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Health Affairs, 26, no. 2 (2007):
408
doi: 10.1377/hlthaff.26.2.408 © 2007 by Project HOPE |
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School & Society |
PROLOGUE
School And Society
Last year’s Health Affairs public health issue (Jul/Aug 06) represented yet another link in a growing chain of public health policy discourse supporting the importance to overall population health of greater interaction between the public health and health care delivery spheres. The depth and sophistication of our understanding of the full spectrum of the major determinants of health status continue to mature. Increasingly, researchers and policymakers alike are beginning to join advocates in recognizing that access to medical care, although critical, represents only one in a penumbra of factors determinative of population health, including socioeconomic circumstances, environmental conditions, and personal behavior. Such an inclusive perspective further exposes the irrationality of the choices we make as a society in terms of overall health spending. Despite the evolving evidentiary base pointing to the significance of nonmedical determinants of health, as a nation we continue to allocate upward of 95 percent of the health care spending pie to the provision of medical care and biomedical research.
Fortunately, increasingly fiscally embattled policymakers at all levels are beginning to awaken to the realization that even ensuring that an MRI machine is on every street corner would do little to stave off the impact to both population health and health budgets of a tidal wave of chronic disease that virtually all agree is heading our way. Preventing chronic disease is clearly preferable to treating it. As a result, examples of forward-thinking policy making that incorporates critical public health principles, such as prevention, into the care delivery model are beginning to pop up around the country. Arkansas, for example, has been widely heralded for its visionary policy targeting the chronic disease precursor childhood obesity.
Health Affairs picks up this thread in its theme issue devoted to children’s health. The papers that follow, in particular, impart needed insight into how public health and health care might successfully intersect in both traditional and nontraditional settings, including schools, to promote wellness among children and help ensure prevention of chronic disease. First, Julia Graham Lear seeks to reintroduce readers to the important role played by school-based health care resources and to offer guidance as to how this "hidden system of health care" might work in successful collaboration with community-based systems of care. Next, Edward Schor, Melinda Abrams, and Katherine Shea go a step further in discussing the contribution of Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program to the overall health status of children as an essential prerequisite for educational success. Finally, William Dietz and colleagues look beyond schools, examining health plans’ application of evidence-based behavioral-change strategies in a variety of settings aimed at preventing overweight and obesity in children. A Perspective by Charles Homer and Lisa Simpson follows.
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