Back in 2010, the Connecticut Association of Directors of Health, the professional association for the state’s 74 local governmental public health directors, created its Ad Hoc Workgroup on Health Reform. I am the staff member who supports that workgroup, and since its inception, we have been on the long journey of understanding the place of public health in an ever-changing health care system.
The mantra of public health is “prevent, promote, protect,” or more specifically, to prevent disease outbreaks, promote policies that support health, and protect the public from public health emergencies and health risks. To consider it another way: public health is about the biggest bang for the buck; because keeping people healthy is cheaper than making people healthy who are already sick.
Accordingly, the Affordable Care Act (ACA) created the Prevention and Public Health Fund, the nation’s first mandatory funding stream dedicated to improving the nation’s public health. Its intended uses were initially vast, ranging from making healthier food more accessible to promoting road redesign to make walking to school safer and more appealing.
But that fund has been pillaged—repeatedly—and ironically to continue investing in the health care system. It’s a little like taking materials from a dam to build a house on stilts: you may protect an individual house from flooding in the short-term, but you put a whole community of homes at risk in the long-term.
With soon-to-be-increased enrollment in health insurance and an already overburdened primary health care system, here’s what a well-funded local governmental public health system can do:
- Provide preventive health services. Many local health department already provide preventive health services—like vaccinations and blood pressure screenings—efficiently, cheaply and a broad scale. Stunningly, most insurers do not recognize local health departments as providers, but that’s slowly changing. Universal reimbursement for preventive health services would allow more robust delivery of these services and allow health departments to make additional investments in community health.
- Create locally-tailored programs to promote healthy living. Local health departments can assess the specific needs of their communities by conducting community health needs assessments, accessing data from CADH’s Health Equity Index, and using other analytic tools. ACA funding, via community transformation grants and other vehicles, supports the creation of community-specific programs to promote social cohesion, physical activity, and other health-promoting conditions.
- Design and implement local policies that promote health and health equity. It’s not just individual-level factors—like genetics, individual behaviors, and access to medical services—that make a community healthy. In fact, at least half of all health outcomes may be driven by community conditions—social, political, economic and environmental—which are also call “social determinants of health.” Appropriate funding allows local health departments to generate policy and practice recommendations, solutions and strategies to meaningfully promote health and health equity for all Connecticut residents.
The changes and challenges presented by health reform are like a flood. Rather than continuing to build individual houses on stilts, let’s invest in the dam needed to safeguard the health of the whole community.
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