Robbing Peter to Pay Paul -- With Our Lives

The U.S. now spends far less on essential public health services than virtually all industrialized nations --.
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In the past week, the present waning of the Ebola epidemic in Africa and the growth of a new measles epidemic here at home have dominated the headlines. These two important threats peaked on an unrelenting plateau of population health challenges including premature and preventable deaths, chronic illness, mental health, and personal and community violence.

These major health issues impact our nation disproportionately as compared to other well-off nations, as a recent report underscores. The U.S. now spends far less on essential public health services than virtually all industrialized nations -- and it shows. The recent Institute of Medicine (IOM)report, US Health in International Perspective, the IOM emphasized that "for many years, Americans have been dying at younger ages than people in almost all other high-income countries...this disadvantage has been getting worse for three decades, especially among women." The report found that in comparison with 16 peer, high-income democracies, Americans' lives are shorter, our health is poorer throughout every stage of our life courses and we rank far worse in 9 health areas including infant mortality, sexually transmitted diseases, homicides and drug-related deaths, obesity, diabetes, heart and chronic lung disease.

The root cause of many of the challenges that face us lie beyond the purview of traditional health care delivery and demand evidence-based, population-focused public health interventions.

Despite these appalling facts, we foolishly continue to reverse course in our funding of essential public health services. There is a well-documented connection between robust public health infrastructure in the form of sufficiently-trained staff and regional centers for the delivery of prevention, laboratory and treatment services and population health outcomes. And while the Affordable Care Act (ACA), has been a very positive step forward toward insuring the U.S. population for health care services delivery, it is not a substitute for the provision of essential public health services or the training and research which support the delivery of these services.

Three recent blows to public health in the U.S. have occurred in rapid succession: the gutting of the Prevention Trust, the component of the ACA that protects the public at large from a broad range of epidemics; the scaling back of the nation's Prevention Research Centers, applied research centers funded by the US Centers for Disease Control and Prevention (CDC), which have for decades enhanced our knowledge of what works in public health; and just last week in the President's 2016 budget, elimination of the long-standing Public Health Traineeship and Health Career Opportunities programs which build the nations' cadre of public health workers.

The Prevention Trust, established through the ACA, has been consistently raided since its inception. The Prevention and Public Health Fund was slashed by 37% by the 2012 deficit reductions bill. What was to have been a $2 Billion a year infusion to shore up the nation's public health efforts over the coming decade is now a shadow of what was originally intended. The defunding of Public Health Training Centers (PHTC) is an example of misguided fiscal prioritization strategies. The explanation given was that such traineeships are subsumed under STEM funding, which in fact only includes medicine, nursing and clinical domains and not public health. The PHTCs have traditionally played a very important role by providing practitioners on the frontline to enrich and replenish their skills through programs offered to them by academic centers at no or very low cost.

If anything, an evidence-focused response would indicate the necessity ofexpanding the resources available for training the public health workforce in our country, not eliminating them given that we spend a comparatively small amount on prevention now.

One reason these cuts are occurring is that policy makers fail to make an appropriate distinction between personal medical care services versus programs aimed at the population as a whole, wherein "the population" is the "the patient." If the American public sits idly by while these cuts occur, we will all pay an enormous price with needlessly lost lives and money.

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