America’s Public Health System ‘Fragmented’ and ‘Inadequate,’ Opinion Pieces State

The "national commitment to an effective public health system" has been on the decline for the past 50 years, leaving the nation's public health institutions "programed to fail" as evidenced by the recent anthrax scare, Gregg Bloche and Lawrence Gostin, who teach health law and policy at Georgetown and Johns Hopkins universities, write in an opinion piece for the Los Angeles Times. Sanitation advances in the early 20th century and the "antibiotic revolution" in the 1940s prompted Americans to think that the "age old struggle against contagion ... ended in triumph." Subsequently, the American view of health shifted from "grand scale ... population-wide ... threats," to a "private" view with "patient autonomy as the central principle." The "unsurprising result" has been a lack of political support for "strong public health programs and institutions," leaving the system "ill-funded, fragmented, highly respectful of personal choice and unprepared for a national coordinated response to crisis." Now, the "profoundly flawed [public health] system" includes "antiquated laws" that prohibit data sharing between public health and law enforcement agencies and policies that fail to provide sufficient power to control "property and persons in the event of bioterrorism." While medical technologies are "sufficient to cope with ... [current] threats," Bloche and Gostin conclude: "The challenge ahead is a matter of organization and resources -- and willingness to see the virtues of personal autonomy against the larger backdrop of the common good" (Bloche/Gostin, Los Angeles Times, 11/4).

Local Infrastructures Lacking
State and local health departments lack the workforce and infrastructure to respond to a public health crisis and should be accredited in ways similar to health care organizations, Eli Capilouto, a professor at the University of Alabama at Birmingham's School of Public Health, writes in a Washington Post opinion piece. Currently, local health departments are "unequal in the ability to respond" to a public health crisis. The funding of public health departments is primarily a state responsibility, Capilouto writes, so budget cuts left "different kind[s] of gaps in departments' ability to handle run-of-the-mill concerns and potential crises." In addition, many health department employees, including those in leadership positions, "lack formal training in public health." To remedy this situation, Capilouto says that the nation must "rapidly" develop a system with "persuasive federal incentives" to encourage the accreditation of state and local health departments by an organization similar to the Joint Commission of Accreditation of Healthcare Organizations that would be "overseen" by the CDC. Such a system would require "more financial support" for the public health sector than currently exists, but accreditation would "push" the public health system from "institutional mediocrity to institutional excellence and reduce the vulnerabilities that threaten our very way of life" (Capilouto, Washington Post, 11/4).