The nature of public health after reform

Many of the pressures now building to reform the American health care system can be traced to an unfortunate fragmentation of the health professions, notably between medicine and public health. Medicine has advanced strikingly in its curative potential in recent decades, but for that very reason has fallen prey to hubris, as technology has outpaced overall strategies of care. Public health offers counterbalance to this effect in that it stresses a population-based perspective on medical care and underscores the importance of prevention in any rational, comprehensive system devoted to the health of the public. Critical elements that must be factored into any major restructuring of the present costly health care arrangements include provision for universal access, enhancement of preventive and primary care capabilities, and education of the public about their health status and its maintenance in such ways that they can become informed collaborators in their overall care. Enhanced appreciation of behavioral cofactors in the etiology of many diseases will play an important role in that education of the public, but it must be achieved in ways that are nonjudgmental lest it be counterproductive to the overall goals of prevention and compassionate care.