This may sound odd, coming from a physician, but I believe that the general public and, in particular, public policy makers, place too much emphasis on medical care and too little emphasis on the other determinants of health. I believe that a country as productive and wealthy as ours should be able to provide a basic level of medical care for all – there are enough health care resources to go around if we allocate them smartly.
What we do not pay enough attention to, in the interest of public health in its broadest sense, are the other determinants of health (and, hint… there are many): poverty, education, mental health, genetics, social support, food and nutrition, public safety and crime, and public transportation. Our current medical model does very little to attack these societal ills. I like to think of it as our nation’s “investment” in the health of our populace. What is our total spend? Is our “portfolio” of investments balanced for the highest return? Do we need to adopt a fundamentally different model of investment so as to produce higher returns on our investment? I believe we do.
We need to start with a “what really matters?” public health campaign. In health care, quite honestly, we do many expensive and invasive things that are not worth it. When you look at the increase in life expectancy in our nation, for example, you quickly learn that it wasn’t a new “look-alike” drug for high blood pressure. It was clean water, tuberculosis control, immunizations, and safer work environments that made the biggest differences.
The funding of public health and community mental health in particular is lagging, and believe me — it shows. Life expectancy and meaningful years of life in many populations is leveling off and even dropping. I say it is time to re-balance our health care and public health investment portfolio. It is seriously out of whack.
American Public Square event
Health Forward is proud to sponsor American Public Square’s Dinner at the Square: Public Health Services. On May 9, 2017, a panel of experts will discuss what life would be like without public health services and, in these days of declining government funding, what does and should get priority. For more details, panelist information and event registration, please visit American Public Square’s website.
Dr. Norman is a Lieutenant Colonel with the Kansas Army National Guard and the State Surgeon of Kansas.