The Promise of Public Health
President Barack Obama will soon sign the expansion of SCHIP -- the State Children's Health Insurance Program that was vetoed twice by George W. Bush. Now that we are beginning to turn to the shameful failure of America to guarantee to each of its citizens access to health care services there remains a danger that once again our national leaders will lose sight of the enormous but perhaps less glamorous contribution that public health makes to the people's wellbeing. That would be a tragic mistake. Like the provision of medical care to the ill, an effective public health system -- which keeps both children and adults from becoming sick in the first place -- depends on both commitment and vision. If we fail to tap the promise of public health, we will spend billions more on treatment that would have been better invested in prevention.
First and foremost, public health is the commitment to improve the welfare of entire populations, not simply care for the sick one at a time. It entails an obligation to protect populations from emerging infections. It is the promise to provide not only information but also resources to prevent chronic diseases such as diabetes and cancer. It is the commitment to address some of our most pressing health challenges including obesity, HIV/AIDS, asthma, and tuberculosis through a collective strategy. New York City Mayor Michael Bloomberg captured the essence of public health when he said that it involves saving millions of people at a time.
But the promise of public health represents more than a powerful tool to save lives. It is a vision of hope for the future, one that must be shared by all Americans to have any meaning.
During World War II, former President Franklin Delano Roosevelt famously articulated the Four Freedoms: freedom of speech, freedom of worship, freedom from want, and freedom from fear. The Four Freedoms drew together shared convictions, emerging from the Great Depression, that we had not only individual rights, but also binding obligations to one another. The federal government -- viewed not as a faceless bureaucracy but as the American people organized to better ourselves -- was vested with responsibility for keeping the promise that all Americans would be free from fear. This entailed a broad effort to ensure the economic security of everyone.
It was during the Great Depression that the Roosevelt Administration and others in Congress began to craft a national public health plan. Their efforts were ultimately unsuccessful, but not because the various packages that were developed over these years were not quite right. They failed because the collective sense of public health as a promise of significance equal to the promise of economic security never took hold. The opportunity for the people to act together to protect and promote the health of all of us was lost.
We face another global economic crisis, another chance to articulate a vision of hope about the public's health. Those who seek to seize this opportunity and put public health on the national agenda for the first time since the New Deal era must inspire people in our society to embrace a vision of public health as a shared responsibility to create a common public good.
Children and adults alike reap the benefits that can only become available when all of us collectively are protected. Like the advantages of a safe environment, the benefits of public health cannot be packaged into divisible commodities. So as we begin a new political era, let us make the commitment to each other and for each other. Otherwise, we may end up with a health agenda without the promise of public health.
Amy Fairchild, PhD, MPH, is associate professor and chair of the Department of Sociomedical Sciences at Columbia University's Mailman School of Public Health. Ronald Bayer, PhD, is professor of Sociomedical Sciences at the Mailman School of Public Health. Both authors are affiliated with the Mailman School's Center for the History and Ethics in Public Health.
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Public Heath. The system work in Cuba, Sweden, Canada, China, France. And will work in USA
and it works there because the mothers actually have the time off work to take the children to the doctors... what about the poor mother who works 3 jobs, do you really believe she has the time to fight thru the bureaucracy and time off from work and wait 3 months for an appointment.....
As a long time Health Care Director and MPH I think that your article is spot on. You did leave out a large Health Care area that would save millions maybe billions across the board if addressed adequately; that is substance abuse and addiction please add it to future communications if for no other reason than to shine light on the problem millions of american families face..
Amen!
Yes, universal healthcare for all. Let's get rid of the profit-making insurance companies.
Yes it is truly appalling that the CEO of United Healthcare is one of the richest people in the country over 1 billion in stock options alone.... and that is at the cost of healthcare being avoided..... See Sicko AGAIN and call your representative....
I hope Americans get public Health care. It is heartbreaking to think of the worry you must have, and no matter how much money you through at insurance companies they will always see more money for their profit margin..not better health care. business will always be about profits.
It is beyond comprehension that Hospitals and Doctors have the right to turn away patients.
Americans Spend the money on health care..you just never seem to get it delivered.
Why does it get syphoned to companies that share it amongst themselves?
It is like going to a butcher for a quart of milk...
No mandates. Public health, not insurance.
Single payer publicly funded healthcare is supremely better than HMOs. Unfortunately we are seeing a shift towards HMO insurance mandates with Tom Daschle being appointed. That is a mistake.
Anyone notice that Hollywood is promoting cigarette use i its recent films? Could this have anything to do with raisning tax revenues to pay for SCHIP? Too cynical of me?
Oh please!!!!!!!!!!
My dream would be to see a Public Health Clinic associated with every elementary school in the country and staffed from early morning until late evening. And equipped with vans for home visits. I have long had an interest in the health care field but refuse to buy into the current patient care methodology. But I could certainly see myself working part-time in some capacity at such a clinic.
There are lots of urgent Public Health problems but one very important one is not being addressed because to do so would not be Politically Correct. That is the issue of males going on the down low behind the backs of their wives / girlfriends and bringing gay diseases home to their families.
This irresponsible behavior is glorified in movies like Brokeback Mountain. Why is this not considered criminal behavior from a public health perspective ? The incidence of MRSA in children is way up,
a year after it was identified as a real problem in gay communities but then immediately taken off the table after the authors of the study had to 'apologize'. We need to get real about issues like this !
Sources : MRSA rising in kid's infections, apnews 1-20-2009
Emergence of MRSA USA300 in Men who have sex with men, annals of internal medicine, vol. 148 #4 Feb 19 2008
UCSF apologizes for MRSA release Bay Area Reporter 1-24-2008 (Apology for 'alarming' and 'homophobic' news releases about the study concerning MRSA and gays)
Really? Gay disease? Really?
I would think that more people are straight. They get to bring home fun stuff like hooker diseases and stripper diseases and craigslist diseases. Since you have more people bringing home the hooker diseases than the gay diseases I would say this is a problem with hookerphobia not homophobia...
OMG you really can't possibly have even read what you wrote.
No doubt about the reality of the growing MRSA problem...but your anti-gay spin is showing....
Is this your first attempt at burrowing in, or are you just not that good at it?
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