Caring About Public Health

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Want to understand health care reform and arm yourself to combat its enemies? Get a grip on public health, advises David Tuller in California(Summer 2010). Most people don’t really understand the field, which is a shame, he explains: “Greater awareness of such basic and essential concepts as preventative care and shared or pooled risk could ease what is likely to be the traumatic process of overhauling our health care system.”

Public health, as both a term and a guiding principle, suffers from an unusual marker of success: invisibility. When it’s effective (widespread adoption of vaccines, for example), our experience of it is defined by absence (lack of disease). And so it becomes easy to ignore. Really easy. In a 2001 study, 78 percent of Americans reported that public health had not affected them in any way, even though successful initiatives are all around them, from smoking bans to blood drives.

The oversight is significant because “as a nation, we suffer from an appealing delusion: that rugged individualism and self-reliance define the American character,” writes Tuller, who is coordinator for public health and journalism at the University of California at Berkeley. This thinking infects our conversations about health care. “No health insurance? Sorry, not my problem,” Tuller parrots. “Your kid has cancer? Too bad, get a job.”

Abandoning the narrow confines of the health care debate to talk more broadly about public health provides a clearer picture of the country’s strengths and weaknesses. It also encourages upstream thinking, which acknowledges that “maintaining healthy communities means more than providing medical care for individuals,” Tuller writes. It means grappling with the social, environmental, and behavioral factors that affect health.

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