National Academies Press: OpenBook

The Future of Public Health (1988)

Chapter: Supplementary Statements

« Previous: 6. Conclusions and Recommendations
Suggested Citation:"Supplementary Statements." Institute of Medicine. 1988. The Future of Public Health. Washington, DC: The National Academies Press. doi: 10.17226/1091.
Page 160
Suggested Citation:"Supplementary Statements." Institute of Medicine. 1988. The Future of Public Health. Washington, DC: The National Academies Press. doi: 10.17226/1091.
Page 161
Suggested Citation:"Supplementary Statements." Institute of Medicine. 1988. The Future of Public Health. Washington, DC: The National Academies Press. doi: 10.17226/1091.
Page 162

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Supplementary Statements HARVEY I. SLOANE There is overwhelming evidence from this report, and from a myriad of studies, that the financial problems confronting the poor must be solved before we can have a significant impact on the other health issues confront- ing the American people. In describing the crisis of AIDS, teenage pregnancy and Alzheimer's disease, I cannot help but be greatly disturbed by the fact that these are minuscule in proportion to the numbers of people in this country who do not have adequate health care. More importantly, most of the other recommen- dations in the report to improve our public health system can never be completely implemented without addressing the indigent care problem. This most commendable report, in my estimation, is severely flawed if it does not come forth with a great sense of urgency to meet the health needs of the 43 million uninsured and underinsured people of this nation. I would ask for the first priority in the recommendations to be a call for the public and private sectors, at the initiative of the federal government, to implement a program that would provide a financing mechanism for the medically indi- gent in this country. Until we resolve this issue, general public health measures will be secondary. Most of the industrialized nations of the world have answered the call for insuring health care to the indigent. This report must issue a clarion call for that same action. 160

SUPPLEMENTARY STATEMENTS 161 ROBERT J. RUBIN After examining a great deal of information and hearing from numerous witnesses, the committee concluded that the primary public sector respon- sibility for health rests with the states. I strongly support that belief. The genius of our federal system, however, is that the various states be free to carry out their responsibility in ways that they deem appropriate. I do not therefore believe that there is one correct structure of state government that will lead to the answer of the public health dilemma so forcefully articulated in this report. Indeed, our own case studies document that many approaches will yield an acceptable solution. Therefore I cannot support a prescriptive approach that seeks to impose a uniform structure on a diverse group of states. This is particularly true as several of the commit- tee's recommendations do not appear to be based on solid evidence, either empirical or practical. As regards the federal government's role, I believe that the committee did not heed its own words that "reorganizing is frequently the first re- sort . . . when in many cases the problem is not truly structural." The federal government is structured in a way that allows "a clearly defined national focal point for public health leadership." Whether that leadership is exercised appropriately is more frequently a political perception than an · . ^. . empiric unc log. In conclusion, our report has much to commend it to all Americans concerned about the future of our nation's public health. I believe its operational recommendations, however, should have reflected the breadth and diversity that exist among our states as they strive to assure their public's health.

Next: Appendix A: A Summary of the Public Health System in the United States »
The Future of Public Health Get This Book
Buy Paperback | $49.95 Buy Ebook | $39.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government—federal, state, and local—at which these functions would best be handled.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook,'s online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!