Nation’s Public Health System Needs ‘Major Overhaul,’ Institute of Medicine Study Says
The nation's public health system needs a "major overhau[l]" to enable states to effectively deal with mounting threats such as infections, preventable diseases and bioterrorism, according to a new Institute of Medicine report, the Chicago Tribune reports. The 500-page report, titled "The Future of the Public's Health in the 21st Century," is a follow-up to a 1988 study that found that the nation's public health system was "fragmented, ill-equipped, underfunded and in disarray." According to the 2002 study, the system has made "little improvement" despite recent funding increases and renewed interest in public health. Dr. Jo Ivey Boufford, co-chair of the committee that wrote the report, said, "The health of the United States is simply not what it can be. We spend more money on health care than any other industrialized country -- $4,637 per capita in 2000 -- yet we rank 37th in the world in the World Health Organization's assessment of global health systems." Several factors, including access to quality care, risky behaviors, socioeconomic status and social networks, all play significant roles in public health, the Tribune reports. Noting that about one million U.S. residents die each year from preventable diseases, including tobacco use, poor nutrition and lack of exercise, alcohol abuse and medical errors, Boufford said, "Yet 95% of our spending -- roughly $1.3 trillion -- goes to personal medical care and biomedical research. Only 1% to 2% of the health care budget is spent on prevention."
Lack of accountability, lack of resources and conflicting jurisdictions all contribute to the inadequate public health system, according to Dr. John Lumpkin, director of the Illinois Department of Public Health and one of the report's authors. He added, "In an environment where we've come to realize that public health and national security are intertwined, that's real cause for concern." According to the report, additional funding for public health is being provided for bioterrorism, but only 30% of those funds are earmarked for state and local agencies. Boufford said, "Our research shows, basically, that the foundation of these agencies is not strong, so when you add more responsibility (bioterrorism response), you're in danger of having the whole thing topple over."
Based on the findings, the IOM said there is an "urgent need" to increase access to health care and called on the government to "examine options and develop plans for making comprehensive and affordable health insurance available to everyone." However, the report stated that the "government alone is not enough," the Tribune reports. Boufford said, "We have to involve more people in partnership with the government to promote and protect health. We cite evidence showing that the communities and private-sector health care delivery systems have important roles to play, as do employers and businesses, the media and academia" (Gorner, Chicago Tribune, 11/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.