With the health care debate typically revolving around personal insurance, the notion of public health often is overshadowed.
It is human nature to view the issue from a personal level rather than thinking about the importance of a healthy community and the effects that has upon the individuals in that community. But public health should not be overlooked. In many ways it has as great an impact upon our health and that of our families as our individual insurance or our personal doctor. Because of that, the Legislature should approve Engrossed Substitute House Bill 1432, which has been passed by the House of Representatives and is in committee in the Senate.
Before looking at the details of the bill, it is instructive to examine the nature of public health. As the American Public Health Association explains: “Public health promotes and protects the health of people and the communities where they live, learn, work and play. While a doctor treats people who are sick, those of us working in public health try to prevent people from getting sick or injured in the first place. We also promote wellness by encouraging healthy behaviors.”
As Dr. Alan Melnick, public health director and Clark County health officer, explained to The Columbian’s Editorial Board, those efforts manifest themselves in several ways. When there is an outbreak of measles or tuberculosis or influenza in a county, the benefits of public health suddenly receive plenty of attention. But when outbreaks or pandemics are not prevalent, it is easy to ignore the work that has gone into preventing them. “Our role is to prevent transmission to other people,” Melnick said.
That presents a Catch-22 for public health departments. When they are most effective, they are largely invisible to the public. You are not likely to hear a lawmaker suggest that epidemiology is an important function of government — even if the lack of such a function quickly becomes evident. Prevention of widespread disease is essential, and it is the type of endeavor that will not be undertaken by the private sector. It is unreasonable to expect private hospitals and clinics to coordinate the tracking and prevention of disease among the population at large.
The bill under consideration in the Legislature would define foundational public health and facilitate coordination between local health boards to better monitor and respond to communicable diseases. Melnick notes several areas in which this is growing in importance, with recent upticks in cases of tuberculosis, whooping cough, and other diseases that can spread quickly through the population. He also uses sexually transmitted diseases as an example, noting that Clark County saw the diagnosis of 377 cases in the first two months of this year, compared with 263 cases in January and February of 2013.
Meanwhile, ensuring a healthy populace also requires funding for public health, with Melnick saying, “As our population goes up and our funding goes down, I’m concerned about our preparedness.” While public health is not as eye-catching as the need to fund public schools or mental health, it should be viewed as an investment. Providing the funding to promote immunizations or catch outbreaks before they become pandemics can help hold down costs in the long run. The most effective way to control health care costs is to attack them from the front end with preventive care.
Paying attention to public health now will provide extensive benefits down the road, and that should be a priority of the Legislature this year.