Friday, July 30, 2010

Building Health Care a Foundation

Health depends more on what you eat and drink, where you live, whether or not you have a job, how often you wash your hands, whether or not you smoke, how far you got in school, and where the factory next door dumps its waste than it does on high tech surgical procedures or the newest pharmaceutical drugs.

This is where public health fits in. Public health is the foundation of health care. As the Institute of Medicine has said, “The mission of public health is to fulfill society’s interest in assuring conditions in which people can be healthy.”

So how do the “conditions in which people can be healthy” relate to health care reform?

Let me give an example.

Let’s say two children are born on the same day, but in different communities. One is born to a mother who has carefully watched her diet throughout pregnancy and has abstained from alcohol and smoking. She lives in a village with pristine water and unpolluted air. The sewage and garbage in her village are transported far from town, where they are carefully processed and recycled. As she grows, her mother carefully teaches her about health and personal hygiene, and makes sure there is always plenty of nutritious food, soap and toothpaste in the house.

The second child is born a bit premature and is small for his age, due to his mother’s inadequate diet and heavy smoking throughout her pregnancy. He grows slowly because of his frequent coughs and bouts of gastrointestinal disease, and because he shares his limited nutrition with the hookworms he has acquired from running barefoot in the village. The water he drinks is questionable, and the air in his home is polluted from the coal-powered stove on which his mother cooks the meager fare which she is able to find in the marketplace. Outside, the stench is almost palpable from the garbage on the streets and the cracked and leaking sewage pipes. His mother knows little about hygiene, and is too busy with her other babies to teach him what she does know.

This exaggerated picture does have a message: It makes a big difference how much effort and the level of resources your community puts into assuring healthy conditions for you and your family. In fact, Dr. Herman Biggs, the Commissioner of Health for New York City in the late 1800s claimed, “Public health is purchasable. Within natural limitations a community can determine its own death rate.”

Now, if these two families came to buy health insurance from you, which would you prefer to insure? Before either child has even entered the “health care system,” you already know which one is going to have the highest health care costs. One has grown up in a community with a rock solid foundation of public health, and the other is attempting to survive in a community that is falling apart.

The choice is ours. “Within natural limitations, (we) can determine (our) own death rate.”

No comments:

Post a Comment