Thursday, November 19, 2015

The Future of Public Health — NEJM

The Future of Public Health — NEJM

Comment by Don McCanne

A century ago life
expectancy was 54. Today it is 79. Public health has played a much
greater role in realizing this gain than has clinical medicine. Although
most health funds are being directed to clinical services, public
health services will need support to continue and to expand the gains
that have been more important to society as a whole.

must remain responsive to the nation’s health needs. Recognizing that,
Congress included in the Affordable Care Act a $15 billion boost in
public health funding. However, that was reduced in 2012 legislation by
$6.25 billion, and then further reduced by sequestration. Public health
appropriations for 2015 are less than half of the $2 billion budgeted.

can these reductions be justified? The need for austerity? Not based on
the billions of dollars being fed into the coffers of the wealthiest
amongst us. Less need for government public health services? Not unless
we are willing to accept a surge in preventable disease epidemics and
injuries from public hazards. Can we justify these reductions based on
the ideological principle that the responsibility for health should be
shifted from the government to the individual? Even ideologues can
suffer or die from uncontrolled epidemics, from uncorrected public
hazards, or because of a lack of beneficial interventions that were not

In addition to these important
public health actions, we would also benefit by adopting a
government-run health care financing system - a single payer national
health program. The failure to act makes our Congress one of the
greatest public health hazards that we face. Electing the right people
to Congress may be the most important single measure that we could take
to maintain and improve the health of our nation.

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