Public Health At Center Stage: New Roles, Old Props

Abstract

The public health system represents a wide variety of actors playing key roles in the ongoing script to improve the quality and quantity of life for the U.S. population. The specific parts that public health is being asked to play and the resources available to support its infrastructure for prevention and response to infectious diseases, chronic medical conditions, and disasters are discussed here in light of new national survey data from state and local jurisdictions. Although the public health system has both traditional and newly defined roles to play, resources, as measured by per capita spending and workforce availability, have not kept pace. [Health Affairs 25, no. 4 (2006): 911-922; 10.1377/hlthaff.25.4 .911]A s s h a k e s p e a r e s o fa m o us ly s tat e d, "All the world's a stage." Indeed, public health has long been accustomed to performing its essential functions before an audience. In a post-bioterrorism world, however, public health now finds itself at center stage, a position it has not occupied since the discovery of the polio vaccine. Ironically, even though recognition has been delayed, the twentieth century may justifiably be termed the "Golden Age of Public Health." This designation is largely based upon the gain of more than 60 percent in life expectancy during the past hundred years, mostly attributable to gains in public health knowledge and its successful application.1 Yet, remarkably, these lifeextending benefits have accrued to the American public despite the relatively limited funding for governmental public health and its oft-neglected infrastructure. 2In fact, financial support for public health stands in stark contrast to its more glamorous sibling, the private health care delivery system, which has contributed more modestly to overall life extension during this time frame. precisely how limited their resources are. 4 In this paper we present salient findings of two recent, unique surveys conducted by the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO). We use this information to briefly describe the structures and functions of U.S. public health departments and to examine their financial support and infrastructure. Lastly, based on the data we provide and on our collective experiences, we make specific policy recommendations.

Obesity Prevention and Diabetes Screening at Local Health Departments

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Swimming Upstream? Patient Protection and Affordable Care Act and the Cultural Ascendancy of Public Health

“…The spending of state and local public health agencies constitutes only 2.4 percent of all US health care spending. 48 Following 9/11 and the apparent looming threat of bioterrorism, public health agencies had a new public health protection role. Many public health officials believed that a new era with new resources was on the horizon.…”

Influenza A(H1N1) and Pandemic Preparedness Under the Rule of International Law

“…As the cost of health care has soared, only about 2.5% of total health spending has been allocated to prevention and public health. 8 A few states have strong surveillance systems, but many others are deficient so that early warning and response are highly fragmented.…”

“…1 Subsequently, these guidelines were broadened to include prevention and treatment of other opportunistic infections in HIV-infected adults and children. [2][3][4][5][6][7][8] As clinicians and publishers became more comfortable using Web-based resources, these guidelines were posted on the Web with links from Web sites sponsored by the Centers for Disease Control and Prevention, the National Institutes of Health, and the Infectious Diseases Society of America…”