• Front page
• Receive this content on your RSS reader

This Speakout has not been edited.

Dr. Mark B. Johnson

Health-care reform is back in the news with a vengeance. Presidential candidates are putting forward major new proposals, Congress and the President are fighting over whom should insure children, and a blue-ribbon panel is studying options for the State of Colorado.

Everyone seems to be focused on what are commonly believed to be the main problems: access to medical services and runaway costs.

I believe this focus is misplaced. Using a luxury hotel as an analogy, I believe we are concentrating on who can have keys to the golden penthouse while the foundations are crumbling in ruins. Meaningful health-care reform must begin by rebuilding a strong and vibrant foundation of public health.

Your health depends more on what you eat and drink, where you live, whether or not you have a job, how often you wash your hands, whether or not you smoke, how far you got in school, and where you throw your trash than it does on high-tech surgical procedures or the newest pharmaceutical drugs. This is where public health fits in. As the Institute of Medicine has said, “The mission of public health is to fulfill society’s interest in assuring conditions in which people can be healthy.”

So how do the “conditions in which people can be healthy” relate to health-care reform? Let me explain.

Let’s say there are two children who are born on the same day but on opposite sides of the world. One is born to a mother who has carefully watched her diet throughout pregnancy and has abstained from alcohol and smoking. She lives in a village with pristine water and unpolluted air. The sewage and garbage in her village are transported far from town, where they are carefully processed and recycled. Her mother teaches her about health and personal hygiene, and makes sure there is always plenty of nutritious food, soap and toothpaste in the house.

The second child is born a bit premature and is small for his age, due to his mother’s careless diet and heavy smoking throughout her pregnancy. He grows slowly because of his frequent coughs and bouts of gastrointestinal disease, and because he shares his nutrition with the hookworms he has acquired from running barefoot in the village. The water he drinks is questionable, and the air is polluted in his home from the coal-powered stove on which his mother cooks the meager fare which she is able to find in the marketplace. Outside, the stench is almost palpable from the garbage on the streets and the cracked and leaking sewage pipes. His mother knows little about hygiene, and is too busy with her other babies to teach him what she does know.

I could go on with this exaggerated picture of extremes, but by now I think you get the message: It makes a big difference how much effort your society puts into assuring healthy conditions for you and your family. In fact, Dr. Herman Biggs, the commissioner of health for New York City in the late 1800s claimed, “Public health is purchasable. Within natural limitations a community can determine its own death rate.”

Now, if you were a health insurance company, which of these children would you want to insure? Before either child has even entered the health-care system, you already know which one is going to have the highest health-care costs. One has grown up in a community with a rock solid foundation of public health, and the other is attempting to survive in a community that is falling apart.

As a state, we are currently looking at reforming our health-care system. We can choose to continue to gild the penthouse and hand out a few more keys, or we can build a much firmer foundation of public health. The choice is ours. “Within natural limitations, (we) can determine (our) own death rate.”

Dr. Mark B. Johnson is the executive director of the Jefferson County Department of Health and Environment.

READER COMMENTS

"Trust the same folks who maintain our bridges, run the post office, secure our borders and establish national energy policies with our health care? You gott' be kidding"