[Mb-civic] Curing our public health system - Madeline Drexler - Boston Globe Op-Ed

[William Swiggard]

  Curing our public health system

By Madeline Drexler  |  February 11, 2006  |  The Boston Globe

LAST WEEK, in his State of the Union address, President Bush bemoaned 
spiraling medical costs -- and rightly so. What he didn't say was that 
99 percent of US healthcare dollars are spent on treating and curing 
disease, and only 1 percent on preventing disease. That logic is 
backward -- and the president's proposed 2007 budget makes matters even 
worse.

Health savings accounts, medical liability reform, and token infusions 
of cash are the wrong medicine for what ails Americans. If the president 
were sincere about nurturing a ''compassionate, decent, hopeful 
society," he would reinvigorate our public health system. Public health, 
after all, is both morally enlightened and economically prudent. It 
rests on the idea that promoting health and averting disease saves more 
lives more cheaply than does high-tech medicine.

It's a concept Bush has consistently weakened. ''This is probably the 
worst administration ever for public health," said Dr. Walter Tsou, 
immediate past president of the American Public Health Association, at 
the group's annual meeting in December. ''They're constantly cutting 
back money -- with the exception of things that actually scare them, 
like bioterrorism and pandemic flu." What's killing us now, as opposed 
to what we fear will kill us, is cancer, heart disease, tobacco-related 
afflictions, complications of obesity, drug-resistant infections, and 
other ills, both chronic and acute.

In fiscal 2006, the Centers for Disease Control and Prevention's core 
programs suffered a 4 percent funding cut, compared with the previous 
year; Bush's proposed 2007 budget lops off another 4 percent. These core 
programs -- that is, nonterrorism-related activities -- are the bread 
and butter of public health. Among the programmatic victims are chronic 
disease prevention and health promotion, occupational safety and health, 
environmental health, and health services block grants to states, which 
cover everything from cancer screening to flu shots.

These aren't just meaningless line items; they're people's lives. In 
2004, Dr. Julie Gerberding, the CDC director, stated that ''robust" 
funding of disease prevention programs could each year save diabetics 
from 43,000 amputations, 165,000 kidney failures, and more than 10,000 
cases of eye disease; reduce by half 40,000 new HIV infections; and 
forestall two-thirds of alcohol-exposed pregnancies.

Healthcare coverage is another foundation stone of public health. In his 
enthusiasm about insurance portability, Bush forgets to mention that 46 
million Americans don't have health insurance to haul around. That's a 
death sentence. According to a 2004 Institute of Medicine report, 18,000 
adults die unnecessarily each year because they lack coverage.

So what's the alternative? How can the administration truly improve the 
state of the union's health?

First, it must follow its own advice. Every decade, the US Department of 
Health and Human Services publishes a document that sets national 
objectives for curbing disease and improving health. Its ''Healthy 
People 2010" report calls for reducing obesity levels to 15 percent of 
the adult population and 5 percent of children and adolescents; cutting 
tobacco use to 12 percent of adults and 16 percent of adolescents; and 
eliminating exposure to hazardous ozone levels. These official goals are 
so far out of reach as to be cynical. Achieving them requires action -- 
not 11 brief sentences of prime-time speechifying.

Second, the administration must think as globally about health as Bush 
is fond of boasting he does about the economy. Many nations, both rich 
and poor, have a keener sense of the value of comprehensive health 
measures than does the United States -- and we should learn from them. 
In Sweden, for example, the national agenda is to ''Create social 
conditions to ensure good health, on equal terms, for the entire 
population." That includes not just wholesome foods and local parks in 
which to exercise, but also jobs and a good education. In the United 
Kingdom, far-flung government authorities are required to collaborate on 
ambitious health targets.

Finally, our history-loving president might borrow a page from the 
annals of public health. During the late 19th and early 20th centuries 
-- the profession's golden age -- its leaders thought big. They didn't 
dole out scraps of rhetoric; the language of social reform came 
naturally. In 1905, Hermann Biggs, New York City's legendary health 
commissioner, famously asserted: ''Public health is purchasable. Within 
natural limitations a community can determine its own death rate."

And no, he wasn't talking about tax-deductible health savings accounts.

Madeline Drexler is a Boston-based journalist and author of ''Secret 
Agents: The Menace of Emerging Infections." She has a visiting 
appointment at the Harvard School of Public Health.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/02/11/curing_our_public_health_system 
<http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/02/11/curing_our_public_health_system/>

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