The avian-influenza threat should terrify us, not merely because we remain woefully unprepared to meet it, but also because it reveals a vastly larger problem: the lack of a robust public-health infrastructure in the United States.
Not only can we not, at present, deal with a flu pandemic, but we cannot effectively face any major health crisis. Even in the absence of crisis, we have been unable to provide regular health care for millions of Americans.
Why is it that we find ourselves so surprised and ill-equipped for the expected flu pandemic?
No doubt, the reasons are many, including a deep tradition of individualism and longstanding opposition to single-payer, universal health care. Additionally, when public-health measures work, few people notice. As long as the water supply is clean and disease outbreaks are prevented or stemmed, we do not sense the effectiveness of funds spent to protect the public’s health.
Beyond clean water and infectious diseases, public health deals with such matters as sanitation, food safety, workplace health and safety, chronic-disease care, environmental health, and vaccination programs. Altogether, according to the Centers for Disease Control, public-health measures have been responsible for extending the average lifespan of Americans by 25 years in the last century!
Public health might not be as technologically exciting as the latest surgical technique or piece of medical equipment, but seemingly invisible public-health practitioners contribute significantly to protecting and improving our health.
Given the great achievements of public health, we ought to fund it much better than we currently do. True, when we see a potential health threat, such as bioterrorism, we shift resources in that direction _ but sometimes at the expense of more immediate and more likely health problems, such as annual influenza outbreaks.
Our response to the likely if unknown possibility of an influenza pandemic reminiscent of the 1918 one should not be a temporary shifting or allocation of resources, focused only on medicines for this particular disease. Rather, we should take the opportunity to examine and build a comprehensive public-health infrastructure, with disease-surveillance systems and emergency resources. We should invest much more money in preventive care. Such funds save many times their initial investment in the long run.
Furthermore, we should work to build a system in which the health care of all Americans would be provided for, and the personnel and logistical infrastructure would be in place to deal with any health-care crisis.
Christopher Koller, now Rhode Island’s first health-insurance commissioner, noted at the Rhode Island Public Health Association’s 2004 annual meeting that we cannot fix our health-care system because we do not truly have a health-care system. What do we have instead? A medical-care delivery system.
We can see that if our current system does not secure our health, if it leaves millions without insurance and basic care, if it places us at risk of a flu pandemic and other health crises, it is not because the system is not working _ indeed, it is working fine, because it is not designed to provide these things.
Instead, we have a system that is quite effective at delivering expensive, technologically-sophisticated services, medications and medical devices to at least to a large segment of the population.
Our system is simply not structured to protect our health, either for individuals or the population. Our medical-care delivery system has its problems, but we ought not to fix it. Rather, we should consider what values and goods we would want out of a health-care system and reorient our resources to build such a system.
As a nation, we do need to better prepare for the possibility of a flu pandemic. Yet, we should not focus too narrowly on this one looming crisis.
We ought to take this as a challenge and an opportunity to assess what we have, imagine what we could create, set ambitious but realizable goals, and start building a genuine and strong public-health infrastructure and health-care system.
(Alan Krinsky is a clinical-research associate in pediatric oncology and is completing his master’s degree in public health at Brown University.)
