Public Health Intersection

In February, prior to the passage of health care reform, I blogged about “Whither Public Health?” and I thought it might be time to revisit the topic.

Recently, there have a couple of presentations and a couple of articles that have caught my attention.

A May 5, 2010 article by David Hemenway in the New England Journal of Medicine points out some of the challenges faced by public health in attracting resources may be due in part to its population based approach, its long term benefits and so on.

I think the author actually gets a little cynical when suggesting that politicians might not support public health interventions because their long term benefits might not be realized in time for the next election.

He seems to suggest that the US needs to systematically invest in public health based on science and outcomes, not the latest headlines.

He also contends that people in the US may take some public health outcomes for granted since they have clean water, safe food and are usually not subject to disease outbreaks.

What experience and the limited survey research conducted in this area has shown is that while people generally appreciate the results that population based health interventions provide, they just don’t know that those interventions are the produts of the efforts of federal, state and local public health agencies.

Another perspective contained in an article by Robert Gould, President & CEO of the Partnership for Prevention suggests that the prevention and wellness resources being made available through the health care reform legislation should be initially be focused on one target. In this case the author suggests tobacco control, maintaining that the science indicates that measurable improvement in health status would be achieved by investing these new resources on the strategies and tactics that have proven successful in controlling tobacco use.

A third perspective was raised in a discussion at a recent meeting of California’s local health officers.

The speaker suggested that the funding and support for classic public health delivered clinical services may be put in some jeopardy by a reformed health care system that provides all necessary clinical services.

All three perspectives raise important points for public health to consider in an era of health care reform.

Here are a few;

• What role should/does public health play in a reformed health system?
• How should health care reform resources, and perhaps other public health funding, be allocated to governmental public health entities to assure measurable results?

Hopefully all of this sparks serious mission and soul searching among public health practitioners that result in the development of strategies and actions that take public health to what it wants to be when it grows up.