Public Health
Volume 123, Issue 12 , Pages 759-760, December 2009

Another high water mark?

Royal Society for Public Health, 3rd Floor Market Towers, 1 Nine Elms Lane, London SW8 5NQ, UK

Article Outline

 

Being the editors of an international journal may – just occasionally – have its personal benefits. One of these was to be in the United States of America on the evening of the 7th of November 2009. We say “may” because there is still a way to go before the health care reform legislation that was voted through by the US House of Representatives late into that unseasonably warm Saturday night, is enacted. The legislation has yet to clear the hurdle of Senate and Presidential approval before becoming law and changing the landscape of American health care provision for millions of uninsured or underinsured people. Of course, healthcare reform has been on the agenda of pretty much every Democrat President of the late 20th century. In this regard, President Obama is no different from any of them except in one major regard: this time the proposals have been adopted by the House, albeit at a very close margin with a sizable minority of Democrat Representatives voting against the Bill.1

By the morning of the 8th of November, there were two very different views emerging. For those 10,500 people who gathered in the Philadelphia Convention Center for the Grand Opening Session of the American Public Health Association's 137th Annual Convention, there was a real sense of progress, of there being a break-through in the making. For those who were wakened by the constant stream of meta-news from CNN, MNBC, ABC and CBS, there was the start of a detailed decomposition of the next stage in the political process that was to unfold, reassuring them – if such reassurance was needed – that all was not yet won or lost. As visitors from the UK, and therefore not really familiar with the use of general television advertising as a political tool, the speed with which the anti-reform lobby switched their advertorials to reflect the change of circumstances was remarkable.

Clearly, widening health care access in the United States is an important component of promoting the public's health. Yet, as those opposed to it were quick to show, socialised health care systems which are predicated on universal access to health services, are not without their problems. Nor are they the ‘be all and end all’ of public health. As this issue of Public Health shows, there are many areas which are highly pertinent to the promotion and protection of the public's health which go beyond health care access. Public health is as much about the control of meningococcal disease,2 falls prevention3 or controlling anaemia through dietary modification at the population level.4 Nor will widening health care access necessarily have a wholly positive benefit. The US may have “the best health care system in the world”, as many opposed to widening access are prone to contend, even though it is accessible to far less than 100% of the population. Yet, as two of our papers this month argue, health care professionals5 and health care organisations6 still need to be exemplars in sustainability.

The political commentators discussing US health care reform on the 8th of November were quick to point out that, given the ‘electoral math’ of the US Senate, there will be less inclination to vote through the health care reform bill in the form presented to the US House of Representatives. Some pointed out that Senate Democrats were less inclined to be of the view that reform of the type proposed was in fact a step forward. They commented on the role that Senate Republicans will have on seeking to talk down the bill so that it will fall due to lack of time. Either way, there is the real potential for the current legislation to get no further than acceptance in the House. If that is the case, it is to be regretted. No health care system starts out as perfectly formed from day one. They have to evolve and develop over time, responding to political, social and economic changes as they occur. It would be foolish to see the successful passage of these reforms through the US system as anything other than a step in the right direction with an acknowledgment that further steps will still be needed.

To do otherwise could make the House vote a new “high water mark” that Americans view with very mixed feelings.

In this issue

 

In this final issue of 2009, we open with two papers that consider the contribution that health professionals and health organisations can make towards achieving a more sustainable use of resources. Linked to this, we are publishing an interesting paper which explores the health impacts of promoting greater local control in Japan, and marks the first time that HIA has been used in Japan in relation to government policy. In relation to long-term health conditions, we have a paper from Canada that presents new data on the gender distribution of diabetes and from Wales, a short communication on the use of aspirin in vascular disease. Post-natal depression (PND) is known to be hard to diagnose, so we are pleased to publish a paper comparing different methods of assessing PND using routine tools. On the topic of prevention, we have papers covering anaemia control, tobacco control in the workplace and falls prevention. In health protection we present an audit of meningococcal reporting in an area of the UK. We also have a report from London on this year's John Snow Society Pumphandle lecture. All in all a gentle reminder that 2009 has not JUST been about H1N1!

Back to Article Outline

References 

  1. BBC News Report . US house backs healthcare reforms. Available at: http://news.bbc.co.uk/2/hi/americas/8348941.stm[last accessed 13/11/09]
  2. Paranthaman K, Kent L, McCarthy N, Gray SJ. Invasive meningococcal disease: completeness and timeliness of reporting of confirmed cases in Thames Valley, 2006–2007. Public Health. 2009;123(12):805–808
  3. Salminen M, Vahlberg T, Kivelä S-L. The long-term effect of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment. Public Health. 2009;123(12):809–813
  4. Sadighi J, Mohammad K, Sheikholeslam R, Amirkhani MA, Torabi P, Salehi F, et al. Anaemia control: lessons from the flour fortification programme. Public Health. 2009;123(12):794–799
  5. McCarthy G, Hanlon P. What can health professionals contribute to the challenge of sustainability?. Public Health. 2009;123(12):761–764
  6. Richardson J, Kagawa F, Nichols A. Health, energy vulnerability and climate change: A retrospective thematic analysis of primary care trust policies and practices. Public Health. 2009;123(12):765–770

PII: S0033-3506(09)00351-5

doi:10.1016/j.puhe.2009.11.002

Public Health
Volume 123, Issue 12 , Pages 759-760, December 2009

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