Plan May Revive Public Health Mission : Medicine: Clinton reforms provide funds for disease control, prevention. Budget cuts have forced agencies to deal with crises after they occur.


Traditionally, the role of the public health system has been one of disease prevention and health promotion--keeping an outbreak of food-borne illness from ever occurring, for example.

But in recent years, most of the nation’s public health agencies, financially strapped from budget cuts, have had to spend more money confronting crises after they occur.

The Clinton Administration’s health reform plan offers some ambitious proposals to help public health agencies return to their original mission.

If enacted, the plan would provide more money for state and local public health agencies to help them perform their traditional functions: environmental protection, through the monitoring of air, water, food and lead; disease surveillance, control and prevention and public health education.


“Public health officials at the state and local levels are very concerned about their inability to keep up their functions,” said a physician who helped draft the proposals. “The system should not be breaking down, and we would like to beef up their abilities. We don’t want the system to fail any longer.”

Many state and local public health agencies now frequently serve as providers of last resort for the poor and uninsured through clinics that deliver primary care, dental and emergency services and treatment for sexually transmitted diseases, tuberculosis and other conditions.

When tough budgetary decisions have to be made, these clinical services most often are preserved--because the need is so immediate--at the expense of longer term disease prevention and health promotion projects.

The reform plan assumes that through universal coverage for all Americans and a new system of health alliances, public health agencies will be relieved of that burden and be able to concentrate on old-style public health concerns.

The plan would accomplish that goal by spending $18 billion in new funds for public health agencies between 1994 and the year 2000. The money would come largely from so-called “sin taxes” and through savings achieved through controls on Medicare spending increases.

New grants also would be provided to states to help them mount programs to address such problems as violence, substance abuse and lack of immunization among children. Furthermore, the plan recommends expanding the National Health Service Corps to reduce the shortage of primary care practitioners in underserved areas and seeks new incentives to encourage doctors and other health professionals in these areas to remain there longer.

The reform proposal assumes that at least some of the funds once used to deliver clinical services could be shifted back to public health functions.

Moreover, the effort would be helped by the reform’s emphasis on preventive medicine, its advocates said.


Public health officials expressed both optimism and reservations about the proposals.

Jeff Jacobs, director of congressional affairs for the American Public Health Assn., applauded the initiative, saying that he hoped it would allow public health to become “proactive instead of reactive.”

But Dr. Margaret A. Hamburg, commissioner of health for New York City, said she is concerned that, if the plan is implemented “and the costs are high, the first thing to go--if past is prologue to future--will be the public health aspects. That’s my fear.”