By Anthony Robbins & Phyllis Freeman

If our new President and the Congress accept the pervasive perception that universal access to medical services will address all important health needs, our nation will miss a magnificent opportunity to prevent disease and to hold off unnecessary medical care expenditures. Moreover, if Congress and the President do not get it right now, the door of political opportunity may not open for many years for a second chance. 

Impending health care reform could take advantage of the extensive medical services system, at little additional cost, to accomplish many previously unattainable health goals for the nation.  We could eliminate causes of disease and offer protection to all citizens.  Repeated references to “access to prevention services,” however, belie a failure to understand the difference between insuring personal health services and assuring public health gains. The distinction is a strategic one.

In 1994, just as President Clinton’s Health Care Reform was dying in the Congress, we published an article in the Journal of Public Health Policy (long before we were the editors) titled “National Health Care Reform Minus Public Health: A Formula for Failure.”  It spelled out specific steps for having the US medical care system contribute to protecting the health of the population, more than just treating people seeking care.

Medical practitioners and institutions can contribute to public health by systematically performing certain key functions: 1) detecting problems in patients that may provide early warning of health threats to others in the community and reporting these to public health authorities for investigation; 2) acting on public health alerts–based on studies of harmful exposures in the environment– to target preventive, diagnostic, and therapeutic services to members of the population at risk; and 3) being part of systematic efforts to assure that every patient receives services of high public health value, such a vaccination, even if the patient is not sufficiently aware of the risks and benefits to seek these services.

What we wrote in 1994 remains true today, thus we have posted the article on the Journal’s website.

Anthony Robbins and Phyllis Freeman are co-editors of the Journal of Public Health Policy. Dr. Robbins, a Professor of Public Health at Tufts University School of Medicine, directed the Vermont, then the Colorado state health department, and the National Institute for Occupational Safety and Health before serving as professional staff to the House Energy and Commerce Committee. Professor Freeman is Professor Emerita in Law and Public Policy at the University of Massachusetts, Boston and served as oversight counsel to the House Energy and Commerce Committee.

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