What Is Public Health?

Via KipEsquire, New York City is trying to set up a required database to monitor its residents' diabetes control:

Conceived after a sharp rise in diabetes deaths over the past 20 years, the plan would require medical labs to report to the city the results of a certain type of test that indicates how well individual patients are controlling their diabetes.

"There will be some people who will say, 'What business of the government is it to know that my diabetes is not in control?'" said Dr. Thomas R. Frieden, the city's health commissioner.

The answer, he said, is that diabetes costs an estimated $5 billion a year to treat in New York and was the fourth leading cause of death in the city in 2003, killing 1,891.

By pinpointing problem patients, then intervening ever so slightly in their care, Frieden said the city can improve thousands of lives. "I don't think we can afford not to do anything," he said.

I can't say I was ever one to get too riled up over medical privacy as a potential problem, but this is ridiculous. I really liked this part:

Over time, doctors could receive letters, telling them whether their patients have been getting adequate care. People who skip checkups might get a note from their doctors, reminding them of the dangers of untreated diabetes.

As a doctor, I find it absurd and offensive that a we need the government to let us know whether our patients are getting adequate treatment. As Kip would say, this is, of course, utter nonsense. If the local goverment and the board of public health are such experts, why aren't they treating these patients in the first place? The fact of the matter is that the physician is following the labs and can competently communicate to the patient the need to control their diabetes. What new information can the city possibly add?

And here's a question I'd truly like an answer from. Anyone is public health out there reading this? What is the defiition of public health? It used to mean those aspects of health where the health of one affected the health of all, such as communicable diseases and the like. After a while it grew to mean any aspect of health care that affected enough of the population that it had a politically viable advocacy group. Now it means pretty much anything related to health care.

The question: if public health has become synonymous with health care (or medicine), can we get rid of some of these superfluous words? When someone is quoted in the news stories saying "this is a public health problem" about some aspect of medicine, is that a redundancy? If not, can one of you give me several examples of diseases or health problems that are not under the public health umbrella?

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Trent, Lemme think on that

Lemme think on that one. I'm away from the school right now, but I might do a little survey of my colleagues about that one. The answer that comes readily to mind is one of the really really rare non-communicable diseases, the kind you could go your whole career without seeing.

Thanks, Lisa. So now I want

Thanks, Lisa. So now I want one, just one, example of a specific disease where a majority of public healthists would say "No, that's not a public health issue."

I'm a grad student in public

I'm a grad student in public health. There are few things that don't seem to be under the umbrella of "public health" nowadays. As far as I can tell, the term is expanding in two ways. First is due to the fact that government funded health care results in many people shouldering the costs for other individuals' health choices. As a result, it's now easy to claim that your health choices (such as diabetes not controlled as well as it could be)affect other people and impose costs on society, and thus are public health issues. The other way that something can be framed as a public health problem is if you can claim it affects somethign like your productivity at work or ability to work, or leads to individuals requiring social services. For example, some professors at my school study the epidemiology of injury as a public health problem, including things like child abuse, car accidents, and gun injuries. This leads to the claim that these things impose costs on society. Between the two, just about everything can conceivably be a public health problem. I think the issue with terminology is that "public health" has traditionally translated into "requires lots of tax money to solve". Labeling something as a public health problem seems to imply that it's beyond the ability of individuals or small groups to solve and thus needs (coercive) government action and tax money. So there's political advantage in using the term public health, even as it gets further and further from its traditional meaning.

I’m not a doctor, nor have

I’m not a doctor, nor have I played one on TV. Regardless, is not diabetes an eminently manageable condition that only affects the individual (physically, that is) who is afflicted? My aging father has been dealing with diabetes for several years now, and it’s rather obvious that such is his burden to bear. Now, it’s not that I’m unconcerned about his health…it’s just that his treatment is a personal matter, rather than a “public health” issue.

I may be overly cynical, but I suspect that the “public interest” lay with the odious entitlement programs, such as Medicaid or Medicare. It gives the concept of a “free society” a brave new meaning.

A lot of money will be spent

A lot of money will be spent to re-discover what we already know. People have poorly controlled blood sugars because they:

  • don't keep their doctor's appointments
  • don't follow their diet/regimen
  • don't track their blood sugars

New York Diabetics May Lose

New York Diabetics May Lose Privacy Rights
New York is preparing to hunt down the latest public health threat — diabetics:Conceived after a sharp rise in diabetes de...

Blogged at BIPPS as well.

Blogged at BIPPS as well. Great analysis Trent. See you at UK in two weeks!