Public Health: A Victim?

“The severe lack of funding for public health today is a direct result of the bad intentions of the private sector.”

That’s the assertion our professor threw at us to discuss today in class, as he played devil’s advocate to every person who had something to say. At first glance it sounds a little conspiracy-theory-esque. And I would’ve quickly blew it off if not for the provocative article I had read the night before.

It was an excerpt of a book on a history of women healers, recounting the rise of modern medicine in America and the denigration of women to the nursing profession. Hopkins was the first American medical institution reformed in light of the newly discovered germ theory of disease. Following its establishment, a man named Flexner went on a tour of American medical colleges and issued the famed Flexner report, naming which schools could remain open and which ones were closed. Coincidentally (?), the ones Flexner chose to close constituted a majority of schools open to blacks and women. Why? The commonly-heard argument is that it was simply a matter of performance. But tellingly, the medical profession then went on to demand the outlawing of midwives—at a time when midwives were more competent than obstetricians (according to a 1912 study published by—ironically—Hopkins). The punchline in all of this is that the initial Flexner study was funded by the Carnegie Foundation. It was funded by private sector.

Conclusive? Certainly not, especially drawing only from a single source with a pretty strong feminist/liberal tone. But provocative? Most certainly. Bringing the discussion back to public health, think about it this way: if we wanted people to be so healthy that the incidence of disease was minimized, public health would need to be going full throttle. But medicine would be out of business.

On the other hand, there is a case to be made for the idea that public health lacks funding because it is ineffective or inefficient (although this can quickly become a chicken-or-egg argument). Or that people instinctively lack faith in public health because its results are silent. Or, as one Wharton student put it, “public health fails because it’s carried out by the public sector and government is intrinsically inefficient.”

The crucial question is, does public health simply need more funding in order to succeed? Or is health on a large scale simply too complex, with too many influencing factors, that the field of public health is an inherently unsuccessful endeavor?

(original post written 2/2/11)

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