The Future of the Public’s Health in the 21st Century

By Curry, Leslie

The Future of the Public’s Health in the 21st Century By the Committee on Assuring the Health of the Public in the 21st Century, National Academies Press, 2002, 536 pp., $39.00 (doth), $29.95 (paper). Also available at http://books.nap.edu/catalog/10548.hml.

In The Future of the Public’s Health in the 21st Century, experts from the national public health community present a framework for assuring the public’s health in the coming decades. Convened through a collaborative agreement among the key federal agencies responsible for public health, the Committee on Assuring the Health of the Public in the 21st Century was charged with extending the scope of the landmark 1988 Institute of Medicine report, The Future of the Public’s Health, to respond to a rapidly dianging national landscape. Demographic trends toward an older and more ethnically diverse population, shirts from acute to chronic disease as the more prevalent challenge, advances in biological science, and the growing importance of global health-all compel a reassessment of the nation’s capacity to provide equal opportunities for optimal health to each of its citizens.

The authors argue that while health has traditionally been recognized as a public good primarily under the purview of governmental public health agencies, thus approach is no longer appropriate. Rather, collaborations among many partners in the public and private sectors are required. Such partners include the public health infrastructure, the community, the healthcare delivery system, employers and business, the media, and academia. (The authors do not identify individuals as partners, it is interesting to note.) These partners, or constituencies, are used as an organizing framework for the book, with chapters devoted to the respective roles and responsibilities of each. The authors observe that despite substantial improvements in health status and life expectancy experienced in the twentieth century, current population health markers are profoundly troubling. The prevalence of certain conditions and chronic diseases such is obesity and diabetes is increasing, newly emerging infectious diseases pose major challenges, and life expectancies continue to tall snort of those in many other industrialized countries. Even more disturbing are the well-documented disparities in health outcomes and access to care that persist among citizens according to ethnic and racial backgrounds, sex, and socioeconomic status (Johnson and Smith, 2002).

One of the book’s more provocative discussions centers on the need to transform society’s perception of health as an essentially individuallevel construct consisting of health status and access to medical care. The authors call for a more inclusive and multifaceted orientation that focuses on population-based health. This broader conceptualization recognizes multiple determinants of health, including genetic, behavioral, social, and environmental factors and has major implications for public health research and policy. To assure the public’s health, the current disproportionate emphasis on biomedical research must be addressed, allowing more appropriate allocation of resources to investigate each of these contributing factors. Health policy must logically extend beyond the healthcare system to examine the roles of agriculture, housing, education, commerce, labor, and transportation.

The authors distill their extensive recommendations into a national call to action comprising six overarching areas:

First, they admonish, adopt a population health approach. second, strengthen the governmental public health infrastructure. Third, build “intersectoral” partnerships that engage diverse communities. Fourth, develop systems of accountability to assure the quality and availability of public health services. Fifth, make evidence the foundation of decision making and the measure of success. And, sixth, enhance communication within the public health system.

What relevance to gerontology and geriatrics research and practice is to be found in this volume? Although content explicitly related to aging is limited, the book offers important guidance for research in public health and aging. Consistent with a multifaceted definition of public health, researchers must recognize the wide array of factors that influence health and must employ a range of quantitative and qualitative methodologies such as basic and applied research, community participatory research, and program evaluation. In order to ensure that scientific advances address the needs of an increasingly ethnically diverse, older population, it is essential to develop effective models of inclusion and participation of these diverse citizens and to understand the influence of culture and ethnicity and race on health status (Curry and Jackson, 2003). From now on, strategies for disease prevention and health promotion, including those to reduce behavioral and socioenvironmental risk, must be informed by aging-related research. In the same way, the public health workforce must be trained to understand the needs of an aging population, with skills to implement effective health promotion interventions appropriate for older adults. Indeed, the authors’ opening salvo, a quote from Goethe (“Knowing is not enough; we must apply. Willing is not enough; we must do.”), demands that the gerontology and geriatrics community and those in public health join to fully engage policymakers (Feldman, Nadash, Gursen et al., 2001) and conduct sound translational research so that what is learned can be applied in evidence-based practices and programs.

This volume itself provides useful information for those interested in policy and practice. A central recommendation urges the establishment and maintenance of partnerships between the public health and aging networks at the state and national levels. Models like the Health Aging Initiative (funded by Chronic Disease Directors and the National Association of State Units on Aging) create such collaborations to implement evidence-based programs to improve health and quality of life for older people. The expected increase in age-associated chronic dis eases poses substantial challenges to developing an adequate workforce; policy questions include recruitment and retention of skilled workers, career advancement opportunities, compensation structures, and quality assurance (Callahan, 2001). Postponing illness and the disability associated with chronic disease (“compression of morbidity”) will remain a central public health objective requiring expanded and improved services and social supports. Attention must be directed toward the provision of adequate housing and transportation, healthy environments, and equitable access to preventive care. Finally, policy makers will be confronted with the extraordinarily difficult ethical and legal issues raised by advances in molecular biology and molecular genetics (Sprott and Pereira-Smith, 2000).

The text includes an excellent executive summary, very useful graphics, and a series of key supportive documents as appendices.

REFERENCES

Callahan, J. 2001. “Policy Perspectives on Workforce Issues and Care of Older People.” Generations 25(1): 12-16.

Curry, L., and (ackson, J. 2003. “The Science of Including Older Ethnie and Racial Group Participants in Health-Related Research.” Gerontolqpia 43(1): 15-17.

Feldman, P., N’adash, P.. and Gursen, M. 2001. “Improving Communication Between Researchers and Policy Makers in Long Term Care, or: Researchers Are from Mars, Policy Makers Are from Venus.” Gerontologist-41(3): 312-21.

Johnson, J., and Smith, N. 2002. “Health and Social Issues Associated with Racial, Ethnic, and Cultural Disparities” Generations 26(3): 25-32.

Sprort, R, and Pereira-Smith, O. 2000. “Introduction to the Genetics of Aging.” Generations 24(1): 6-7.

Leslie Curry, Ph.D., M.P.H. is assistant professor of medicine and of community medicine and healthcare, Center on Aging, University of Connecticut Health Center, Farmington.

Copyright American Society on Aging Summer 2005