Public Health  5/96

Public health has been defined as the art and science of preventing disease, prolonging life, and promoting physical and mental well being. Among the general populace, there emerged a recognition of the importance of organized community effort in public health.

There are more than 100,000 voluntary agencies in the health field functioning mostly at the local level but also at state and national levels. These agencies are supported largely through private sources and contribute or provide programs in education, research, and health services.

The approach to and understanding of public health has changed from century to century and, more recently, from year to year. In early societies as the knowledge of sources and modes of infection increased, governments attempted to control the environmental factors in public water, milk and other foods.

In our century efforts were directed towards welfare of mothers and children, the aged, the handicapped, mental illness, and the control of infectious disease. Public health changed its emphasis to preventive measures such as immunization and case finding and treatment in tuberculosis and venereal diseases. These were totally curable until the advent of AIDS. Public health principles could not be implemented in AIDS. Many practitioners felt that it would have been even more important to use standard public health techniques to find and isolate contacts in an incurable disease such as AIDS.

The US Public Health Service is the principle health agency at the national level. It works with state agencies and other countries on international health matters.

In a number of countries there has been a recognition of the inadequacies of personal medical care and increased emphasis on more accessible, efficient, and effective forms of medical care. The full range of health services -- promotive, preventive, curative, and rehabilitative -- is now seen as inseparable. There is increasing emphasis on integrating these sectors into comprehensive health-service systems aimed at both individuals and communities.

This has caused tensions throughout our larger medical and political community as forces have emerged to address this integration. At our recent society board retreat, "Ethical Issues in Managed Care: Guidelines for Clinicians..." was discussed. The Midwest Bioethics Center developed this project involving physicians, nurses, consumers, and managed care organizations. This task force agreed on 15 basic assumptions. The first was that every person is equally entitled to basic health care.

In the discussion, one physician asked why health care should be considered a basic guaranteed right, when, with perhaps the exception of food, we don't consider shelter or clothing as a basic right. Another pointed out that unless we provide to everyone basic health care such as immunizations and treatment of infectious diseases, it will impact on the rest of us and jeopardize our lives. Is basic health care now replacing public health care?

The state of Oregon has determined basic health care by enumerating those diagnosis and treatments that are considered a right while others will not be provided to everyone. Should our Society be the impetus for CMA to evaluate and develop such a project for California? Our society is involved in the SPIRIT program. Should our Society provide some basic services and be the continuing agency for the SPIRIT project? There was considerable interest in community projects at this meeting. Should our society be involved in other public health measures such as immunizations?

As this debate for greater involvement in service to our community continues, perhaps this altruism will again be our unifying force, as the members of the profession again realize that the members of our medical society are at the center of important health issues.