The Future of the Public's Health in the 21st Century (2003) / Chapter Skim
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1. Assuring America's Health
1. Assuring America's Health
Pages 19-45
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From page 19... ...
healthy people in healthy communities with its recognition of both individual and community dimensions. Healthy People 2010 calls for a national effort to improve overall population health and, where possible, to eliminate disparities in health in the United States.
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In the past century, infant mortality declined and life expectancy increased (DHHS,2002~. Vaccines and antibiotics made once life-threatening ailments preventable or less serious; and homes, workplaces, roads, and automobiles became safer.
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The prevalence of obesity and chronic diseases like diabetes are increasing, and infectious disease constitutes a growing concern because of newly recognized or newly imported agents like West Nile virus, the emergence of drugresistant pathogens, and the all-too-real threat of bioterrorism (DHHS, 2002~. Moreover, a focus on national averages often masks serious and persistent disparities in health status between racial and ethnic groups, men and women, and populations with lower and higher levels of income and education.
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From page 22... ...
The community as a whole has a stake in environmental protection, hygiene and sanitation, clean air, uncontaminated food and water, safe blood and pharmaceutical products, and the control of infectious diseases. These collective goods, and many more, are essential conditions for health, but these "public" goods can be secured only through organized action on behalf of the population (Gostin, 2000~.
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The collaboration of multiple actors in a public health system, broadly conceived, offers the best prospect for protecting and promoting the nation's health for the future. ISSUES THAT MAY SHAPE THE NATION'S HEALTH STATUS Societal Norms and Influences Faced with a mixture of satisfaction and concern about the status of population health in the United States, the committee sought possible answers.
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The personal health and health care agenda has dominated the nation's health concerns and policy for quite some time. In fact, the majority of funding in the health care delivery system is public and there is a major public investment in biomedical research, yet the United States has failed to make the same level of commitment to population-based health promotion and disease prevention as it has to clinical care and research and biomedical technologies (Starfield, 2000~.
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With the decline of infectious disease in the twentieth century, public perception of the usefulness and necessity of governmental public health services diminished. However, with the resurgence of infectious diseases and the escalation of chronic diseases, as well as the newfound awareness of the multiple determinants of population health and the potential impact of macro-level and even global threats to health, the necessity of population-oriented approaches has become clearer.
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The preceding discussion underscores the necessity of complementary and collaborative health care and population health orientations (Brands and Gardner, 2000~. Investing in population-based health promotion and disease prevention, in concert with the attention already given to personal health care, can be expected to positively affect the general health status and health outcomes of the American people (McGinnis et al., 2002~.
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Governmental public health agencies constitute the backbone of the public health system and bear primary, legally mandated responsibility for assuring the delivery of essential public health services. Therefore, the role of government in assuring the nation's health is one that must be continued and sustained.
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Furthermore, we must assure that our health and social policies facilitate their involvement in actions for health. Actors in the Public Health System The governmental public health infrastructure (e.g., local and state health departments and laboratories)
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· A nation not as prepared for future health challenges as it should be Societal norms and influences · Disproportionately greater emphasis on spectacular biomedical advances over routine preventive measures (treatment over prevention) · An individual rather than population health approach · Lack of awareness of the multiple determinants of health and the impact of public policy on health 1 ~ 1 Systems problems · A governmental public health infrastructure that is fragmented, inadequately funded, and needs updating · Lack of partnerships · Insufficient accountability · Insufficient, inadequate evidence · Lack of communication 1 + 1 1 Actors in the public health system (see also Figure 1-2)
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Although the report examines the governmental public health infrastructure, some of its potential partners in an intersectoral public health system are also described. The committee has selected five actors who, together with the government public health agencies, are in a position to act powerfully for health.
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The media also shapes public opinion, knowledge, and even behavior in the way in which it uses language and images and also through entertainment and advertising. Communities schools, voluntary organizations, civic groups, local law enforcement and fire-fighting agencies, religious organizations, and others play multiple roles in shaping health status, in terms of promoting a social connectedness that may support health instrumentally or psychologically, implementing organizational efforts and activism to attain policy change, and managing or engaging in population-level health interventions.
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. For example, health care providers can contribute to public health surveillance and assessment of community health status (ESs 1 and 2)
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Adopt a population health approach that builds on evidence of the multiple determinants of health; 2. Strengthen the governmental public health infrastructure the backbone of any public health system; 3.
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Improving communications capacity will involve, among other things, investment of resources, efficient adoption of cutting-edge technologies, training of workers, and even change in institutional cultures. The vision of healthy people in healthy communities can be achieved only if the governmental backbone of the public health system is strong; intersectoral partnerships create environments and conditions conducive to the best population health; accountability is valued and practiced by all stakeholders; evidence is effectively developed, shared, and translated into practice; and effective communication becomes a priority among all public health partners.
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Although care needs for the elderly have declined somewhat in recent years, there are concerns about society's ability to respond effectively to the needs of this demographic group (Wolf, 2001~. An aging population will require effective means of chronic disease prevention and management to help older people maintain the best possible levels of health and function.
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Continuing disparities in health status and the outcomes of health care demonstrate the need for a greater effort to ensure equitable access to and services from the health care delivery system for people of different backgrounds (IOM, 2002~. With an increasingly diverse population, the nation will need a more highly developed knowledge base concerning the social determinants of health and a continuing reassessment and improved understanding of the ways in which social, cultural, and ecological factors shape health behaviors and influence health status (IFTF, 2000~.
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Some advances, like highly sophisticated medical instruments and better pharmaceuticals, seem most pertinent to the personal health care delivery system, but others are highly relevant for the protection of population health. Developments in genetics, for example, have shed new light on disease causation, thus providing new opportunities for intervention for disease prevention and health promotion (Khoury et al., 2000; Omenn, 2000~.
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Such a responsibility implies that health departments, health care delivery systems, and perhaps others engaged in population-oriented health efforts will be expected to construct and maintain a presence on the World Wide Web and use cyber methodologies to educate and inform consumers and communities. The public health system must gain greater skills to meet the challenge of using the mass media to promote health and to keep pace with the communication revolution.
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The liberalization of trade may benefit health status and outcomes by facilitating the diffusion of biomedical technologies and international food and agricultural safety standards (Bettcher et al., 2000~. However, greater openness to trade may also have negative implications if the global economy engages in practices detrimental to health; examples include the export of tobacco products in developing world markets and the production and dumping of environmental toxins such as methy~mercury Weigher and Lowery, 1998; Sen and Bonita, 2000~.
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and that our nation must become engaged in matters of global health law (Fidler, 2002~. In some instances like bioterrorism and infectious diseases it is a matter of national security, and in others it is a matter of national self-interest and positive identity (IOM.1997)
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From page 41... ...
and other influences from the social, economic, natural, built, and political environments, ranging from the availability of shelter and food to questions of social connectedness and behavior. These multiple determinants of health, among others, constitute a reality that makes it impossible for one entity or one sector alone to bring about population health improvement.
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U.S. Bureau of the Census, Current Population Reports, Population Projections, P25-1131.
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New York: Council on Foreign Relations and the Milbank Memorial Fund. Available online at www.milbank.org/Foreignpolicy.html.
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1999. Progressing from disease prevention to health promotion.
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2000. Global health status: two steps forward, one step back.
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