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Winter/Spring 2003 Vol. 3 No. 1

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A Prescription for Public Health

Prior to 9/11, few people gave much thought to the vitality of America's public health system. Now that public health initiatives and advances in medicine have tamed once-common killers, such as measles and polio, the importance of public health services has come to be taken for granted. Over the last few decades, this system has been consistently underfunded and politically neglected, its largely behind-the-scenes efforts to keep populations healthy generally overlooked.

The events of autumn 2001 threw a glaring spotlight on the consequences of that neglect, highlighting a lack of coordinated communications, shortages of resources and funding, and reliance on outdated technology. The publicity served as a wake-up call that the nation's public health infrastructure needs to be overhauled if it is to meet a new era of health challenges.

Two reports by the Institute of Medicine offer blueprints for the reforms needed. Both emphasize that while public health departments and the professionals who staff them remain the backbone of the system, public health should no longer be thought of as limited to those functions historically provided by government health departments and clinics. Rather, it should operate as a concerted effort that also includes the medical care community, businesses, nonprofit groups, and other public and private partners.

The reports emphasize the need to bridge the schism that has gradually split public health and the medical care industry. This divergence hinders the nation's ability to cope with health issues that cannot be solved through medical treatment alone. Community action and policy change are needed to address chronic conditions and other health problems shaped by behavioral and environmental factors. Currently, only a fraction of public health workers earn public health degrees, and most medical and nursing students receive little or no public health training. The curricula of medical and nursing schools should include basic public health instruction, and these schools should pursue partnerships with schools of public health, such as joint classes and new degree programs.

But partnerships need not end with those between the health sector and academia. Many other entities can influence population health and hence play an important role in promoting and protecting it. For example, businesses provide the majority of health care coverage and affect workers' health and safety through the design of their workplaces. The media influence behavior through the images they portray and the issues they focus on. These and other groups could serve as valuable partners with public health professionals in devising and trying out new approaches to addressing the behavioral, environmental, and societal factors shaping the health of communities and individuals.

Even with a new partnering approach, however, public health departments and clinics remain the pre-eminent actors in health promotion and disease prevention, and they must be given funding and other resources commensurate with their central role. Of the $1.3 trillion America spent on health in 2002, only 1 percent to 2 percent went to prevention. Yet, as many as 1 million Americans die each year from health problems related to preventable factors, such as tobacco use and inactivity coupled with unhealthy diets.

Recent influxes of funding to improve public health departments' abilities to respond to terrorist attacks have helped alleviate some of the system's shortfalls. However, public health needs a concerted and sustained boost to adequately meet all of its obligations. Federal, state, and local governments must appropriately allocate the dollars earmarked for health to ensure that every community has access to essential services and that the public health system can meet new health challenges as successfully as it tackled those in the past.   -- Christine Stencel

The Future of the Public's Health in the 21st Century. Committee on Assuring the Health of the Public in the 21st Century, Board on Health Promotion and Disease Prevention, Institute of Medicine (ISBN 0-309-08622-1; $39.95 plus $4.50 shipping for single copies).

The committee was co-chaired by Jo Ivey Boufford, former principal deputy assistant secretary for health, U.S. Department of Health and Human Services, and dean, Robert F. Wagner Graduate School of Public Service, New York University, New York City; and Christine Cassel, dean, School of Medicine, Oregon Health and Science University, Portland. The study was sponsored by the U.S. Department of Health and Human Services.

Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Committee on Educating Public Health Professionals for the 21st Century, Board on Health Promotion and Disease Prevention, Institute of Medicine (ISBN 0-309-08542-X; $42.95 plus $4.50 shipping for single copies).

The committee was co-chaired by Kristine Gebbie, director, center for health policy and the doctor of nursing science program, Columbia University, New York City; and Linda Rosenstock, dean, School of Public Health, University of California, Los Angeles. The study was sponsored by the Robert Wood Johnson Foundation.

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Copyright 2003 by the National Academy of Sciences