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By MICHELLE BRANDT When Christine K. Cassel, MD, and fellow members of an Institute of Medicine (IOM) committee met earlier this year to identify public health threats, they hesitated when considering one possible threat. "We decided not to focus on terrorism. We said to one another that we didn’t want to be too alarmist," said Cassel, who co-chairs the Committee on Assuring the Health of the Public in the 21st Century. "After Sept. 11, of course, we changed our minds."Cassel discussed terrorism and other public health threats, as well as ways to ensure health security, during the 11th Jonathan J. King Lecture last week. A renowned medical ethicist, Cassel is the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Adult Development, professor of geriatrics and internal medicine at the Mount Sinai School of Medicine and director of the Geriatric Research, Education and Clinical Center at the Bronx VA Medical Center. She was recently named dean of the Oregon Health Sciences University School of Medicine, a position she will assume Jan. 1, 2002. During her talk at Fairchild Auditorium, entitled "Your Health and Public Health: What Really Matters," Cassel said that Americans rarely think of our nation’s government-funded public health infrastructure as a determinant of personal health – instead thinking of such things as behavior, genetics, medical care and environment. She presented data showing that socioeconomic status is a powerful determinant of health and also argued that public health threats – identified by the IOM committee as environmental problems, terrorism, social fabric breakdowns and problems with health care delivery – can directly affect our personal health. "She made the point that health is a collective good and that no one individual can be totally responsible for his or health," said Barbara Koenig, PhD, associate professor of medicine and executive director of the Stanford Center for Biomedical Ethics, one of several sponsors of the lecture. Cassel said a strong public health infrastructure – which can support such things as medical surveillance, crisis prevention and intervention, and response to threats – can play a key role in achieving health security. But she added that physicians, community members, and elected officials don’t seem to understand the important role of the public health system. "Public health has always been the poor stepchild of the healthcare world. It has always been under-funded, and medical students are rarely taught about it," she said, adding that one public health agency – the Centers for Disease Control and Prevention – receives only 1 percent of overall federal health care spending. She also noted that a recent study found that more than half of all public health departments lacked the means to send out faxed warnings of public health risks. Cassel believes that achieving health safety requires an additional investment in the public health system. She said that members of the IOM committee, which was designed to make recommendations to various federal agencies on ways to improve public health, agree that additional money and resources are needed, as well as more involvement from physicians, elected officials and community members. "If all of us stand to benefit from community health, all of us need to engage in the process," said Cassel, citing several ways for people to take action. She suggested that elected officials work to ensure certain systems are in place; physicians more readily report illnesses to, and work with, public health departments; and community members play a greater advocacy role in the community. Using obesity as an example of a health threat that community members can work to prevent, she pointed out how physicians should advocate for the removal of soda machines from schools. Established in 1991 to honor the late King, a computer scientist who received his doctorate from Stanford, this lecture was designed to educate caregivers, patients and families about critical decisions affecting an individual’s health care. "The primary goal is to have people take time away from other pressing demands to think about issues of humanism in health care," said Koenig. Cassel said during her talk that she thought King would understand the importance of her topic. "Humanism demands a concern for the health of the community, along with that of the individual," she said.
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Stanford Report, October 17, 2001
