1994
Public Health Service
Primary Care Policy Fellowship

"Public Health and Health Reform"

Terence R. Collins, M.D., M.P.H., M.P.S.
Professor and Vice Chairman
Department of Preventive Medicine and Environmental Health

Charlene M. Hanson, Ed.D., F.N.P.-C, F.A.A.N.
Director, Center for Rural Health and Research
Georgia Southern University

Joyce M. Johnson, D.O., M.A.
Director
Division of National Treatment Demonstrations
Substance Abuse and Mental Health Services Administration

Terry Mizrahi, M.S.W., Ph.D.
Professor, Hunter College, School of Social Work

Linda Rae Murray, M.D., M.P.H.
Medical Director
Near North Health Service Corporation

Robert W. Sherwood, Jr., M.A., M.S.
Director
Bureau of Primary Care and Rural Health Systems
Utah Department of Health

William R. Taylor, M.D., M.P.H.
Medical Officer
Centers for Disease Control and Prevention

Michael J. Till, D.D.S., Ph.D.
Professor of Pediatric Dentistry
University of Minnesota, School of Dentistry

Principles

A primary role of government is to protect the health and well-being of its people and communities at the local, state, and federal levels.
The national health system must address the social and economic conditions and the quality of life in communities in order to improve health status. Public health assumes responsibility for reducing the disparities in health status among different population groups.
Federal, state and local governments and communities should be active partners in the design, implementation, and evaluation of a comprehensive health care system.
The core public health functions of assessment, policy development, and assurance are the essential foundation for the delivery of effective primary care services.

Problems

The public health and medical care sectors are isolated from each other, which makes teamwork and integration of services difficult.
The public has been insufficiently informed and involved about the value and contributions that core public health functions make to improved health status. There is no required mechanism for public and community participation in health planning and decision making.
Public health and prevention have a narrow political constituency, receive only 1 percent of the total national health dollar, and are at a disadvantage in competing with the heavily financed medical care industry.
Health reform discussions center around medical care financing and delivery; public health and the integration of individual- and population-based services have not been part of the debate.
The transition toward a comprehensive single-tiered health system will be lengthy and complicated. Investments must be made to maintain the full spectrum of public sector health care services.

Recommendations for a Reformed Health System:

Integrate health and social services to maximize the nation’s well-being. The first priority for the health system is to eliminate the present health gaps by race, class, and gender.
Support, stimulate, and encourage communities to control their health care resources, determine their needs and priorities, and hold the delivery system accountable.
Develop new public health partnerships with primary care centers, community-based organizations, businesses, and other government sectors to promote the public’s health. Public health programs should inform the public to improve the perception and understanding of the accomplishments and potential of public health.
Develop a common data base for all public health and primary care services accessible to individuals and community-based organizations.
Reduce artificial barriers among various categorical programs to increase efficiency and flexibility in addressing local health problems.
Establish a public health fund from an assured financing source to establish and maintain the core public health services and infrastructure.
Establish global health budgets for communities to optimize health status through a unified personal health service and public health delivery system.