Physicians Call for Improvements to Country's Public Health System

A call for an improved public health infrastructure that works collaboratively with physicians in order to ensure the publics safety and health was made today by the American College of Physicians (ACP). The action was highlighted by the release of a new policy paper, "Strengthening the Public Health Infrastructure," at Internal Medicine 2012, ACPs annual scientific meeting in New Orleans.

This paper points out that strengthening the public health infrastructure is imperative to ensure that the appropriate healthcare services are available to meet the populations health care needs and to respond to public health emergencies, says Virginia L. Hood, MBBS, MPH, MACP, president of ACP. A strong public health infrastructure provides the capacity to prepare for and respond to both acute and chronic threats to the nations health, yet ill-advised budget cuts at the federal, state and local levels pose a grave threat to the health of U.S. residents.

ACPs paper makes the case for adequate investments in public health, which is the practice of preventing diseases and promoting good health within groups of people. Public health depends on an underlying foundation, or infrastructure, to support the planning, delivery, and evaluation of public health activities and practices. Public health works to protect and improve the health of communities through education, policy development, promotion of healthy lifestyles, and research. It concentrates on the health of the population, rather than care of the individual patient, although these are becoming more intertwined as non-communicable diseases are becoming a priority focus for both population and patient-directed care.

The paper calls for adequate funding for the public health infrastructure, but recognizes that the tight budget environment requires that funding be prioritized. It makes the case that the consequences of underfunding essential and effective programs that prevent diseases and promote good health within groups of people would be an unwise, and ultimately very costly, use of limited resources. The paper recommends that funding priority be based on assessment of which programs have demonstrated effectiveness in achieving key public health objectives.

ACP recognizes that funding for public health programs should be based on evidence that a particular program is effective in achieving better health outcomes for the population, notes Hood. Earlier this year, ACP provided Congress with recommendations to achieve hundreds of billions of dollars in federal healthcare savings while ensuring adequate funding of critical programsincluding public health. We need better coordination and less fragmentation of public health agencies, which could achieve savings by eliminating duplication and costs associated with inefficient sharing of information and resources."

To strengthen the public health infrastructure, ACP presents seven public policy positions:

Position 1: ACP supports investing in the nations public health infrastructure. Priority funding should be given to federal, state, tribal and local agencies that serve to ensure that the healthcare system is capable of assessing and responding to public health needs. ACP is greatly concerned that recent and proposed reductions in funding for agencies responsible for public health are posing a grave risk to the United States ability to ensure the safety of food and drugs, protect the public from environmental and infectious health risks, prepare for natural disasters and bioterrorism, and provide access to care for underserved populations.

Position 2: In the current economic environment, it is particularly important that federal, state, tribal and local agencies prioritize and appropriately allocate funding to programs that have the greatest need for funding and the greatest potential benefit to the publics health. All programs that receive funding should be required to provide an ongoing assessment of their effectiveness in improving population health. ACP recommends that priority for funding be given to programs based on their effectiveness in improving the health of the public.

Position 3: Having a healthcare workforce that is appropriately educated and trained in public health related competencies is essential to meet the nations healthcare needs. The education and training of sufficient numbers of physicians, nurses, allied health personnel, clinical scientists, health services researchers, public health laboratorians, and public health practitioners is an important part of the public health infrastructure. Accordingly, priority funding should be devoted to educational and training programs that prepare physicians, nurses, and allied health personnel that are in short supply and that help meet the healthcare needs of underserved populations.

Position 4: The public health workforce should educate the public on new healthcare delivery models and the importance of primary care. It is also important for the public health sector to promote the need to have a doctor or health center so care can be better coordinated.

Position 5: To address current and looming pharmaceutical therapies and vaccine shortages, the federal government should work with pharmaceutical companies to ensure that there is an adequate supply of pharmaceutical therapies and vaccines to protect and treat the U.S. population.

Position 6: Programs to inform the public of the benefit of vaccinations for children, adolescents and adults, to counter misinformation about the risks of vaccinations, and to encourage increased vaccination rates, particularly for vulnerable populations, are especially important for the health of the population. Evidence-based educational strategies should be used to influence behavior and increase vaccination rates.

Position 7: ACP encourages the development and implementation of a comprehensive, nation-wide public health informatics infrastructure, sharable by all public health stakeholders. This will require significant investments in new and improved technologies, standards, methodologies, human resources, and education.

"It is appropriate that today's report is being released in New Orleans, which acutely understands from experience how it important it is to fund public health activities, including being prepared for natural or human-made disasters," Hood says. Pointing to a fact sheet available at the briefing that describes the specific public health challenges faced by Louisiana residents--including disaster preparedness, but also high rates of smoking, obesity, asthma, and low vaccination rates -- Hood noted that "ACP's recommendations will strengthen public health, not only in New Orleans, but across the United States."