Chapter 5: The Boundaries of Public Health

Much like public health at the turn of the 20th century, public health at the turn of the 21st retains much of the negative publicity of a century ago. While the practice of public health is becoming “cool” again, at least according to a New York Times article last week, the idea of the County Public Health Department is wrought with stereotype. Be it the commonly served population, who is often poor or minority, or the basic buildings in which care is provided, most people would rather not use public health, given the choice.

However, after our discussions about how to fix health care in this country for the 47 million uninsured, it occurs to me that public health might be the cure. Public health cannot provide everything for everyone. It can provide, however, the basic care that we as a group agreed should be a right. Vaccines to prevent the diseases we thought formerly eradicated, basic check-ups, neonatal care for poor mothers, eye and ear screens for children (although schools continue this practice, early detection is largely held as key to resolving and dealing with these issues), and nutrition information can all be disseminated by a public health department. Furthermore, for many people, the services provided by government are a mystery. For example, people know that food stamps are available, but the process of applying for them seems too laborious. Public health departments can also serve as a hub for more general community health.

But of course the question emerges, how do we pay for this? We pay for this the same way we provide a free, basic education for everyone- through taxes and grants and some in-kind donations. Paying for public health will cost money, but in many ways, we are already paying it. People who use Emergency Room services who have the ability to pay are already absorbing some of the costs of those who cannot pay. People who are not healthy enough to go to work impact our workforce and our productivity. Children who do not have adequate healthcare spread illness to children who do. There are so many discriminatory elements of life in this country, particularly along socio-economic lines. Although paying for public health may have a more direct cost, I believe a full cost-benefit analysis would reveal that the benefits outweigh the costs.