Politicians ignore best way
to improve people’s health

By Neil E. Weisfeld

(Published in Trenton Times, August 24, 2006)

By any measure, Americans are obsessed with health care.  We spend lavishly on it—one-sixth of the nation’s entire gross domestic product goes for health care!  We talk about it endlessly.  We bitterly resent any limits on health benefits set by government, employers, or insurers.  We enshrine health care as a “right” and “public good,” as our largest and probably most glorified industry, and as the source of personal well-being. 

In language we are even getting used to seeing “healthcare” as a single word, expressing at once a unified construct, a key aspiration of families, a dominant economic sector, the largest category of employers in almost every area of the country, a high-priority personal activity, and an unrivaled political network of interest groups.

As personal health care spending continues its dizzying ascent, though, the nation quietly has made a turn to reduce spending for health care’s neglected twin, public health.  This is a perilous error.

What is public health?  While personal health care consists of services rendered to individual patients, public health consists of efforts to protect the health of a whole group of people, or population. 

To give just a few types of examples, public health includes health services for victims of hurricanes and other disasters, widespread immunizations against flu and epidemic childhood diseases, and those behind-the-scenes acts to assure the safety of drinking water and food served in restaurants.  It includes medical research, as well as advocacy to reduce smoking and obesity.

Since the World Trade Center bombings and anthrax scare in the fall of 2001—events that resonated more in New Jersey than almost anywhere else—greater attention has gone into a new public health priority, preventing bioterrorism.   The initial hope of many public health advocates was that increased outlays for biodefense would be used to strengthen the entire public health system. 

Instead, recent attention to bioterrorism has joined with other budgetary pressures to jeopardize basic public health programs.  This year, for the first time in memory, a President has proposed cuts in the budgets of the National Institutes for Health and the Centers for Disease Control and Prevention—two federal agencies that shine as the crown jewels of public health.  At the same time the President proposed overall cuts in federal support for public health programs on the state and local levels.

Let’s look at this possible new trend in context.

The United States spends more on health care than on education, defense, and Social Security combined.  Yet, only three percent of all health expenditures go to public health, which in general is a far more efficient way to improve the health status of a population.  Public health, not personal health care, is credited with 25 of the 30 years that Americans’ life expectancy increased during the 20th century. 

Does it make sense, then, that public health should be the single area of health spending that is facing a possible downward spiral?  Hardly.  That’s the situation, though.

And, our tendency to undervalue public health isn’t limited to federal budgetary decisions.  One important aspect of public health consists of free and low-priced care for poor people, including immigrants.  This care benefits all of us. It stops contagious diseases like tuberculosis early, before they spread throughout society.  It attacks agents of disease like rats and food-borne infections before they show up in affluent areas.  It prevents premature births that end up creating huge taxpayer burdens in hospitalizations and social services.

Nevertheless, the House of Representatives, in an altogether unworthy display of mean-spiritedness, has proposed making it a criminal offense to provide services to illegal immigrants.  Presumably this proposed ban includes public health services.  Talk about cutting off your nose to spite your face!

With perhaps equal vindictiveness and short-sightedness, we fail to fund substance abuse treatment programs above a minimal level.  Yet, as we all know, substance abuse is clearly tied to crime.  Instead of investing moderately in substance abuse prevention and treatment, elected officials consistently choose to spend enormous sums of money on law enforcement, jails, and prisons to warehouse drug offenders. 

You probably won’t hear about public health this fall when candidates seek your votes.  Instead, liberal candidates, appealing to your interests as a patient, will tell you that we have to expand health care.  Conservatives, appealing to your interests as a taxpayer, will say that we have to cut government programs even more.  No one will appeal to your interests as part of a population. 

In the view of our elected leaders, Americans’ obsession with health goes only so far as their own next visit to the doctor, their next prescription, their next hospital stay.  The leaders see a big return from the nearly $2 trillion spent on personal health care in our country each year.  They should widen their focus to the comparatively tiny but bustling and vital system of public health.

Neil Weisfeld is a principal of the consulting firm NEW Associates, LLC, Princeton.