Public Health in the Next Decade

Abstract

,9Zq how to do for the public's health, we have done very little. And it goes without saying that the greatest threat to people, the arms race, has expanded unabated. What can we expect in the next decade? Are there major breakthroughs over the horizon? Will we apply what we know how to do? Will we demand the power and resources that we need? Will governments respond to our demands? In short, the question is whether or not public health people will challenge the social forces that preserve the conditions that cause disease, disability, and death. Improved knowledge is not sufficient! Epidemiology is the basic science of public health. It continues to give us improved understanding of the causes of disease, disability, and death. We can identify the populations at risk. And we have learned the ways to protect these people and to prevent disease. We are not lacking for targets and achievable goals for intervention. A simple analysis, comparing health indices for populations in the same country, suggests that improvements in health status are within the means of national government. Similar differences often occur in much smaller geographic areas, making the problems amenable to local government intervention. To grasp what prevention can accomplish, I have looked at the geographic, social class, and racial differences in total and cause-specific mortality in the United States. The age-adjusted death rate for black men in 1982 was 10.5 /1000 and for white men, 7.1, a 32 percent difference. In 1977 the death rate in West Virginia for all individuals age 45-64 was approximately 1.5 times as high as in Utah. The death rates in Kentucky and North Carolina were almost as high as in West Virginia. It should be