Health and Health Care for the 21st Century: For All the People

Abstract

As I reflect on my more than 6 decades of public health service, I am awed at what has been achieved and shocked at what has not. We can prevent and treat diseases formerly considered capricious death sentences. Yet many proven strategies for preventing disease and disability sit on the shelves. The gaping holes in our health care coverage net leave approximately 47 million Americans without coverage.1 Our capability to prevent and treat disease seems to exceed our willingness to apply our interventions. Through most of history, medicine could really cure very little, and the concept of science-driven public health did not exist. By the early 20th century, the so-called medical miracles to prevent and treat disease began to emerge at an increasing pace. Average life spans in the United States increased by nearly 30 years, allowing most people to live into their 80s and some of us substantially longer.2 Services to enable people to spend those additional years free of disability, disease, and pain have not advanced proportionately. Obesity and its associated problems, including diabetes, cardiovascular disease, and orthopedic injury, are largely preventable; unintended pregnancies are too frequent, and many result in abortions that could have been avoided by stronger efforts to guide and assist our young; and we are not adequately prepared for potential influenza pandemics, bioterrorism, or the next global epidemic that, like HIV/AIDS, is unexpected, incurable, and unusual in many aspects of its transmission. As you read this commentary, transplant patients are waiting for organs that could be provided by a better system of distribution; millions of people are crying out because of inadequately treated pain; an aging person is suffering a debilitating hip fracture because no one told her how to get up from a chair; someone will be injured or killed on the highway by the abuser of an addictive drug that will most likely be alcohol; and drug-addicted people seeking help will be told to wait for a treatment slot to open. Four of my own areas of special interest illustrate the promise, peril, and unrealized potential that public health professionals should consider in charting a course for the 21st century.