Why health reform can’t succeed without public health

The year-old health reform law takes important steps to reorient the nation’s health system toward disease prevention and health promotion. But achieving the goals of the sweeping health measure is at risk without sustained, adequate investment in the public health workforce, says a new report from APHA.

Enacted 15 months ago, the Affordable Care Act reauthorized and created several programs that could increase the supply and expertise of the public health workforce — those professionals who oversee community health programs such as immunizations, tobacco cessation, restaurant inspections and other preventive health services. But according to the issue brief — Public Health Workforce Provisions in the Affordable Care Act, only 11 of 19 provisions it assessed have received funding to date. Those that have received monies have been funded at substantially lower levels than authorized.

“Under health reform, we have a real opportunity to transform our nation’s health system — by moving from a ‘sick’ care system to one that prioritizes prevention and wellness — and save lives and money,” said APHA Executive Director Georges C. Benjamin, MD, FACP, FACEP (E). “But we’ll miss that opportunity if we fail to adequately invest in our nation’s public health workforce.”

Further exacerbating the situation, the National Association of County and City Health Officials reports that nearly 20 percent of the governmental public health workforce has been lost since 2008 as a result of the economic recession, resulting in cuts to public health services, such as immunizations, prenatal care, and air and water quality monitoring, among others.

“Protecting and defending the health of residents in local communities and meeting their expectations for service is increasingly difficult,” said NACCHO Executive Director Robert M. Pestronk in a statement. “These annual budget cuts and job losses threaten the ability of local health departments to prepare for and respond to emergencies, and provide basic services that all individuals and families count on.”

The Affordable Care Act includes many provisions to improve the size and capacity of the public health workforce. Most, however, have not yet been funded, said the APHA report. Those that have been funded target the clinical health care workforce, such as primary care physicians and nurses, who make up only a fraction of the public health workforce. Only two of the five programs aimed at training public health workers have received funds, and one of them — the preventive medicine residency program — trains physicians.

APHA released the issue brief in concert with its Midyear Meeting, where more than 600 public health officials and practitioners gathered in late June to focus on health reform implementation. Read more about the meeting and the report on the APHA Midyear Meeting Blog.