Georges Benjamin, American Public Health Association Q&A: Sustaining Public Health

Sep 6, 2012, 4:28 PM

An upcoming Institute of Medicine symposium on September 10 and 11, 2012—Sustaining Public Health Capacity in an Age of Austerity—will look at the impact of recent budget cuts on the ability of public health systems to be the front line in the prevention, identification, and control of infectious diseases, and public health generally.

The discussion is critical. Public health experts say the public health infrastructure in the United States and other counties has suffered decades of neglect and insufficient investment compounded by the global financial crisis and has resulted in substantial decreases in funding, resources and staff and inadequate training.

Discussion topics during the symposium include the changing nature of communicable and non-communicable diseases and their impact on global health and economic well-being; the current level and opportunities to improve preparedness of public health systems for anticipating, preventing, detecting, and responding to communicable disease outbreaks; and the impact of current and anticipated budget cutbacks on the health of the public.

Georges S. Benjamin, MD, executive director of the American Public Health Association, will be a participant in a key symposium panel: “New Thinking and Action in Public Health Practice, Workforce Development, and Retention.” NewPublicHealth spoke with Dr. Benjamin recently about the symposium and the impact of public health budget cuts.

NewPublicHealth: Tell us about the discussion you anticipate.

Dr. Benjamin: This is a forum on microbial threats and one of the areas being looked at is what so many of us in public health are facing—significant resource restraints as we go through the next several years. You have this collision of these two great forces: reduced resources and the need to be innovative as the system changes. We’re always trying to improve the system, but how we do that in the concept of the collision.

In addition to the panel, the full meeting has a lot of discussion about the impact of reduced public health capacity and in particular I’ll be speaking about workforce training and retention in the context of thinking about a path forward.

NPH: Why is a forum on microbial threats is taking such a broad view on public health capacity?

Georges Benjamin: We don’t yet know what the public health system should look like. We have not come to an agreement about what the basics are. What should be the core of what we do? But I think the evolving world around us serves as a lever for us to, once and for all, say, okay, because we can now visualize an environment in which everyone is part of the health system in that they have an insurance card [under the Affordable Care Act] , what should the public health system do? What should it look like?

We know that there are some things that will change. There will be some places where the public health system will have a totally new role, but there will also be some retention of some things that public health does more efficiently than anybody else. For example, in some communities, the tuberculosis program or STD clinics may be better off run by public health. In others, it may be better off run by the private sector. But there is also a range of public health programs that have historically been done in support of vulnerable populations that may very well, because of their value, be normalized to the whole population—such as nurse home visits after a new baby is born.

There’s no question that we are still grossly under-resourced, and I think there will be better understanding of that after this symposium. The great value of the upcoming meeting is that it’s not a consensus group—this is a workshop, and the purpose of a workshop is to help people think through some of the questions that need to be asked. What will come out of this are more questions than answers, but I think they’ll be much more informed questions.

NPH: And what is the value to the future of public health of more informed questions?

Dr. Benjamin: When all the right people get in the room and they’ve all heard the evidence, you get a consensus by the fact that everybody’s had a chance to hear the same evidence, think through the process, allow for a more structured pathway, and then people tend to come out and support common concepts. There’s always some fine tuning in people’s individual thoughts, through their perspective, but it gets people on the same pathway.

This commentary originally appeared on the RWJF New Public Health blog.