The Future Of Public Health

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SUPPLEMENT TOMANAGEDCareThe FutureOf Public HealthWhat Will It Take To KeepAmericans Healthy and Safe?Based on a symposium at the University of the Sciences in Philadelphia,May 10, 2005HIGHLIGHTS3 Perspectives on the Challenges Ahead Which Road Will Public Health Take? Funding and the Mechanisms of Change Preventive Care Is KeyPANEL DISCUSSIONChallenges in improving the health of all AmericansSupported by an educational grantfrom AstraZeneca Pharmaceuticals LPVolume 14, No. 9September 2005

MANAGEINTRODUCTIONDCarCareROBERT I. FIELD, JD, MPH, P h DDirector, Graduate Program in Health PolicyAssociate Professor of Health PolicyUniversity of the Sciences in PhiladelphiaEditorJOHN A. MARCILLEManaging EditorFRANK DIAMONDSenior Science EditorPAULA SIROISAssociate EditorTONY BERBERABESenior Contributing EditorPATRICK MULLENContributing editorto this supplementJACK MCCAINDesign DirectorPHILIP DENLINGEREditor, Custom Publications,MediMedia Managed MarketsPublishingMICHAEL D. DALZELLSenior Editor, Custom PublicationsKATHERINE T. ADAMSGroup PublisherTIMOTHY P. SEARCH, RPHDirector of New Product DevelopmentTIMOTHY J. STEZZIEastern Sales ManagerSCOTT MACDONALDMidwest Sales ManagerTERRY HICKSDirector of Production ServicesWANETA PEARTCirculation ManagerJACQUELYN OTTMANAGED CARE (ISSN 1062-3388) is published monthly byMediMedia USA, 780 Township Line Road, Yardley, PA 19067.This is Vol. 14, No. 9. Periodicals postage paid at Morrisville, Pa.,and additional mailing offices. POSTMASTER: Send addresschanges to MANAGED CARE, 780 Township Line Road, Yardley,PA 19067. Price: 10 per copy, 93 per year in the UnitedStates; 120 per year elsewhere.E-mail: editors mail@managedcaremag.com.Phone: (267) 685-2788; fax (267) 685-2966; circulation inquiries(267) 685-2782. Copyright 2005 MediMedia USA.The future of public health would have interested few people,outside of a relatively small circle of health care policymakers, just a few years ago. Even much of the medical pro fession saw it as a peripheral concern. Then came AIDS, anthrax,SARS, West Nile virus, and a range of other infectious threats ofwhich we are now keenly aware. We also are increasingly consciousof how chronic diseases such as diabetes, hy pertension, and asthma take an even greatertoll on our health, although some of thecauses, like smoking and obesity, are largelypreventable. Population-based health care isclearly essential in keeping us all healthy andsafe.The first public health departments func tioned at the state and local levels. They were confined largely totreating infectious diseases, with some attention to maternal andchild health. Today’s public health system is a national networkwith a broad focus that cuts across all levels of government. It ad dresses an array of challenges, including chronic diseases, mentalhealth, substance abuse, traumatic injuries, environmental and oc cupational health, and, more recently, bioterrorism. The infra structure required to respond to these challenges must include ahighly skilled workforce, sophisticated information and data sys tems, an intricate organizational capacity, and substantial fund ing. The challenge to policymakers is great.Beyond these immediate challenges to public health policy, asconsiderable as they are, there is a looming threat that may dwarfthem all. With increased life expectancies, older Americans willconsume an ever-growing share of health care dollars, but with asmaller proportion of working-age Americans to provide finan cial support. Population-based prevention of chronic illnessesthat are characteristic of older adults, rather than individual treat ment, is the only approach to maintaining the health of largenumbers of Americans into their later years that will be econom ically viable. The scientific, demographic, and economic forces thatare converging could well lead public health to preempt clinicalmedicine in the decades ahead as the primary focus of Americanhealth care. The sooner we begin to frame its needs and concerns,the better we can meet the challenges ahead.

SUPPLEMENT TOMANAGEDCarCareeSeptember 2005The Future of Public HealthWhat Will It Take To Keep Americans Healthy and Safe?Based on a symposium at the University of the Sciences in Philadelphia, May 10, 2005Introduction.OppositeRobert I. FIELD, JD, MPH, PHDOVERVIEWPublic Health: Community and a Shared Future .2KRISTINE M. GEBBIE, DRPH, RNINTRODUCTORY REMARKS3 Perspectives on the Challenges Ahead.3Which Road Will Public Health Take?.5JEFFREY P. KOPLAN, MD, MPHFunding and the Mechanisms of Change.8C. EARL FOX, MD, MPHPreventive Care – the First Step .10JAMES S. MARKS, MD, MPHPANEL DISCUSSIONA discussion on ways to keep Americans healthy and safe .13KRISTINE M. GEBBIE, DRPH, RN, Moderator; JEFFREY P. KOPLAN, MD, MPH, C. EARLFOX, MD, MPH, JAMES S. MARKS, MD, MPH, panelistsThis supplement is supported by an educational grant from AstraZeneca Pharmaceuticals LP. Opin ions are those of the authors and speakers and do not necessarily reflect the views of the institutionsthat employ them, or of AstraZeneca Pharmaceuticals LP, MediMedia USA, or the publisher, editor, oreditorial board of Managed Care.Clinical judgment must guide each clinician in weighing the benefits of treatment against the riskof toxicity. Dosages, indications, and methods of use for products referred to in this supplement mayreflect the clinical experience of the authors or may reflect the professional literature or other clinicalsources and may not be the same as indicated on the approved package insert. Please consult the com plete prescribing information on any products mentioned in this publication. MediMedia USA assumesno liability for the information published herein.

OVERVIEWPublic Health:Community and a Shared FutureKristine M. Gebbie, DrPH, RNTPublic health worksonly if all Americansunderstand that theyshare a future.— Kristine M. Gebbie,DrPH, RNhe vast majority of health professionals in this country is actually in thesick-care business. Our current focus as a nation on the cost of illnesscare, unfortunately, has overshadowed our attention to true health care.Moreover, those health professionals that work in public health do so with littlepublic awareness of their efforts.The scope of public health is very broad, addressing issues ranging from motorvehicle safety to childhood immunization. I was attracted to public health becauseof my interest in mental health. My colleagues may have entered the field becauseof their interest in children or infectious diseases. Whatever the initial motivation,all public health professionals are united in wanting to take action early to reducethreats to health before problems emerge.The language of public health generally describes a set of services and the regu latory authority that supports those services. Services include surveillance and in vestigations to learn what is happening to the public’s health, using public infor mation and community education programs to inform the public, and helpingcommunity organizations to develop policies. The regulatory authority enables pub lic health professionals to provide access and delivery, making certain that qualityand effectiveness are maintained, and doing the research that informs all of our ac tivities.Successful pursuit of public health requires an understanding of community anda shared future. It also requires a degree of enlightened self-interest, and acceptanceof the role of government to achieve goals. Our public health system operates onmany levels of government. Because health issues respect no geopolitical bound aries

3 Panelists Discuss the Current State Of Public Health and Strategies For Improvement . P. ublic health in the United States is the responsibility of a network of some 3,000 federal, state, and local governmental health agencies that, together with busi ness, voluntary, and professional health associations, provide basic health serv

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