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Amy L. Fairchild, Ph.D. and Ronald Bayer, Ph.D. Headshot

The Promise of Public Health

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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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