Experts Urge Widening of Health Focus

State health experts called Wednesday for a reorganization of public health services to focus on community concerns rather than individual medical needs.

The message to examine broader issues, such as behaviors and social conditions that lead to poor health, emerged at the opening session of a statewide conference sponsored by the California Coalition for the Future of Public Health at the Los Angeles Hyatt Regency.

The meeting, which features three days of seminars and workshops for health professionals, is in response to a 1988 Institute of Medicine report charging that the nation has lost sight of public-health goals and has allowed the system to fall into disarray. The Institute of Medicine acts as an adviser to the federal government and studies medical-care issues.

According to the report, decision-making in public health is driven by crises and competition between interest groups instead of concern for the health of entire communities.

“We all recognize it’s a system with problems and a system that’s inefficient,” said Dr. Robert Melton, chairman of the California Coalition for the Future of Public Health.

Conference participants will debate recommendations to improve public health in the state, he said.

The new agenda should focus on broad approaches to disease prevention instead of being organized around diseases, such as AIDS and heart disease, said Leonard Syme, an epidemiologist at UC Berkeley.

“Most of what we do in the field of health promotion and disease prevention is focused on individuals in one-to-one programs that not only fail, but that are doomed to fail,” Syme said, citing smoking-cessation programs as an example.

“In one-on-one programs . . . we have done nothing to influence those forces in the society that continue to create new people at risk,” he said. “The task of public health is to intervene on and change those forces in the community that initiate our problems in the first place.”

The state’s public health goals in the next century will be heavily shaped by the growing numbers of elderly people and young Latinos, said David Hayes-Bautista, director of UCLA’s Chicano Studies Research Center. California’s elderly population is expected to double by the year 2030 while three-quarters of all children will be Latino, Asian or black, he said. Hayes-Bautista called minority children the “emerging majority.”

“The issue of who we are is changing,” he said. “It’s going to be very difficult for the younger generation to carry this burden.”

Minority groups bring unique strengths and traditions to the public health care system, Hayes-Bautista said, but are generally not recognized for their potential contributions.