Public health leaders hope for renewed health agenda under new administration: Health outlook
=============================================================================================

* Teddi Dineley Johnson

With the dawn of both a new presidential administration and Congress, public health leaders across the nation are setting priorities and making recommendations for ways to improve the health of Americans. Health advocates are calling on new leaders to recognize the importance of health in all policies and to reframe health discussions beyond the traditional focus on care.

With health a key message in President-elect Barack Obama’s campaign, there is great anticipation for reforming the U.S. health system and rectifying some of the decisions that have been harmful to public health in recent years.

“This is a very exciting time for America,” said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E). “We have a real opportunity to make an impact on the health of our nation.”

In light of the U.S. economy, the biggest obstacle in the way of every public health leader’s wish list is money. Still, the prevailing sentiment is hope, even though public health experts agree that in the first year of the new administration, funding increases for domestic programs will be lean. Health leaders’ long-term public health goals include investing in federal agencies that provide protection and prevention activities for the American public, including the Health Resources and Services Administration and Centers for Disease Control and Prevention.

Myriad issues need to be addressed quickly, Benjamin said, including the uninsured, Medicare, substance abuse, mental illness, climate change, prenatal care, HIV/AIDS and prevention that addresses and reduces chronic disease. Another top priority is the reauthorization of the State Children’s Health Insurance Program, he said. The troubled U.S. economy could drive more demand for programs such as Medicaid and SCHIP, noted Benjamin, so it is especially important that such programs are supported.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/38/10/1.2/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/38/10/1.2/F1)

Health leaders are hoping Obama’s campaign focus on health will continue once he takes office in January.

Photo courtesy Barack Obama/Flickr

Calling SCHIP “unfinished business from the Bush administration,” Kathleen Stoll, deputy executive director of Families USA, noted that the new Congress will likely move quickly, “without perhaps a lot of controversy,” to pass reauthorization legislation.

“It could even be part of an economic stimulus package,” said Stoll, adding that the reauthorization of SCHIP is a critical investment in child health. Congress created SCHIP in 1997 to provide health insurance to children who live in families with incomes that are too high for the eligibility requirements of Medicaid but often too low to afford private health insurance. More than 7 million children were enrolled in the program in 2007, a 5.9 percent increase from the previous year. In 2007, Congress extended the program until 2009, but advocates are hoping for a more long-term program reauthorization that would expand SCHIP’s reach to about 4 million more uninsured children.

The reauthorization of SCHIP “is important to our economy and will create momentum for further health care reform,” Stoll said. “There is a real sense that stakeholders across the spectrum, what we sometimes call ‘strange bedfellows,’ are talking to each other in serious ways with a serious commitment to finding a compromise in which everyone can feel a little pain and a lot of joy, and move forward with real health care reform.”

The health issues that need to be addressed by Obama’s administration and the next Congress are many and complex, said Jeff Levi, PhD, executive director of Trust for America’s Health, which in October released a blueprint that it hopes will help the new administration and Congress improve the health of Americans.

“If I had to pick three (priorities), the first would be to develop a government-wide prevention plan that clearly charges every agency of the federal government to make sure that everything they do promotes health,” said Levi, an APHA member. “Second would be to develop a dedicated funding stream for public health, so that, just as with entitlement programs, we would have a guarantee of funding for public health on a year- to-year basis. Third would be in the context of health reform — that community-based prevention be given the same level of attention as other forms of prevention.”

Levi also urged the new Congress to repeal a 20-year-old ban on federal funding for needle exchange programs.

Studies have shown that needle exchange programs help stem the rate of infection from HIV/AIDS and other diseases among drug users who might otherwise share dirty needles. Moreover, such programs bring intravenous drug users to facilities where social services and medical treatment is available to them. According to CDC, as of November 2007, close to 200 locally funded needle exchange programs were operating in 36 states, the District of Columbia and Puerto Rico.

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/38/10/1.2/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/38/10/1.2/F2)

AIDS activists rally in Washington, D.C., Nov. 20 to challenge President-elect Barack Obama to put an end to the AIDS epidemic through prevention programs and other measures.

Photo by Chip Somodevilla, courtesy Getty Images

Retaining the ban on federal funding for needle exchange programs is “bad public health,” Levi said.

Looking at the big picture, APHA member Robert M. Pestronk, MPH, executive director of the National Association of County and City Health Officials, told *The Nation’s Health* he is expecting the new administration to take a more comprehensive approach to ensuring the nation’s health.

The new administration should invite representatives from local health departments to participate with their federal counterparts when health decisions and recommendations are being formed, said Pestronk. He also called for greater attention to the success local health departments have had improving health status as well as more flexibility allowing departments to tailor funding to the specific needs of their communities. And he echoed the sentiment of colleagues across public health of the need to take full advantage of health information technology to track disease.

