Health care reform: Fulfilling the promise of public health

Posted on January 20, 2010


By NJ Voices Guest Blogger/For January 15, 2010, 3:16PM


[Aristide Economopoulos/The Star-Ledger]
While the nation debates health care reform, the state’s county and local health departments are in a day-to-day struggle as stewards of public health.

Every day, the headlines confirm what many of us have known for a long time: The nation’s health care system is in desperate need of repair.

While the national drama escalates about how to afford coverage for everyone, another battle is being fought much closer to home– in fact, right here in our communities. This is the day-to-day struggle waged on your behalf by county and local health departments, the local stewards of public health.

Former Surgeon General David Satcher once said, “Until we invest as much in prevention as we do in cure, we will never reduce health care costs.” This is simple and largely true. The nation’s public health system is perfectly positioned to help deliver on this proposition if brave agreements can be achieved by political leaders currently tugging in opposite directions.

Local health departments are bedrock to the health care system. From protecting the water we drink, the food we eat, to the air we breathe, the Hunterdon County Health Department, along with the other 113 local health departments in New Jersey and the rest of the nation’s 2,700 local health departments, truly are “on call” every day.

But the job doesn’t just end there. Actually, it is from that first-hand experience of delivering on-the-ground services on a daily basis that local health departments do their most critical work: advancing policies and supporting conditions that make good health the desired norm for every community.

lndeed, day-to-day public health is about creating conditions that support individuals and families to make healthier choices in diet, exercise, tobacco use; about enforcing environmental standards; about promoting the birth of healthy babies to high risk mothers, about working to prevent and reduce the effects of chronic disease; even about controlling disease-spreading mosquitoes. All these programs, all these efforts, occur not in anonymity but through face-to-face counseling and direct contact at the most local level.

And then there are the dramatic events that suddenly vault public health to center stage: a major health threat — be it by natural event or man-made consequences. In these times that can literally redefine life in a community, the local health departments do the heavy lifting in the direct line of fire to stop outbreaks of disease, administer vaccines, and contain the impact of food-borne illness. No small tasks for anyone who has lived the experience. The scary fact is that communities are largely on their own when coping with emerging public health threats. No one will ride in to rescue us.

Today’s unsettling paradox is that at the very time when communities need a strong public health system the most, local health departments have never been more tenuous — a result of years of being underfunded and victim to overly aggressive budget cutting at the most local level. This year’s pandemic provides a timely illustration: Local health departments are stretching to the limit to respond to spiking demand for public health services at the very same time their budgets are being slashed by local governments reeling from a protracted economic downturn.

Nationwide, an estimated 55 percent of local health departments, and 76 percent of state health departments, reported program cuts in the past 12 months. These funding cutbacks also translate into fewer community-based interventions mounted against chronic diseases such as diabetes, and asthma, further escalating illness, disability and health care costs. In Hunterdon County alone, we have lost more than 20 percent of our workforce in the last two years including cuts in public health nursing, health education, and environmental health staffing. Things are not getting done.

A recent Health Management Associates report makes a strong case for why the federal government should dedicate sustainable funding for local health departments. The report, funded by the Robert Wood Johnson Foundation for the National Association of County and City Health Officials, recommends both that the federal government fully fund state and local health departments under grants from federal agencies, while also establishing a prevention and public health investment fund that is insulated from budget cuts that accompany economic slowdowns and ongoing political battles.

As Congress passes some version of health reform, let us hope that the final bill provides a much-needed shot in the arm for public health. A sustained investment in public health, as featured in both the current Senate and House health reform bills, will strengthen local and state health departments’ abilities to provide the basic public health protection that individuals and families in every community expect, deserve, and pay for through taxes.

If they are better funded and working together more seamlessly, federal, state, and local health departments can prevent disease and protect health in ways far beyond the capacity of health insurers and individual medical care providers. This much is readily acknowledged without debate. So what holds us back?

Year 2010 is already a pivotal year and it has just begun. So many look ahead with great anticipation. Right here in New Jersey’s counties and municipalities, and elsewhere in communities across America, there is plausible hope that the federal government will come to its collective senses and, among other things, make good health the default option for everyone, enabling people to seek healthier choices, to prevent disease, and to manage chronic medical conditions. The time clearly has come to fulfill the ultimate promise of health reform – a healthier America.

John Beckley is president of the New Jersey Association of County Health Officers and health officer and director of the Hunterdon County Department of Health.