Stronger health system will bring a healthier population

A major overhaul of funding, organization and coordination will help the public health system meet the challenges coming its way, says an Institute of Medicine panel.

By Susan J. Landers, amednews staff. Dec. 2, 2002.

Washington -- Connecting the work of the solitary physician to the health of the entire nation is a bit of a stretch, but the Institute of Medicine did just that in a recently released report that examined the nation's health care system and found there is a need for much improvement.

"America is not as healthy as it can be," said Jo Ivey Boufford, MD, who co-chaired the committee that wrote the IOM report.

Reaching out
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Topic: Terrorism in America

However, the tools and techniques that can contribute to a healthy population are at hand, said Dr. Boufford, a professor at New York University's Robert F. Wagner Graduate School of Public Service.

What is needed is a coordinated push by the health care delivery system, businesses, the media, academia and the community itself to improve the health of everyone, she said.

The IOM provides advice on health policy issues under a congressional charter to the National Academies of Science. The report, The Future of the Public's Health in the 21st Century, was sponsored by the Centers for Disease Control and Prevention, the National Institutes of Health, the Health Resources and Services Administration and other government agencies.

A computerized reporting system for disease outbreaks is a top public health need.

"It's important for physicians to realize that they are an important part of the system to improve the health of the public," said committee member John Lumpkin, MD, MPH, who directs the Illinois Dept. of Health.

"I know when I was working in the emergency department it was very difficult to see beyond the next patient -- or even beyond the next day -- because of the frustrations of trying to get my patients taken care of," he said.

But a quick glance around would allow physicians to see that they are already working within the context of the broader health issues that relate to the health of the community, said committee members.

Reaching the community

Issues of prevention such as immunization, health screening and counseling patients on behavior changes are extremely important, said committee co-chair Christine Cassel, MD. "So very obvious things like that can have an effect," she said.

Physicians who participate in community activities, perhaps taking an afternoon to speak to the PTA about childhood obesity, are one example of individual physicians interacting with the community, said Dr. Cassel.

"Physicians really have an important leadership voice in the community and getting involved at that level could make a difference," she said.

Looking to the future

The committee took a broad look at the health system going well beyond the local and state entities known as public health departments.

"The charge to the committee was not just to look at the public health system and comment on it and its efficiency," said committee member Judyann Bigby, MD, associate professor of medicine at Harvard Medical School and director of Community Health Programs at Brigham and Women's Hospital in Boston.

"The charge was 'What do we need to do as a nation to ensure the health of the people of the United States in the next century?' " said Dr. Bigby.

It turns out that there is a lot in this category.

Included in the committee's list is solving the problem of the 41 million uninsured people in the country. "Not having people insured is a threat to our public health," said Dr. Boufford.

Adequate funding to repair a badly neglected health care system is another necessity, said the committee.

The panel was already deep into the writing of the report when the terrorist attacks occurred in September 2001 and were closely followed by the arrival of anthrax-tainted letters in the mail. Both disasters placed their work firmly into perspective, said Dr. Lumpkin.

"What we learned since [then] is that you can't separate public health from national security, and to the extent we are going to have a strong and prepared nation, we need to have a strong and prepared public health system," he said.

While the states and localities welcomed the federal funding that came their way after the events of last fall, a concern of the committee was that there would be a misperception that funding needs had been addressed, said Dr. Boufford.

"But the bottom line is that only about 30% of all the bioterrorism funding is coming to state and local public health agencies," she said.

Upgrade communications

One of the most pressing needs is for the development of computerized reporting systems, said several committee members.

Physicians are already on the front lines when it comes to encountering any unusual outbreaks of disease. However, "we currently operate our infectious diseases reporting system using 1920s technology -- telephone and the mails," said Dr. Lumpkin.

There are some exceptions.

One is Massachusetts, which has recently funded a project to link the public health department and Harvard Vanguard Medical Group to help in the tracking of outbreaks.

This is a system that all states, as well as the CDC, should have, said Dr. Bigby.

"The whole anthrax scare highlighted what the deficits are," she said. CDC's internal computers broke down during that time, said Dr. Bigby, something that should never have happened.

"In an era when technology is so emphasized and everybody is in awe of what we have accomplished, we don't have access to that technology in our most basic public health functions," she noted.

Congress's interest in a Homeland Security bill also attracted the attention of the committee members.

"I would hope that department would have a very key role for health and for the health care sector," said Dr. Cassel.

"Obviously you have to worry about weapons and missiles, but something more insidious is much more likely," she said. "The health of our people is also a part of the strength of our country."

ADDITIONAL INFORMATION:

Reaching out

A new Institute of Medicine report offered a new approach to protecting public health that includes diverse, nongovernmental players. Among the specific recommendations:

Building partnerships across the public and private sectors. Businesses, academic institutions, faith-based and nonprofit groups should work jointly with state and local health departments and health care organizations to develop and promote workplace and community health education programs.
Investing in the public health infrastructure. The government public health infrastructure is the backbone of the nation's efforts to promote health. Federal, state and local governments must provide adequate and sustained funding for the public health system.
Enhancing communication. The federal government should facilitate the development of an enhanced health information infrastructure to improve the public health system's ability to gather, process and share information. In addition, the media should donate more time to public service announcements during prime time TV hours, a step that the Federal Communications Commission should encourage by reviewing its regulations.
Reforming health care availability. A significant obstacle in achieving the best possible health for the nation is the lack of health insurance for 41 million Americans.