BLOOMINGTON, Ind. — The new Affordable Care Act provides both short- and long-term plans for health improvement. Its success depends on full implementation of short-term health insurance access and long-term public health elements.
Public health is the act's long-term game plan to improve health and reduce cost, because it addresses the determinants of health — those conditions that make us well or sick.
Without public health systems and programs, our sick care system will continue to grow in size and cost. This point should not be lost during our current debate on the impact of budget cuts.
ACA's short-term game plan expands health insurance access using public and market mechanisms. Important patient protections and incentives for preventive health screenings will identify leading causes of illness and death. This will lead to early and manageable treatment, resulting in healthier populations and reduced health system costs associated with late diagnosis.
Our short-term success is mediated by our system of government. States decide whether to expand insurance access for the working poor through Medicaid.
As of today, 14 states will not do so. Of note is that people in these same states have the burden of the worst health outcomes in our country. So, the jury will be out about the full extent of health benefit from reform for these Americans. Enter: the public health system.
ACA's public health system investments are historic, and bolster the safety-net health system to assure access for those estimated 24 million people who will not be granted insurance access under ACA.
Examples include community health centers, mental health centers, local health departments, family planning clinics and migrant health centers.
While health-care access is an important determinant of health, it is by far not the only one.
Let's face it. We're overweight or obese. We smoke. We eat food about which we know little, and we are sedentary.
Reducing our weight, eating well, stopping smoking and increasing activity would significantly reduce our chronic health conditions, lead to more productive lives and reduce the need for sick care.
The job of the public health system is to make these life changes easier by addressing the environmental, policy, social, community and behavioral conditions that must change in order to make healthier behaviors possible and easier.
The ACA provides unprecedented support for public health because it is the only reform component focusing on reducing demand for health care by addressing the determinants of health.
This public health game plan, however, is less certain because of our historic tenuous relationship with public health investment.
Congress threatens to eliminate the Prevention and Public Health Fund that provides grants to states and communities to reduce chronic disease, improve nutrition and increase physical activity.
The fund also strengthens the primary care safety net, prevention research centers, public health workforce, laboratory infrastructure, breast and cervical cancer screening and all the other safety-net and preventive activities that sustain population health and reduce system cost. We lose the Prevention and Public Health Fund, and we lose the health game in the long run.
Health insurance access is part of our health, but it alone cannot go the distance to assure health for all populations. Public health's preventive, systems approach to health determinants will help us win the long race toward health.
The vision of ACA — with both short and long-term game plans — will usher in the reforms America needs. We must fully invest to benefit.
Beth Myerson is an assistant professor at the Indiana University School of Public Health and national policy director of Cervical Cancer-Free America.
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