THE BLOG

The Affordable Care Act Is Great, But We Can't Forget About Public Health

04/09/2014 04:08 pm ET | Updated Jun 09, 2014

It's no secret that we spend a lot on healthcare in the US. In fact, we spend 18 percent of GDP on healthcare, which is almost double that of other developed countries. Health care spending amounts to $2.8 trillion this year, and the spending is growing faster the economy. Now I am not an economist, but I can certainly see the threat in this large sum of money. This is a danger that may push out other critical economic investments such as education, infrastructure, while contributing to the growing national debt.

The argument over healthcare reform has been highly politicized, so I am not going to talk about the Affordable Care Act. Instead, I want to begin by focusing on the health outcomes that our high cost system produces which are consistently ranked among the lowest across all ages and socioeconomic groups.

According to the American Public Health Association, the US ranks 17th in health among developed countries. Some of the alarming statistics in this ranking include the second highest death rates by heart and lung disease, highest death rates by car crash and highest death rates by violence.

While the fact that millions of people gained access to affordable health care this year is certainly a major public health accomplishment, there are other issues that need to be addressed in order to improve health outcomes in the United States. And that's where public health comes in.

The easiest way to define public health is in direct comparison to healthcare. While healthcare focuses on treating disease in individuals, public health focuses on promoting health in entire populations. Examples of promoting health are preventing disease, protecting against harmful agents that may cause disease, regulating health systems and services, developing and advocating for policy to ensure services are available, researching causes of disease, and enhancing quality of life and health outcomes. Healthcare is clearly included in the scope of public health, but in order to promote health we must expand our horizons.

The three components of health policy are cost, quality, and affordability. Public health best addresses cost concerns. One way to drive down costs and improve outcomes is to focus on prevention. There is truth to the adage, "an ounce of prevention is worth a pound of cure." In fact, for each dollar spent on prevention in the United States, there is an additional savings of $5.60 in healthcare costs. Three quarters of health spending is on preventable chronic conditions. For example, obesity costs $152 billion dollars annually. That's almost $500 dollars per person each year.

Obesity is a major risk factor for heart disease and stroke, which were the leading causes of death in 2008. It is a health problem that simply cannot be ignored, especially because it is preventable.

Michelle Obama's "Let's Move!" campaign has the right idea; however, discrepancies in health status are too dependent on additional factors such as zip code, race, and socioeconomic status. Again looking at obesity, rates differ among racial groups. According to the Centers for Disease Control and Prevention, blacks have the highest rates of obesity (47.8 percent), followed by Hispanics (42.5 percent) and then whites (32.6 percent). Additionally, there is a inconsistency in obesity rates across the country. My home state of Colorado has the lowest rate of 20.5 percent. In contrast, in Louisiana, where I attend college, obesity peaks at 34.7 percent. Individuals with lower income and education levels are at greater risk for obesity.

Public Health argues that health is not merely the absence of disease. Health is a result of many factors including but not limited to where we live, our environment, genetics, behavior, socioeconomic status, education. These are known as the determinants of health. These determinants create deep inequalities in health status across groups.

The Affordable Care Act gives more individuals access to treatment, but it does not address the underlying social and demographic inequalities that exist in our country. It is a positive achievement for public health, but by no means will it fix our poor health outcomes. While we will never be able to rid the world of disease, we must continue to create good public health policy that intends to create optimal health status among all individuals, regardless of personal background.

The public health field needs three times the current graduates to achieve a strong workforce. While thousands of college students enter their university with their eyes on medicine, students should additionally focus on public health -- the place where critical change begins.