So it’s all change at the White House – but will it make a difference to health care in a country in which unprecedented amounts are spent on health care, and yet in which 45 million people have no health insurance, and health inequalities are rife? According to the health care plan published by the incoming president, ‘the nation faces epidemics of obesity and chronic diseases ... Yet despite all of this less than 4 cents of every health care dollar is spent on prevention and public health. Our health care system has become a disease care system, and the time for change is well overdue.’ ‘Five chronic diseases – heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes – cause over two-thirds of all deaths each year’.
It is encouraging for the public health community that this crisis is so prominent in the Obama–Biden healthcare plan (see below), just one sign that there could be a shift in focus towards better preventive efforts. In addition, there are other hopeful signs. The Agriculture Department will be addressing obesity and poor diet in a number of ways – 2009 will see the renewal of all their federal nutrition programmes, which include children’s school lunches, food stamps and farmers’ market initiatives, which could have a highly beneficial effect, particularly among the parts of society that are traditionally hardest to reach. And the incoming secretary of health and human services, Tom Daschle, will be undertaking an ‘aggressive’ overhaul of the system – and, again, health, not just sickness, is at the heart of his thinking: ‘Wellness has to be cool. And prevention has to be a hot thing. And we've got to make prevention hot and wellness cool.’
Finally, it is worth noting that the new president is leading by example. He is a keen athlete, with a particular fondness for basketball – he said during the campaign that he would replace the White House bowling alley with a basketball court.
Sources: Obama–Biden Health Care Plan (click here >>); Reuters, 8 January 2009.
Public health in the Obama–Biden Health Care Plan (in brief):
The new administration ‘will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities’. Five key groups are targeted in public health/prevention:
- Employers: the plan states that Obama/Biden believe that ‘worksite interventions hold tremendous potential to influence health and they will expand and reward these efforts’;
- School systems: the new administration will ‘work with schools to create more healthful environments for children, including assistance with contract policy development for local vendors, grant support for school-based health screening programs and clinical services, increased financial support for physical education, and educational programs for students’.
- Workforce: funding will be expanded ‘to ensure a strong workforce that will champion prevention and public health activities’
- Individuals and families: ‘Preventive care only works if Americans take personal responsibility for their health and make the right decisions in their own lives – if they eat the right foods, stay active, and stop smoking’, and this will be helped by improving environments (‘sidewalks, biking paths and walking trails; local grocery stores with fruits and vegetables; restricted advertising for tobacco and alcohol to children; and wellness and educational campaigns’) and by ‘increase[d] funding to expand community based preventive interventions to help Americans make better choices to improve their health’.
- Federal, state and local governments: the new administration will prioritise working together across all parts of government to develop strategies for public health, including assessing and improving agricultural, educational, environmental and health policies’ effect on public health.