Where’s the Public Health?

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4 Responses

  1. Gwendolyn Majette says:

    Richard aptly points out a coverage gap that I too noticed about the topics in Fragmentation. While the book overlooks the topic of public health, the U.S. Senate committees working on health care reform did not view public health as a minor or side issue. As a Fellow working with a Senator on the Health Subcommittee of the Senate Finance Committee, I was a part of the conversations laying the framework for the health care reform legislation. Our framework was three-fold: (1) Coverage, (2) Delivery System Reform, and (3) Prevention, Wellness & and Public Health. Staffers for both the Health Subcommittee of the Senate Finance Committee and the Health, Education, Labor, and Pension Committee attended regular meetings on these topics. In thinking about public health, some of our conversations included speaking with the US Preventive Services Task Force, the Task Force on Community Preventive Services, Trust for America, and Partnership for Prevention.

  2. Some could argue the alleged spill only affected 120 or so residents on canal water. But the lack of response and, really, the lack of urgency by the county Public Health Department and the county Agricultural Commissioner’s Office makes us wonder about their response on a more widespread scale.
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  3. Elizabeth Weeks says:

    Gwendolyn, Your comments and perspective on this question are terrific. I am guest editing a Journal of Law, Medicine, & Ethics Symposium on public health and health reform this spring. It would be wonderful if you would contribute. The call for papers is here: http://www.aslme.org/JLME_Call_For_Papers

  4. Frank Pasquale says:

    This is a very important angle that needs to be explored more fully in future books on the topic. I believe the book was planned in 2008, before the battles over what became ACA. Those battles revealed a huge obstacle to a public health perspective: demagoguery based on “death panels” and other imagery. As Doug Coupland recently quipped, “The future of politics is the careful and effective implanting into the minds of voters images that can never be removed.”

    For example, any expert who has read, say, Kevin Outterson and Aaron Kesselheim’s work on conserving antibiotics would likely agree with your concern that “physicians tend to be imprudent stewards of the antibiotic supply.” But can you imagine the outrage if remedial measures were legislated? We might hope that payment systems could reflect the need for conservation here, as O & K propose. (http://healthaffairs.org/blog/2010/09/13/fighting-antibiotic-resistance-by-paying-for-appropriate-use/)

    I am afraid that, in the current political climate, it will be very hard to promote statutes designed to promote public health via better balancing of physicians’ relational and regulatory duties. Nevertheless, discussion of these matters is a good step toward “consciousness raising” among physicians themselves.