In my 50 years of practice, never have I witnessed such confusion, mistrust and nihilism about public health.
Public safety and education have their critics and opinionated experts, but seem to recognize what they are. Although the nature and magnitude of services and activities may vary from location to location, the basic concept/process is largely static.
Public health began to abandon the driving process/concept several years ago and replace it with a definition of services and approaches. Samuel Brookfield, an Australian academic, in the Journal of Public Health Policy spends pages dissecting whether a service or approach is considered “public health†depending on many variables, such as government role, scientific nature, social construct and methodology. Why?
In the old days, the process/concept was simple. It was a “process†by which a community assessed the health status of its population and its environmental and social stresses and threats, instituting actions to reduce or eliminate threats and promote improved population health status. Services selected to accomplish that end could be provided by local, state and central governmental and private entities. How a community was defined was largely a governmental determination.
Eugene Wood, CEO of Advocate Health, in a recent Harvard Business Review interview, opined that we no longer have the will from a policy perspective to how we orient ourselves toward the care of our people. Although, the excuse can always be reduced by some as indicative of a shortage of health resources, it goes beyond that and is more complex.
Health practitioners have always claimed to display an ethical and moral obligation toward the welfare of humanity. Examples are still plentiful in the clinical arena but often missing in involvement in local public health policy determinations and actions.
A few years back, I was a participant in a medical education activity designed to address this issue. Attendance by physicians, other health professionals and community health agencies was large and enthusiastic over several weekends. It ended with the participants formulating a plan to bring together various health and social participants on an ongoing basis to study priority health issues and develop community health recommendations and actions to address them. It was surreptitiously killed by corporate interests.
There have been recent articles on various states beginning to study the adverse effects of corporate health entities upon health care in local communities. Loss of practitioners and hospitals are most often mentioned. However, of equal concern is the loss of corporate health staff involvement in community public health policy and actions. In many smaller communities they represent the expertise required.
My plea is for a return to a simple definition of the public health process and the participation of local community health professionals in the exercise of it.
James Felsen is a semi-retired public health physician living in Great Cacapon.
