Public Health Partnerships And Reform

Public health has always been the neglected stepchild of theU.S. health care system. It subsisted on whatever funding wasleft over after flashier parts of the system took their cut,and it took on tasks, such as being the provider of last resortfor the uninsured and indigent, that no one else was willingto perform. In Washington, D.C., legions of lobbyists in expensivesuits frequented congressional hearings on Medicare policiestoward physicians or pharmaceutical manufacturers, while publichealth hearings attracted much smaller crowds and far less sartorialsplendor. After September 11, 2001, and the anthrax attacksaround the country, some $5 billion made its way from Washingtonto state public health and emergency preparedness systems. Manythought that between this and the reemergence of infectiousdisease threats, public health’s neglect was a thing ofthe past.

In their call for comprehensively rethinking the public healthsystem, Eileen Salinksy and Elin Gursky suggest that this viewis simplistic. Certainly, some improvements in the public healthinfrastructure have occurred. However, the post-9/11 federalgrants coincided with the worst state revenue shortfalls indecades, which meant that states were asked to add new preparednessresponsibilities with few net new resources. More importantly,the new money, rather than sparking a long-needed new visionfor public health, reinforced the status quo. It flowed accordingto existing geographic lines reflecting political, not functionalboundaries. States that sought to use the grants in imaginativeways were, ironically, criticized by their local public healthagencies. Among the reform ideas put forward by Salinsky andGursky are interstate compacts and other regional approaches.

Paul Simon and Jonathan Fielding propose taking public healthoutside its current box in a different way, by creating partnershipsbetween business and public health agencies on issues such astobacco control, workplace injuries, and infectious diseasesurveillance. Business has a larger stake than ever in supportingpublic health efforts, Simon and Fielding point out: Companiespaid a quarter of the $1.7 trillion spent on health care in2003, and they lose billions every year to diminished productivitystemming from chronic disease. On the flip side, the publichealth agenda is immeasurably strengthened if a supportive businesscommunity provides what Georges Benjamin refers to in his Perspectiveas an "unanticipated messenger." Benjamin seconds the call forpartnerships with business, and he also calls for making thepublic active participants in the public health dialogue, ratherthan simply passive recipients of information.

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Public Health Partnerships And Reform