This week, healthcare reform took on a quintessentially American character with the availability of none other than a toll-free hotline to acquire information on how to navigate the newfound exchanges. I must admit that I was skeptical at first, but after dialing 1-800-318-2596, I was immediately welcomed by an automated message to “the new health insurance marketplace.” Some states, like California and Maryland, are operating their own exchanges and also have call centers open to the general public. Enrollment will begin October 1st and every state must offer insurance by way of a state-run exchange, a partnership with the federal government, or otherwise delegate it to the latter to ensure compliance with the January 1, 2014 deadline. This flurry of activity makes for good headlines but is also timely for our reflections on how entangled our public health and healthcare priorities have become under the sweeping—and at times, misleading—label of “health insurance.”
Words matter. Almost a century ago (April 18, 1919 to be exact), B.S. Warren, the Assistant Surgeon General, and Edgar Sydenstricker, the Public Health Statistician, of the U.S. Public Health Service published a commentary in the now famous ‘Public Health Reports’ that focused on the ‘health insurance, the medical profession, and the public health.’Public Health Reports, Vol. 34, No. 16 (April 18, 1919) They remind us that “health insurance” was formerly termed ‘sickness insurance,’ a method by which the economic loss caused by sickness is distributed among a group of persons. In other words, it was what we have come to know as health or healthcare insurance in common parlance. But for Warren and Sydenstricker, this was inadequate, for:
“proposals for governmental health insurance…not only adopt the principles just mentioned [relating to sickness insurance], but include…provisions for rendering the health insurance system an aid to disease prevention...by linking the health-insurance system to the existing public health agencies. In this sense, ‘sickness insurance,’ it is believed, would become a real health measure.”
History teaches us that interdisciplinary teams and collaborations among the public and private sectors are not new, but we have become accustomed to thinking they are because we have failed to prioritize disease prevention as part and parcel of meaningful health reform. For the moment, let’s put aside the political issues regarding support for (or opposition to) a single payer system or whether the Affordable Care Act is simply an insurance reform bill. The take home message is that disease prevention, which is the heart of public health, has become a secondary issue in our national debate. So it is incumbent on those of us (all of us?!) who want to advance population health to remember the Institute of Medicine’s landmark report in 1988 that defined public health as what we do collectively to “assure the conditions for people to be healthy.”The Future of Public Health (January 1, 1988) And, perhaps more importantly, the IOM’s follow up report 15 years later that found that the governmental public health infrastructure had been neglected, and required a significant overhaul of components, specifically, the workforce, laboratories, and public health law.Assuring the Health of the Public in the 21st Century (November 11, 2002) This last point is particularly noteworthy because for decades, the role of law in public health was woefully undeveloped in public health scholarship and research; but thankfully, over the past decade, there has been a tremendous surge among researchers and practitioners to collaborate and tackle issues at the interface of both disciplines to advance population health. In doing so, we begin to appreciate the multitude of stakeholders and partners who must collaborate beyond the modern healthcare system to secure population health.
With this background, perhaps “health assurance” would be a more purposeful guide to lead our efforts, consistent with the IOM’s findings, and rooted in a prescient characterization 95 years ago—long before the advances of modern medicine and public health—that prevention and treatment must go hand in hand to assure the conditions for people to be healthy. So as we go forward, let’s take a tip from history and not repeat our prior mistakes.
Words matter. Almost a century ago (April 18, 1919 to be exact), B.S. Warren, the Assistant Surgeon General, and Edgar Sydenstricker, the Public Health Statistician, of the U.S. Public Health Service published a commentary in the now famous ‘Public Health Reports’ that focused on the ‘health insurance, the medical profession, and the public health.’Public Health Reports, Vol. 34, No. 16 (April 18, 1919) They remind us that “health insurance” was formerly termed ‘sickness insurance,’ a method by which the economic loss caused by sickness is distributed among a group of persons. In other words, it was what we have come to know as health or healthcare insurance in common parlance. But for Warren and Sydenstricker, this was inadequate, for:
“proposals for governmental health insurance…not only adopt the principles just mentioned [relating to sickness insurance], but include…provisions for rendering the health insurance system an aid to disease prevention...by linking the health-insurance system to the existing public health agencies. In this sense, ‘sickness insurance,’ it is believed, would become a real health measure.”
History teaches us that interdisciplinary teams and collaborations among the public and private sectors are not new, but we have become accustomed to thinking they are because we have failed to prioritize disease prevention as part and parcel of meaningful health reform. For the moment, let’s put aside the political issues regarding support for (or opposition to) a single payer system or whether the Affordable Care Act is simply an insurance reform bill. The take home message is that disease prevention, which is the heart of public health, has become a secondary issue in our national debate. So it is incumbent on those of us (all of us?!) who want to advance population health to remember the Institute of Medicine’s landmark report in 1988 that defined public health as what we do collectively to “assure the conditions for people to be healthy.”The Future of Public Health (January 1, 1988) And, perhaps more importantly, the IOM’s follow up report 15 years later that found that the governmental public health infrastructure had been neglected, and required a significant overhaul of components, specifically, the workforce, laboratories, and public health law.Assuring the Health of the Public in the 21st Century (November 11, 2002) This last point is particularly noteworthy because for decades, the role of law in public health was woefully undeveloped in public health scholarship and research; but thankfully, over the past decade, there has been a tremendous surge among researchers and practitioners to collaborate and tackle issues at the interface of both disciplines to advance population health. In doing so, we begin to appreciate the multitude of stakeholders and partners who must collaborate beyond the modern healthcare system to secure population health.
With this background, perhaps “health assurance” would be a more purposeful guide to lead our efforts, consistent with the IOM’s findings, and rooted in a prescient characterization 95 years ago—long before the advances of modern medicine and public health—that prevention and treatment must go hand in hand to assure the conditions for people to be healthy. So as we go forward, let’s take a tip from history and not repeat our prior mistakes.
