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Investing in Public Health

Today's Wall Street Journal has an article about the oft quoted World Health Organization statistic that the US ranks 37th in the world in health care.  I very much agree that the WHO ranking has flaws and makes many assumptions (as do all composite statistics that try to aggregate insanely large amounts of information).  The article correctly points out if you don't adjust the ranking for the amount of money spent per captia, the US actually ranks 15th.  15th is certainly better than 37th, but I wouldn't go patting ourselves on the back just yet.

The second half of the WSJ article also correctly points out that the flawed WHO report shouldn't obscure the fact that the U.S. is lagging in some major barometers of public health. For instance, the U.S. slipped from 18th to 24th in male life expectancy from 2000 to 2009, according to the United Nations, and from 28th to 35th in female life expectancy. Its rankings in preventing male and female under-5 mortality also fell, and placed the US in the 30s.  These sad and embarrassing stats won't be improved with impressive medical degrees, expensive health care technology or the latest designer biologic.  Investing in the US's public health infrastructure is crucial to improving these scores.

This bring us back to the health reform legislation that is getting ever so close to being voted on in the House and Senate.  The various pieces of legislation moving through Congress have the largest investment in the public health system in history.  Specifically, the legislation establishes a public health investment fund and deposits a total of $89 billion for use over the next ten years (FY 2010 – FY 2019).  $38 billion of those dollars are appropriated to Community Health Centers to build up the public health infrastructure.

Additionally, the House legislation establishes a public health workforce corps at HRSA to address public health workforce shortages. Modeled on the National Health Service Corps, the program provides scholarships and loan repayment support for public health professionals serving in areas of need.

There is also a major investment in prevention and wellness in both the Senate and House health reform bills.  It establishes a Prevention and Wellness Trust that authorizes  a Prevention Task Force, Prevention and Wellness Research, Delivery of Community-Based Prevention and Wellness Services and Core Public Health Infrastructure and Activities.

These provision are necessary first steps to establishing a true public health system.  I am glad that Congress is thinking beyond the hospital and clinic walls to improve the health of our nation.

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