Public Health Is More Important than Health Care

Author(s): Larry Gordon

Source: Journal of Public Health Policy, Vol. 14, No. 3 (Autumn, 1993), pp. 261-264
Published by: Palgrave Macmillan Journals
Stable URL: http://www.jstor.org/stable/3343038
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 Public Health Is More
ImportantThan Health Care
LARRY GORDON

GUEST EDITORIAL

a m
6*a U
UBLIC health practitionersseem to be sufferingan
G identity crisis. Perhapsthey have felt ignored and
D ) 2 underfundedfor so long that they are eagerto latch
i 3onto anythingthat includesthe word "health."Or
perhapssome publichealthpractitionersunderstand
that health care receives94% of the health services
dollarswith only 3% going to publichealth,so they mistakenlythink
they should be part of the 94%. Or perhapsthe identitycrisisis due
to the fact that many public health personnel originallyhad their
roots in healthcare, so they still have latentdesiresto practicehealth
careratherthan publichealth.Or perhapsthe identitycrisisis a man-
ifestationof the fact that manypublichealthpractitionersdo not un-
derstandthe basic differencesbetweenpublic healthand healthcare.
Or perhapsthe identitycrisis is due to some public healthpractitio-
ners not really believingin the primacyand cost-benefitdesirability
of diseaseprevention,healthpromotionand environmentalhealthas
differentiatedfrom healthcare. Or perhapssome public healthprac-
titionersdo not understandthat public health is in eternalcompeti-
tion with healthcare for the budgetdollar,just as certainlyas public
healthis competitivewith such otherbasicgovernmentalfunctionsas
welfare,educationand nationaldefense.
Public health is the art and science of preventing disease and injury,
and promoting health and efficiency of populations through orga-
nized community effort.
Environmental health and protection is the art and science of pro-
tecting against environmental factors that may adversely impact hu-

z6i

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z6z JOURNAL OF PUBLIC HEALTH POLICY * AUTUMN 1993

man healthor the ecologicalbalancesessentialto long-termhuman

healthand environmentalquality.Suchfactors include,but are not
limitedto air,food and watercontaminants;radiation,toxic chemi-
cals, wastes,diseasevectors,safetyhazardsand habitatalterations.
Healthcareis the diagnosis,treatmentor rehabilitationof a patient
undercare,accomplishedon a one-on-onebasis.
Publichealthpractitionersshouldingesta healthydose of skepti-
cism regardingthe currentnationalhealthcaredebates,while inten-
sifyingtheireffortsto enhancethe deliveryof properlydesignedand
prioritizedpublic health and environmentalhealth and protection
servicesdeliveredthroughour variedand complex system of state
and local healthagencies.
As a practitioner,I practicedpublic health and environmental
healthand protectionin the trenchesand at the policy levels at the
city, county,district,state and nationallevels. In variousleadership
roles and as a state cabinetsecretaryfor healthand environment,I
testifiedbefore local, state and federallegislativebodies for forty-
threeyears,andhaverepeatedlylearnedthe hardway thathealthcare
is not publichealth,publichealthis not healthcare,and certainlyen-
vironmentalhealthand protectionis not health care. Publichealth
and healthcarecompetewith each otherfor the limitedbudgetdol-
lar.As a cabinetsecretary,I consistentlylearnedthat any reasonable
requests to expand my health care budget would probably be
granted,and in fact, my healthcare budgetwas frequentlyincreased
in the absenceof a departmentalrequest.Not so for publichealthor
environmentalhealthandprotection.My numberone priorityhas al-
ways been public health and environmentalhealth and protection.
But while consistentlyadvocatingpublic health and environmental
healthandprotectionas my numberone priority,my healthcarebud-
get continuedto increasedisproportionately.I frequentlyfound it
somewherebetweendifficultand impossibleto gain approvalfor one
morepublichealthnurse,or one moreenvironmentalhealthscientist,
or one morepublichealtheducator,or one morepublichealthphysi-
cian,or one morepublichealthdentist,or one morepublichealthnu-
tritionist,or one morepublichealthlaboratoryscientist,while being
criticizedby legislatorsfor not requestingmorefor our department's
healthcare programs.On many occasions,I experiencedlegislative
bodiestransferringfundsfrom publichealthto supporthealthcare.

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GORDON * PUBLIC HEALTH z63

On one occasion, my environmentalhealth and protection budget

was reducedin orderto shore up our medicaidbudget.Duringlegis-
lativebudgethearings,the roomswere filledwith effectivehealthcare
advocateswearingtheir caps, bannersand badges. Only once in my
years of experiencedid a non-departmentadvocateof public health
show up to testify.That personwas a public healthnurse.
Publichealth continuesto be difficultto sell, whereashealth care
continuesto be demandedand betterfunded.Publichealthprograms,
unlikehealthcare issues, lack an effectiveconstituency.Publichealth
has always been a rocky road, as it providesno immediategratifica-
tion or feedback.It requiresthe abilityto look to the future,which is
not a commonplacetrait of our political leaderswho are looking to
the next electionratherthan the statusof theirconstituents'healthin
coming decades.Publichealth,thus far,lacks the glamourassociated
with hospitals, organ transplants,emergencymedicine, diagnosis,
treatmentand rehabilitationand does not compete well with crisis
healthcare.
Publichealth practitionerswho think national health care reform
will enhancepublichealthprogramsmay be in for a rudeawakening,
and may findthey have beenworshippingthe falsegod of healthcare
in vain. The national health care reformefforts are being designed
to contain health care costs and improveaccess to health care-not
public health.In fact, the estimatedI 50 to zoo billion dollar annual
cost of revampingthe nation'shealthcaresystemmay well mean less
funds for public health and environmentalhealth and protection.
When our federal politicians start looking for funds for national
health care reform,less federaland state funds may be availablefor
currentand additional efforts to deliver public and environmental
healthand protectionservices.Our politicalleadersdo not appearto
understandthat public health measureshave done more, and can
continue to do more, to improve the status of the nation's health
than all the healthcaremeasurescombined.And publichealth,prop-
erly supported,stands readyto effectivelyattackthe currentleading
causes of death and disability.
As publichealthpractitioners,what should we do?

- Understandthat publichealthis not health care.

- Explainthat publichealthproducesmore benefitsfor less cost than
does healthcare.

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z64 JOURNAL OF PUBLIC HEALTH POLICY * AUTUMN 1993

- Explainthat any significantimprovementsin the statusof the pub-

lic's health will be derivedfrom improvedeconomic vitality;en-
hancededucationalachievement;healthfullifestyles;and effective
disease prevention, health promotion, and environmental health
and protection services which are delivered, primarily, through
state and local public health and environmental health and protec-
tion agencies.

In summary,we should circle the wagons in the name of public and

enviromental health and protection and understand, explain, pro-
mote, market, sell, interpret, propose, advocate, and communicate
the need for improved public health and environmental health and
protection services.
National health care reform is important from the viewpoint of
current politics, public sentiment, compassion, access to services, and
cost containment. Public health is vastly superior and essential from
the viewpoint of enhancing the health status and quality of life and
environment of our citizens. If public health practitioners cannot un-
derstand and market these simple concepts, WHO CAN, and WHO
WILL?

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