Why is it so important?

When you hear the term “public health,” what comes to mind? You might picture a crowded waiting room at your local health department. Maybe, you think about policies put in place by the government in order to make widespread changes to protect the health of a community. While both of these might be correct, public health is so much more. It has a significant impact on numerous people’s health, but it is usually significantly underfunded. Why is this the case?


0604 Public Health TNIn order to get a better understanding of what public health means, we need to take a look at both words separately. “Public” can mean a small group of people to several continents of people and “health” is the physical, mental and social well-being of the group, not just the prevalence or absence of a disease or problem. With these definitions in mind, the role of public health is to prevent people from getting sick/injured by encouraging healthy behaviors and protecting the health of people and the communities that they live, work and play by promoting health policies. By analyzing the health of a population, the threats to it and using this data to make informed choices to organize the efforts of society, organizations (public and private), communities and individual people, it becomes easier to prevent disease and improve quality/prolong life. Public health is not just one field but a combination of many fields that work together. It can include people from fields like environmental health, community health, behavioral health, health economics, public policy, mental health, occupational health and sexual/reproductive health to name a few. By working together, they are able to use biostatistics to discover the epidemiology of diseases/issues and determine what type of health services need to be offered to correct them. This ability to track disease outbreaks through the surveillance of cases and using health indicators to help reduce further transmissions and where to send resources is vital. Not only do public health officials help implement these changes, but they educate the public about them. One example of a public health program that has been successful is the use of vaccines in children at preventing diseases. This is why polio and smallpox have been eliminated in the United States and cases of measles, rubella and diphtheria are infrequent (although there has been an increase in some of these due to parents choosing not to vaccinate their children). Some other programs that have been effective include:

• setting standards that protect workers while they are performing their job which has increased workplace safety considerably
• developing nutrition programs for schools to promote healthier choices for children
• improved motor vehicle safety by promoting the use of seatbelts and airbags
• better sanitation/cleaner water supply through standards that require water goes through a certain filtration process before it is considered safe for consumption
• decrease in tobacco use through public awareness campaigns
• focus on family planning/contraceptive services, which have helped to decrease infant/maternal mortality, sexually transmitted infections and unwanted pregnancies

There is no question that these changes and other changes have improved the lives of millions of people. However, these, and many other, programs are typically not what is considered “health care.” Many programs are aimed at preventing diseases/injuries through simple, nonmedical techniques. This is why many people don’t understand how public health truly functions and that is about prevention, not treatment.

Most governments recognize the importance of public health in not only reducing the incidence of disease and disability, but also the role it plays in how a population ages and the physical/mental health of their society. This applies to ancient civilizations as well. Many rulers realized that they had a responsibility to their subjects to ensure they were healthy as this helped to maintain social stability/order and increased prosperity. Very early on, they realized that polluted water and improper waste disposal would spread disease. Early religions tried to regulate people’s behavior specific to health by forbidding certain types of foods and regulating indulgent behaviors, especially those related to alcohol and sexual relations. Around 1000 BC, ancient Chinese doctors developed a way to inoculate people during a smallpox epidemic. In 1485, the Republic of Venice created the first public health governing branching by establishing a permanent court that supervised the health of the population. Their primary focus was on preventing the spread of disease in their area from foreign visitors.

Today, we have several ways of monitoring public health. On a global scale, there is the World Health Organizations (WHO), which is an international agency that helps to coordinate with countries to act on global health issues. Most countries have their own government public health agencies, often called Ministry of Health. Unfortunately, in developing countries, this can be challenging because public health infrastructures are still forming, making it difficult for people to get access to health care due to the lack of public health initiatives. In the United States, we have several layers to our public health system. We have local health departments, state health departments and Public Health Service (PHS), which is under the control of the United States Surgeon General. In addition, we have the Center for Disease Control and Prevention (CDC), which handles not only national issues, but international ones. The purpose of these public health agencies is to provide guidance on important health matters, join forces with other agencies when needed to combat a disease, determine research areas, use the collected information to find a course of action and share that information with public, set/monitor standards for various industries and monitor the trends and health within their community through surveillance programs. These surveillance programs are able to be used as an early warning system for public health emergencies, record the effect of an intervention, clarify the source of a health problem and use scientific data to update health policy. Some examples of effective public health surveillance programs that have led to the identification and treatment of public health issues are HIV/AIDS, diabetes, antibiotic resistance, waterborne disease and diseases that are passed to humans by animals. Due to the public health initiatives that took place, American life expectancy at birth increased from 47 years old to 77 years old during the period of 1900 to 1999. Currently, while overall life expectancy remains high, it can vary greatly from some parts of our country to another and is impacted by gender, income, race, etc. In some areas, life expectancy is actually worse than some developing countries. When you consider that the United States leads the world in spending per capita on health care, our health status and outcomes should be significantly better than they are. In addition to life expectancy, the cutting of public health funding has huge impacts on other aspects of health care. One example is in the 1980s, funding for public health programs related to tuberculosis prevention was cut and now we are seeing a rise of tuberculosis that is resistant to medicines used to treat it. Another example is that if we don’t fund programs that promote healthy behaviors, the overall health of the population decreases and this causes people to need to use the health care system to get better. When people are unable to pay for the health care that they receive, then the cost of services rise and those increases get passed on to the rest of us via even higher medical bills and insurance costs. While there always seems to be funding for public health emergencies, like Ebola, there isn’t steady funding to help over the long haul.

