NATIONAL-HEALTH CARE REFORM MINUS PUBLIC-HEALTH - A FORMULA FOR FAILURE

Universal access to medical services will not address all important he alth needs. Impending health care reform, guided by public health stra tegies, could achieve many previously unattainable health goals. Howev er, such a public health role seems unlikely. Public health reaches be yond the current popular notion of prevention focused on individual li festyle, yet attention to public health authority has waned. The histo ry of immunization, a personal health service effective only within a public health strategy, illustrates the dilemma. Britain required 40 y ears of National Health Service before it invoked a public health stra tegy to assure effective immunization. Reformed health care must perfo rm certain functions systematically that in the past were optional for medical practitioners or left to health departments by default. Refor mers must rebuild public health authority in states, to assure that me dical service we will pay for under health care reform accomplish func tions critical to the health of the public.