As leaders work toward fixing the nation’s health woes, other areas of emphasis should include a greater focus on the crisis of an aging public health work force, said Pestronk, noting that scholarships and loan repayment programs should be made available to a range of public health professionals to attract more young talent.

For Stacie Propst, PhD, vice president of science, policy and outreach at Research!America, research to prevent disease and improve health is “absolutely critical” to every discussion related to improving the health of Americans that will occur under the new Obama administration.

“Research weaves its way through health,” she said, pointing to the study of embryonic stem cells, a debate she believes will be resolved by executive order. Propst noted that Research!America’s last national poll showed that most Americans support federal funding of stem cell research, despite a ban by President Bush on such use of funding.

Paul E. Jarris, MD, MBA, executive director of the Association of State and Territorial Health Officials, said one of his top priorities for the new administration to address is funding for the federal Preventive Health and Health Services Block Grant, which states depend on to design and tailor prevention and promotion programs around their unique needs. Moreover, Jarris expressed concern about funding for state and local pandemic influenza and biopreparedness programs and called on the Obama administration to earmark funds to support a robust public health system that will help ensure the nation’s safety in the event of a natural or manmade disaster.

Like other health leaders, Jarris said he would like to see the debate reframed from “health insurance” and “health care” to simply “health.”

“We have framed the problem far too narrowly,” said Jarris, an APHA member. “We spend 16 percent of our gross domestic product on health care, about double that of most major industrialized nations, and yet ranking after ranking shows the health status of the people of the United States is among the lowest of the industrialized nations.”

Noting that 45.7 million people in the United States were without health insurance in 2007, APHA’s Benjamin said uninsurance will continue to be a serious issue for the new administration and Congress. The nation’s growing economic problems and continuing health inequalities also demonstrate that it is now more important than ever to revamp the nation’s health system, he said.

“We have to talk about it as ‘health,’ and not as ‘health care reform,’ because the issues are obviously going to be about more than just getting an insurance card,” Benjamin said. “Getting an insurance card, but having no access, doesn’t do people a lot of good.”

## Focus on health system reform a welcome one for health leaders

One of the key issues President-elect Barack Obama has pledged to address during his term is one that has been of high importance to health leaders for decades: reform of the U.S health system.

During his campaign, Obama frequently focused on his plans for health system reform, making a promise to sign a universal health care plan into law by the end of his first term. Obama pledged to focus the U.S. health system on prevention, reduce health insurance costs for businesses, improve quality of care and, above all, make health insurance accessible for all.

In December, Tom Daschle, leader of Obama’s Transition Health Policy Team, announced plans to hold community discussions nationwide that month to “help flesh out key issues around health policy.”

Obama is expected to work closely with Congress on health reform, and legislators on Capitol Hill wasted no time after the November election to take up his challenge. On Nov. 18, Sen. Edward Kennedy, D.-Mass., announced the creation of three Senate working groups that will work toward a comprehensive health reform bill. The groups will focus on prevention and public health, improvements in the quality of care, and insurance coverage.

The Kennedy announcement came less than a week after Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, released a blueprint for health reform, calling for achieving universal coverage, reducing health care costs and improving quality of care.

APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E), praised the intensified congressional focus on health system reform, noting that prevention and public health should serve as its foundation.

“We must make sure that any discussion of health reform includes a focus on community-based prevention along with clinical and other preventive services, as well as a dedication to supporting our nation’s public health system,” Benjamin said Nov. 12.

The push to reform the U.S. health system is in step with the desires of the majority of Americans, according to recent polls on the issue. An Oct. 21 poll from the Kaiser Family Foundation found that 62 percent of American voters believe that in light of U.S. economic challenges “it is more important than ever to take on health reform.”

According to APHA members, the most important public health provision to consider as part of health system reform is universal health coverage, followed by comprehensive health benefits, and education and training of health workers, an October Association survey found. APHA members also said they’d like to see the Association advocate on health reform, with an emphasis on universal coverage, preventive services and health equity.

With a new presidential administration that is open to change, now is the time to cooperatively take on such issues, according to health leaders such as former U.S. Surgeon General David Satcher, PhD, MD. Speaking at the APHA 136th Annual Meeting closing session in October, Satcher predicted that “we have the best opportunity that we’ve had in a long time to really reform the health system in this country.”

“Clearly, our public health system is not working,” Satcher said. “It’s not responding to the best public health science. We should not rest until it does.”

— Michele Late

*   Copyright The Nation’s Health, American Public Health Association