Rebuilding US Public Health System Needs More than Short-Term Funding Directed at Bioterrorism

Abstract

FigureSince the tragedies of September 11 and the subsequent bioterrorism with anthrax, there has been repeated discussion of the state of the nation's public health infrastructure and the need to rebuild it. While this subject may appear to be an emerging issue to persons working in clinical medicine, for those of us in the field of public health, it reflects longstanding concerns. What is meant by “public health infrastructure”? Broadly, the term refers to the national system for preventing disease, whether through primary prevention (surveillance, reducing risk factors, and immunization) or through secondary prevention (outbreak response and screening).FigureThe public health infrastructure includes the major federal agencies of the US Department of Health and Human Services, the 50 state departments of health, and more than 3,000 county and local health departments throughout the nation. The scope includes enforcing laws to protect health and the environment, investigating the causes of disease, tracking disease patterns and risk factors, and implementing education and prevention strategies. From the prevention of communicable diseases to tobacco control, public health agencies have had a profound impact on the nation's health. The major gains in life expectancy over the last 100 years largely reflect the consequences of public health interventions and not the benefits of improved patient care. After decades of neglect, America's public health infrastructure has weakened. A victim of quiet successes, it functions with limited resources, particularly at the local levels. Demoralized by neglect, diminished funding, and political buffeting, the public health workforce urgently requires enhanced expertise and greater professionalism. The recent terrorist events have awakened our political consciousness to the need for preparedness. But rebuilding will require long-range planning and commitment; a short-term fix directed at bioterrorism will not suffice. Similar Crisis in Cancer Prevention A similar crisis is evident in the area of cancer prevention. Despite a national network of cancer registries and prevention grants, the partnership between public health agencies and health care providers has failed to reach its potential. Although we have some effective methods of preventing cancer, they are delivered haphazardly and often fail to reach those at highest risk. Clinicians are generally ineffective at providing prevention services, which, despite their potential to reduce medical costs, receive inadequate emphasis from health care delivery organizations. The CDC has targeted screening initiatives for breast and cervical cancer screening, but without increased investment such programs are not sufficient to meet the need. Post-September 11th, we can expect vigorous discussion and some new resources to improve preparedness and vitalize the public health infrastructure. However, an influx of short-term funds directed only at bioterrorist threats will do little to address longstanding weaknesses. We should take notice of other public health gaps that need to be reinvigorated, including those concerned with cancer prevention. In this time of heightened awareness we can ill afford another missed opportunity for broad long-term improvements in the health of America's population. Oncology-Times.com heck the above Web site for basic information about OT. Although the articles themselves are available as yet only in the print edition, the site does have a Table of Contents list of all articles to date starting in January 2001.