WHEREAS: The inaccessibility of health care coverage for millions of Americans is requiring that an increasing portion of public health dollars be spent on providing personal medical care to those who otherwise would be without; and

WHEREAS: Personal medical services are effective only in the context of healthy communities and environments; and

WHEREAS: The basic functions of public health include engagement of community health status (including personal and environmental health), quality and range of health services, community concerns, and resources ; policy development using the data gathered from assessments and geared toward improving and protecting the health of the community; and assurance that necessary and high quality health services are available to all; and

WHEREAS: Public health programs should provide public health, health promotion, disease prevention and environmental health services,
encourage or provide population-based health services, maintain the capacity to respond to emergencies, administer quality assurance programs, recruit and train health care professionals; and

WHEREAS: Comprehensive health care reform should insure that individuals receive needed individual medical care through the personal care delivery system, thereby freeing the public health system to concentrate on public health functions;

THEREFORE BE IT RESOLVED THAT: The Arizona Public Health Association calls for health care reform legislation that acknowledges basic public health functions, requires that states carry out these functions, and that states provide and receive adequate, dedicated funding for the activities related to public health functions.

Passed by Board of Directors

Passed by Membership Annual Meeting 9/15/94





1. Statement of the problem

a. Summary

The 1988 Institute of Medicine study on The Future of Public Health said “Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.” A reformed health care system must recognize public health, its mission, and the activities necessary for fulfilling the mission, as well as personal and family medical care. Adequate and dedicated funding for recognized core public health functions is an essential part of any health care reform legislation.

b. Background

“Safeguarding America’s public health has been the province of our public health agencies since the early days of the 20th century.

But in recent years, these agencies have been unable to fully carry out their mandate of prevention and education. While the nation’s health care crisis was worsening and private health care costs increasing, more and more people were becoming unable to use the private health care system and seeking help from the public sector. Consequently, official public health agencies have had fewer resources with which to perform their core community disease prevention and health promotion services.”

In a universal, comprehensive health care system (which AzPHA endorses as a legislative priority), the vast majority of individuals should receive their personal/family medical care from private practitioners. This should relieve the strain on the public health system.

“Freed from the burden of providing individual medical care, official public health agencies can fulfill their traditional mission of promoting and protecting the nation’s health.

“To keep communities healthy, public health agencies must have the resources to perform their three Core Functions:

“Assessment – Public health agencies must assess community health needs and the resources for handling disease, injury, and environmental dangers. Public health agencies must assess personal health, environmental health, community concerns and resources and data on the quality, range, and use of public and private medical services.

“Policy development – Public health agencies must develop policy in response to specific community and national health needs. Public health agencies must develop comprehensive public health policies to improve health conditions, incorporating scientific information and data from assessments; ensure that policies are politically and organizationally feasible and that they respect community values; devise measurable objectives and implementation strategies; and identify resources needed to implement the health policies developed.

“Assurance – Public health agencies must assure that conditions contributing to good health, including high-quality services, are available to all. Public health agencies must provide essential public health and environmental health services; respond to personal and environmental health emergencies, such as outbreaks of disease and spills of toxic chemicals; administer quality assurance programs, such as enforcing health standards and laws, and licensing health professionals and facilities; and guarantee care for those unserved after health care reform.”

Health care reform legislation should acknowledge these core public health functions, require that state and local public health agencies fulfill these functions, recognize the responsibility of these agencies, and ensure adequate and dedicated funding for the activities. The American Public Health Association has suggested that legislation specify an allocation of 3-6% of total national health expenditures for public health. The source of this money could be a portion of health insurance premiums or excise or “sin” taxes, an income tax check off and/or general revenues.

2. Statement of the desired action

The Arizona Public Health Association proposes that health care reform legislation acknowledge the core public health functions and requires that states carry out all of these functions and that they receive adequate, dedicated funding for the activities related to those functions.

3. Which other groups. organizations support this effort?

The American Public Health Association strongly supports the inclusion of and adequate funding for public health core functions and programs in any national health care reform legislation.

4. Describe the relationship of this issue to the current AzPHA Legislative Priorities.

Not only is this issue directly related to the legislative priority of Universal Access to Health Care, but is also directly related to the future of public health activities in both Arizona and the nation. The public health issues that comprise the other legislative priorities depend on public policy and legislation that recognizes the importance of 1) public health activities in protecting and
improving the health of our nation, and 2) adequate funding to effectively carry out these activities.

5. Is this an issue for legislation?

This issue is an integral part of the current debate and legislative proposals regarding health care reform at the federal level and may, at a future date, be a part of state efforts at health care reform.

6. Financial and public health analysis.

The resolution has no impact on the financial status of AzPHA. It does, however, imply that dedicated funding as a part of federal health care expenditures be identified, leading to improved funding of public health activities.

129~1994_(1)Public health in health care reform (public health infrastructure, legislation)

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