ACP advocates for strengthening public health infrastructure

The American College of Physicians (ACP) released on April 20 a policy paper that calls for improvements to the U.S. public health system.

“This paper points out that strengthening the public health infrastructure is imperative to ensure that the appropriate healthcare services are available to meet the population’s healthcare needs and to respond to public health emergencies,” said Virginia Hood, MBBS, MPH, MACP, president of ACP in a prepared statement. "A strong public health infrastructure provides the capacity to prepare for and respond to both acute and chronic threats to the nation’s health, yet ill-advised budget cuts at the federal, state and local levels pose a grave threat to the health of U.S. residents."

The paper recognizes that the current tight budget environment requires that funding be prioritized. It also states that the consequences of underfunding essential and effective programs that prevent diseases and promote good health “would be an unwise, and ultimately very costly, use of limited resources." The paper recommends that funding priority be based on assessment of which programs have demonstrated effectiveness in achieving key public health objectives.

“We need better coordination and less fragmentation of public health agencies, which could achieve savings by eliminating duplication and costs associated with inefficient sharing of information and resources,” said Hood.

Hood delivered her remarks at a press briefing during Internal Medicine 2012, ACP’s annual scientific meeting attended by more than 6,200 physicians in New Orleans. She commented on the significance of the locale: “New Orleans, of all cities, knows how critically important it is for communities to be prepared for the consequences of natural or human-made disasters. Yet federal funds for state and local preparedness have declined by 38 percent from fiscal year 2005 to 2012, adjusted for inflation. Let’s hope that it doesn’t take another Katrina to remind people that reducing funding to ensure that hospitals and physicians are prepared – and have the capacity to deal with a major emergency affecting an entire population – is an extraordinarily ill-sighted and dangerous policy.”

ACP presented the following seven public policy positions:

  • Position 1. ACP supports investing in the nation’s public health infrastructure. Priority funding should be given to federal, state, tribal and local agencies that serve to ensure that the health care system is capable of assessing and responding to public health needs. ACP is greatly concerned that recent and proposed reductions in funding for agencies responsible for public health are posing a grave risk to the United States’ ability to ensure the safety of food and drugs, protect the public from environmental and infectious health risks, prepare for natural disasters and bioterrorism, and provide access to care for underserved populations.
  • Position 2. In the current economic environment, it is particularly important that federal, state, tribal and local agencies prioritize and appropriately allocate funding to programs that have the greatest need for funding and the greatest potential benefit to the public’s health. All programs that receive funding should be required to provide an ongoing assessment of their effectiveness in improving population health. ACP recommends that priority for funding be given to programs based on their effectiveness in improving the health of the public.
  • Position 3. Having a healthcare workforce that is appropriately educated and trained in public health-related competencies is essential to meet the nation’s healthcare needs. The education and training of sufficient numbers of physicians, nurses, allied health personnel, clinical scientists, health services researchers, public health laboratorians and public health practitioners is an important part of the public health infrastructure. Accordingly, priority funding should be devoted to educational and training programs that prepare physicians, nurses and allied health personnel that are in short supply and that help meet the healthcare needs of underserved populations.
  • Position 4. The public health workforce should educate the public on new healthcare delivery models and the importance of primary care. It is also important for the public health sector to promote the need to have a doctor or health center so care can be better coordinated.
  • Position 5. To address current and looming pharmaceutical therapies and vaccine shortages, the federal government should work with pharmaceutical companies to ensure that there is an adequate supply of pharmaceutical therapies and vaccines to protect and treat the U.S. population.
  • Position 6. Programs to inform the public of the benefit of vaccinations for children, adolescents and adults, to counter misinformation about the risks of vaccinations, and to encourage increased vaccination rates, particularly for vulnerable populations, are especially important for the health of the population. Evidence-based educational strategies should be used to influence behavior and increase vaccination rates.
  • Position 7. ACP encourages the development and implementation of a comprehensive, nationwide public health informatics infrastructure, sharable by all public health stakeholders. This will require significant investments in new and improved technologies, standards, methodologies, human resources and education.

Karen DeSalvo, MD, MPH, an internist in New Orleans who serves as the city’s health commissioner, commented, “The traditional role of public health departments at any level of government is changing. It’s moving out of a direct-delivery service model and into a broader focus on the population’s health and public health about those highly important, winnable battles with chronic diseases and the causes thereof, like obesity and smoking, but also some of the challenges in healthcare access and disparities in care.”


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