"This paper points out that strengthening the public health infrastructure is imperative to ensure that the appropriate health care services are available to meet the population's health care needs and to respond to public health emergencies," said Virginia L. Hood, MBBS, MPH, MACP, president of ACP. "A strong public health infrastructure provides the capacity to prepare for and respond to both acute and chronic threats to the nation's health, yet ill-advised budget cuts at the federal, state and local levels pose a grave threat to the health of U.S. residents."
ACP's paper makes the case for adequate investments in public health, which is the practice of preventing diseases and promoting good health within groups of people. Public health depends on an underlying foundation, or infrastructure, to support the planning, delivery, and evaluation of public health activities and practices. Public health works to protect and improve the health of communities through education, policy development, promotion of healthy lifestyles, and research. It concentrates on the health of the population, rather than care of the individual patient, although these are becoming more intertwined as non-communicable diseases are becoming a priority focus for both population and patient-directed care.
The paper calls for adequate funding for the public health infrastructure, but recognizes that the tight budget environment requires that funding be prioritized. It makes the case that the consequences of underfunding essential and effective programs that prevent diseases and promote good health within groups of people would be an unwise, and ultimately very costly, use of limited resources. The paper recommends that funding priority be based on assessment of which programs have demonstrated effectiveness in achieving key public health objectives.
"ACP recognizes that funding for public health programs should be based on evidence that a particular program is effective in achieving better health outcomes for the population ," noted Dr. Hood. "Earlier this year, ACP provided Congress with recommendations to achieve hundreds of billions of dollars in federal health care savings while ensuring adequate funding of critical programs - including public health.
"We need better coordination and less fragmentation of public health agencies, which could achieve savings by eliminating duplication and costs associated with inefficient sharing of information and resources," concluded Dr. Hood.
To strengthen the public health infrastructure, ACP presents seven public policy positions:
- Position 1: ACP supports investing in the nation's public health infrastructure. Priority funding should be given to federal, state, tribal, and local agencies that serve to ensure that the health care system is capable of assessing and responding to public health needs. ACP is greatly concerned that recent and proposed reductions in funding for agencies responsible for public health are posing a grave risk to the United States' ability to ensure the safety of food and drugs, protect the public from environmental and infectious health risks, prepare for natural disasters and bioterrorism, and provide access to care for underserved populations.
- Position 2: In the current economic environment, it is particularly important that federal, state, tribal, and local agencies prioritize and appropriately allocate funding to programs that have the greatest need for funding and the greatest potential benefit to the public's health. All programs that receive funding should be required to provide an ongoing assessment of their effectiveness in improving population health. ACP recommends that priority for funding be given to programs based on their effectiveness in improving the health of the public.
- Position 3: Having a health care workforce that is appropriately educated and trained in public health related competencies is essential to meet the nation's health care needs. The education and training of sufficient numbers of physicians, nurses, allied health personnel, clinical scientists, health services researchers, public health laboratorians, and public health practitioners is an important part of the public health infrastructure. Accordingly, priority funding should be devoted to educational and training programs that prepare physicians, nurses, and allied health personnel that are in short supply and that help meet the health care needs of underserved populations.
- Position 4: The public health workforce should educate the public on new health care delivery models and the importance of primary care. It is also important for the public health sector to promote the need to have a doctor or health center so care can be better coordinated.
- Position 5: To address current and looming pharmaceutical therapies and vaccine shortages, the federal government should work with pharmaceutical companies to ensure that there is an adequate supply of pharmaceutical therapies and vaccines to protect and treat the U.S. population.
- Position 6: Programs to inform the public of the benefit of vaccinations for children, adolescents and adults, to counter misinformation about the risks of vaccinations, and to encourage increased vaccination rates, particularly for vulnerable populations, are especially important for the health of the population. Evidence-based educational strategies should be used to influence behavior and increase vaccination rates.
- Position 7: ACP encourages the development and implementation of a comprehensive, nation-wide public health informatics infrastructure, sharable by all public health stakeholders. This will require significant investments in new and improved technologies, standards, methodologies, human resources, and education.