October 20, 2013
Most of us learn at a very young age what “medical doctor” means. Far fewer of us learn what “public health” means. Our nation’s public health system functions largely as a backdrop to promote the well-being of all of us in the U.S. As a member of the Institute of Medicine–IOM–committee that wrote the report, “Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century,” [http://www.iom.edu/Reports/2002/Who-Will-Keep-the-Public-Healthy-Educating-Public-Health-Professionals-for-the-21st-Century.aspx] this reality emerged time and again, as we discussed and debated the roles that the public health force play.
I often teach Korean and Chinese graduate students who look to the U.S. for a model for public health and how to organize and deliver it in their countries where policies are newer and emerging.We tend to take for granted that someone has inspected the safety and health of restaurants where we eat, the meat and produce that we buy to consume, and the water quality coming into our work sites and homes. These “luxuries” sometimes become more salient when we visit outside the boundaries of the U.S. In reality, these illustrate ways that our health is being safeguarded, not only for our individual well-being but for the health of all of us–with inoculations required for public school one of the most recognized acts taken for this aim.
The public good is served when actions are taken to protect and promote the health of each one of us as individuals in order to reduce the likelihood that any one of us will contribute to the illness of others and/or incur costs linked to the poor health of others. This principle frames some of the actions taken as part of the Affordable Care Act but has not been emphasized or clearly explained.
October 10, 2013.
Political discourse related to naming access to health care as a priority shows expansion to the underserved and needy during the era of the Great Society, when Presidents Kennedy and Johnson expanded the social welfare and services system. During this era, the arguments in support of an economic model to support the government’s role in health and health care extended well beyond the need to keep a work force healthy. They included powerless groups, such as the elderly, who needed government assistance. They also included migrant farmworkers who harvest much of the nation’s food but often lack access to health care. Edward Murrow first exposed the conditions in which these laborers exist in the documentary, “Harvest of Shame.”
My first doctoral student to complete her degree as my advisee told me about her mother’s labors in harvesting the nation’s crops in the fields of California. Her mother died at a young age from cancer likely the result of pesticide exposure during those long hours of harvesting.
From a social justice side, it seems only fair to provide care to the nation’s harvesters of food. When that assertion did not work, evidence that a harvester’s poor health and poor sanitation habits–failure to wash hands, for example–could contaminate the food supply was brought forth. This argument relates to public health and the public good, such that safeguarding the health of those who harvest our food benefits everyone’s health. Too little discussed in conversations about affordable health care are the issues related to public health and the public good.
September 6, 2013
The news often tells us something about the quality of our food. It may be a story about salmonella and chicken. Or it may be about a recall based on something being in a food that should not be there–perhaps due to defective equipment in a processing plant or two foods getting mixed together or peanuts being present when they should not have been. These stories help us select healthy food and should make us realize how much is done to keep our food safe. One of the more recent policies relating to our food safety is explained at http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm247559.htm and makes clear that illness from food remains a big problem. With one in six of us becoming ill from foodborne illness, more than 120,000 hospitalizations, and about 3,000 deaths each year–we should all be aware of what we can do to stay safe and what the modernization act does to make it more likely.