The verities of public health: are they fundamental truths or tired cliches? This issue of Public Health Reports allows us to look at se of these truths—and some from other fields—in practice and in policy.
“Everyone Understands the Importance of Schools”
Marion Nestle, whose last feature article for us was on obesity, makes another important contribution to public policy discussion in “Pouring Rights.” What lies behind the situations she describes is the continued and even increasing abandonment of public functions and public institutions. Schools seek partners in the corporate world for many good and important reasons such as expertise, political support, and opportunities for students and fac-ulty, but increasingly schools, underfunded and often under attack, need corporate partners for the funds that should be in basic budgets. Corporate partners that seek to improve education so an educated workforce and educated electorate will thrive in America are one thing; corporate partners that see schools as a means to get customers, to develop brand loyalty, are another. In addition to thinking about all Nestle brings to this discussion, there needs to be a national conversation on the appropriate role and function of government. Corporate contracts of this type are not the 21st century version of bake sales.
“We Count What Counts”
Skeptics often argue that instead of counting what we value, we value what we count. That may be no more than a play on words, but the public health community along with others concerned with public policy have long debated whether we measure those things that are most important and most useful in understanding problems, identifying need, and targeting resources…or whether we tend to count those things that are easiest to measure. Many proponents of community-based programs and policies argue that we should spend as much time measuring community assets and capabilities as we do community deficits and needs. Public health depends on our ability to assess—to survey, monitor, count, analyze, and compare. Epidemiology and biostatistics, two cornerstones of both the science and practice of public health, rely not just on accurate measurement, but on the appropriateness of what we choose to measure, and the correct translation to public policy.
Several articles in this issue of PHR reflect the importance of gathering good data, the need to analyze data cleanly, and the importance of raising the right types of questions in order to formulate good public policy. They also reflect the need to think more broadly about the effects of policies and programs.
Concern about lead levels in children has, appropriately, produced programs for lead paint removal and other remediations. The Tumpowsky, Davis, and Rabin article demonstrates that there has not been concomitant attention to the health of lead removers and other workers. Similarly, Backer et al. demonstrate that educating the nation about the importance of adding more raw fruits and vegetables to our diets has not always produced an accompanying lesson in food cleanliness and safety. NCHS Dataline gives us raw data and raises important questions for policy makers. Do we look deeply enough behind the numbers of infant deaths to guide us in developing policies on infant mortality?
Have we thought enough about the relationship between assisted fertility and infant mortality? Have we looked at the immigrant experience and its effect on infant survival? Looking at injury rates among the elderly should raise the issue of health insurance payment for home safety surveys.