On March 31, 2009 the House Energy and Commerce Subcommittee on Health held a hearing to examine the role of public health in health care reform. This was the fourth in a series of hearings held by the Energy and Commerce Committee as it readies to begin work on health care reform legislation this year. Committee members and witnesses acknowledged two main principles about the relationship between health care reform and public health:
- Broadening the scope of health care reform to include public health is essential to improving the health of individuals and reducing the economic burden that this country currently suffers from due to treatment of diseases that could have been prevented.
- Health care reform cannot be successful without a strong public health foundation of prevention and wellness programs and behaviors.
Health Subcommittee Chairman Frank Pallone (D-NJ) presided over the hearing. In his opening remarks he stated that addressing chronic disease is a vital part of reforming the health care system, shifting thought to “investing in the prevention of these horrible diseases, rather than just focusing on those who are already sick” with aim to “potentially save the system billions of dollars per year, not to mention the benefits to patients.” He charged the witnesses with addressing how public health can ensure people and communities are leading healthier lives at a local level.
Chairman of the full Energy and Commerce Committee Henry Waxman (D-CA) echoed Chairman Pallone’s sentiments, stating that public health reform must include: working with groups and communities to improve health locally; tailoring health insurance and health care to focus more on diagnosis and prevention (for example screenings and immunizations) rather than treatment; providing safety nets, like community health centers, for what is not covered by insurance; and making sure disease control and health promotion infrastructure is in place.
Ranking Member Nathan Deal (R-GA) focused on the role of the Centers for Disease Control and Prevention (CDC) in prevention and wellness, placing emphasis on the need to continue their current initiatives of research on infectious disease and prevention and community outreach programs. He also stated that patients must be given incentives to take responsibility for their own wellness and promote preventative behaviors. Health IT and coordination of patient care to prevent duplicative testing and treatment was a third component mentioned for improving public health and preventing wasteful health care spending.
Dr. Richard Besser, Acting Director of CDC, was first to testify before the Committee. He cited numerous evidence-based examples of prevention techniques and programs that successfully improve public health and reduce health care costs, including: immunizations, public media campaigns and education programs for tobacco use prevention and cessation, the CDC “Healthy Communities” program to prevent and reduce obesity and related health risks, the “Racial and Ethnic Approaches to Community Health Program” to reduce health disparities, and behavioral interventions for HIV prevention, among others. Dr. Besser also discussed the immediate prevention efforts taking place through the American Recovery and Reinvestment Act (ARRA) at the Department of Health and Human Services (HHS). The ARRA provided $1 billion under the Prevention and Wellness fund in three critical areas: improving access to immunizations, reducing health care associated infections, and implementing evidence-based clinical and community-based prevention and wellness strategies that target chronic disease rates.
Dr. Jonathan E. Fielding serves as Director and Health Officer of the Los Angeles County Department of Public Health, Chairs both the “Task Force on Community Preventive Services” and “Prevention Objectives for 2020,” and serves on the Secretary’s Advisory Committee on National Health Promotion & Disease. Dr. Fielding emphasized three points for the Committee to consider in its prevention efforts: (1) the nation will not be able to maintain a high level of economic productivity unless a healthy workforce and population is maintained through population-oriented policies and programs; (2) research and evidence to guide the proper development and implementation of these policies and programs are essential to fully achieve health improvement; and (3) cited the Task Force on Community Preventive Services’ process and organization that can be expanded to meet the research and evidence needed to actively disseminate the results so they become a part of standard practice on a national scale.
Dr. Jeffrey Levi, Executive Director of Trust for America's Health, echoed the message conveyed by Dr. Fielding, and added that there is a “need to create a reliable, stable funding stream for public health programs and services” as part of a successful health reform policy.
New Jersey Health and Senior Services Commissioner Heather Howard stated that nearly 80 percent of the nation’s health care dollars are spent on chronic illness, and that the only way to control those costs is to take a system approach to prevention, providing every individual access to essential preventive services and screenings and ensuring that there is a public health workforce to deliver that basic package. Howard also focused on the role of the state in prevention and public health efforts, such as keeping drinking water clean and assuming responsibility to reduce state health disparities by implementing healthy lifestyle programs and prevention campaigns. Director of the Satcher Health Leadership Institute at Morehouse School of Medicine and former U.S.
Surgeon General Dr. David Satcher defined access to quality healthcare, biological/genetic background, environment (physical and social), and lifestyle/human behavior as the four factors that contribute to a person’s health, and argued that these factors are further influenced by major social issues such as poverty, income, and working conditions. With that in mind, he stated that a public health approach to health reform is the only long-term, sustainable approach to accomplish the goals of improving the nation’s health and reducing health care costs.
CSWE government relations staff will continue to follow the development of health care reform legislation this year and engage the House Energy and Commerce Committee to ensure a role for social work and social work education.