’s fourth and final section, titled “A Science for a Better Health,” that truly stands on its own. It wisely portrays methods for actual problem-solving, showing the how and the why. Galea deftly illustrates the give and take of human negotiations that lead to action, urges the need to think and work flexibly in environments rife with complexity and doubt, and offers a rather unexpected ending about the necessity of humility. To Galea, humility is not only a virtue; it is a state of mind. Humility allows for “(knowing) that we don’t know what we don’t know,” as well as not knowing when we are done.

Every one of us (well, maybe not hermits) has been touched by the destructive hand of COVID-19 and the legion of societal problems it has amplified and released. The gravity of this pandemic continues to mount, with so many of us still in its crosshairs and no certain end in sight (I found this out myself when, despite being fully vaccinated and diligent about prevention, I became very ill and required hospitalization for a breakthrough COVID infection). That’s the enemy at our gates.

Can you imagine an even more malevolent “contagion next time”? Galea can. But rather than shrink from the terror this concept might produce, he answers the challenge and provides a guide to what we must do to forestall yet another disaster.”

“In 1963, James Baldwin, one of the USA’s greatest essayists, published The Fire Next Time. The book’s title comes from a slave song—”God gave Noah the rainbow sign/No more water but the fire next time”. Baldwin’s words sounded a warning that the USA needed to confront its racial hierarchy by embracing racial equality or doom its future. Sandro Galea’s book, The Contagion Next Time, is titled in a homage to Baldwin and it also sounds a warning. Galea’s central argument is that vulnerability to COVID-19 lies with a societal failure to recognise that the foundation of health rests on a healthy everyday life and not simply in the provision of health care. He ponders why this key lesson is not at the centre of pandemic discourse, which instead focuses on vaccination and treatment. In often lyrical prose, Galea roams across history, culture, literature, moral values, economics, politics, and personal pandemic experience. Although situated in a global context, the book’s focus is the USA. Galea considers especially the enduring impacts of racism on health and the centrality of structural racism to understanding the USA.”