When you consider all the contributions to health care that public health makes and realize an estimated 80% of the things that influence our health occur outside of hospitals and doctors’ office, it is surprising that over 95% of health-related funding goes to pay for medical services only. Public health can play a vital role in the health care system by evaluating current health services that are being offered and assessing if they are meeting the objectives of the health care system. In addition, it can help to identify the best interventions, their appropriateness, the resources needed to implement them and their cost-effectiveness. By seeking the recommendation from health care professionals, the public and other stakeholders, public health services help to shape decision making processes in health care and can easily inform and educate the public about necessary changes. Currently, half of recommended preventive services are not being delivered due to lack of public awareness. Public health programs could increase awareness of these services with better funding. Some of essential areas that still need to be worked on are new vaccines for HPV/better flu shot, improving HIV/AIDS treatment/prevention, developing a plan of action for drug-resistant tuberculosis, continuing to decrease tobacco use, decreasing the maternal/infant mortality rate (United States is one of the highest for developed countries) and reduction in prevalence of heart disease, cancer and lead exposure in children. If public awareness was better, then legislative changes would most likely follow from the public demanding it. Most legislative interventions are usually inexpensive to put into effect and result in a vast, positive impact due to their ability to tackle issues at a national level.

The good news about public health programs is not only their benefit on the health of a population, but they are often very cost effective. According to an analysis by the Trust for America’s Health (TFAH), every dollar spent on public health prevention programs saves $5.60 in spending on health care. When we look at medical interventions, we usually are hoping that they are at least cost effective, not they are saving more than they cost. This ability to pay for themselves is what makes investments in public health so valuable. In looking at the spending of a few of the public health services in the United States, it might seem like a massive amount of money is already spent on public health. The Center for Disease Control spends $12 billion yearly, the Health Resources & Services Administration (which helps uninsured people get access to health care) spends $10 billion yearly and the United States Agriculture Department spends $100 billion on nutrition assistance and $1 billion on food safety yearly. This is a substantial amount of money, but it is a miniscule amount when compared to what is spent yearly on health care costs. An example of the underfunding that is occurring is provided by the TFAH analysis, which states that $30 billion is spent on chronic disease yearly and this $20 billion shy of the amount need to actually provide the most of benefit to the public. So, despite all of the positive benefits public health services can provide and knowing what happens when there is enough funding, why isn’t more money distributed to the public health sector?

There are several reasons why public health is underfunded. One of the main reasons is that the private sector cannot make any money on it, so this leaves all of the funding coming from the public sector, which any spending or taxes are subject to political forces. Most politician are more likely to focus spending on projects that are more visible to the public and provide immediate benefits because this is what will be most likely to get them reelected. If politicians support a public health initiative, they wouldn’t get the credit for the end result because how far in the future that takes place. This is why we need to not rely on the government and elected officials alone to fund public health and need to encourage everyone to participate since all of us are affected by it. Another big reason that there is little interest in, and sometimes opposition to, public health initiatives is that they essentially tell people what to do, which many people don’t like. This is due to most public health initiatives require a societal change and people are naturally resistant to change. The challenge of implementing public health programs gets even more difficult when it imposes costs on special interest groups. The third biggest reason that public health is underfunded is because of lack of interest on the part of the public. This is the results of public health initiatives being difficult to measure because the “lives” that are saved is represented by a number versus a face, which is often the representation of a medical illness. People are more likely to emotionally identify with victims if they can see an actual person rather than a number. A fourth component in the deficiency of funding for public health is the lack of awareness of what public health programs actually do. Overall, the American public has no idea of what these programs are because there is little news value in reporting on it. We all benefit from public health measures (ex. cleaner air, safer food, safer roads, etc.), but take them for granted and don’t realize that we’ve been “helped.”

We all benefit from public health programs, so the funding for them shouldn’t just come from public funds raised by taxes that politicians have primary control over how it is spent. Funding should could from all of us and we, the public, should be taking a more active role in our public health system. In order to do this, we need to become better informed about public health initiatives and share this knowledge with others. If we have a better understanding of what public health is and how it operates, then it will have a better chance at continuing to protect everyone’s health. Public health is a vital component to the future health of our country and we need to do our part to protect it.