Health Care Reform and Public Health: A Paper on Population-Based Core Functions.

This article presents the necessary role of public health and population-based programs for supporting and enhancing the effectiveness of a reformed health care insurance system in the U.S. Preventive measures focused on chronic and infectious diseases and injuries provide much of the substance of these programs, but there are also core public health functions that are necessary to support and sustain efforts that address the health needs and conditions of populations, as distinct from individuals. The importance of a population-based approach is illustrated by a report, cited in a 1982 study by the Institute of Medicine, which concluded that only 10 percent of premature deaths in the U.S. could have been avoided through improvements in access to medical treatment. For health care reform to succeed, the supporting and complementary functions of public health must be enhanced. If the amount used by State and local health agencies and the U.S. Public Health Service for public health functions had maintained their proportionate position to the treatment services they support, their 1993 level would have been nearly 30 percent more than it actually is. The debate on reform of the U.S. health care system offers both mandate and opportunity to redress the erosion that has occurred in the public health infrastructure by establishing a secure and adequate funding base for the core functions of public health at every level.