Preparing for the Onslaught
Preparing for the Onslaught | Public Health, Prevention, Chronic Disease Management, Dr. Georges Benjamin, American Public Health Association, APHA, Affordable Care Act, ACA


Public Health Braces for Increasing Need, Decreasing Funds

“The biggest threat that we have today is the stability of the public health system itself,” declared Georges C. Benjamin, MD, FACP, FACEP(E), executive director of the American Public Health Association.

Save the Date

There are a number of key dates coming up on the public health calendar. For a complete schedule of activities, go online to

  • April 2-8: National Public Health Week 2012 (
  • June 26-28: APHA Midyear Meeting in Charlotte, N.C.
  • Oct. 27-31: 140th Annual Meeting & Exposition in San Francisco


He doesn’t make the statement lightly. Benjamin, who has held his APHA position since 2002, has watched funding shrink in the face of increasing demand during the country’s recent economic woes. “Since about 2008 or so, if you look at the numbers from state and local associations, we have lost at least 49,000 people across the country – that’s in the governmental public health workspace.”

The decrease in manpower has been coupled with a decrease in funds, and more proposed cuts are slated for the coming year despite the call for the public health system to take an increasingly prominent role as part of the Affordable Care Act (ACA).

In response to President Obama’s proposed budget for fiscal year 2013, which was released in mid-February, Benjamin said, “APHA recognizes today’s tough economic environment, but in the midst of fundamentally transforming our nation’s health system to emphasize disease prevention and wellness, now is not the time to underinvest in our already underfunded, overburdened public health system.”

Enumerating the obesity epidemic, influenza outbreaks, food-borne illnesses, continued tobacco usage and a host of other ongoing issues, Benjamin pointed out, “The health threats have not gone away.”

He added, “The public health community is still in its infancy in many ways trying to address our new focus on chronic diseases.” Benjamin said this prevention and management focus is expected to intensify now that the baby boom population has begun entering the senior years when healthcare needs typically increase. He added the demographic group, of which he is a part, carries with it past behaviors that haven’t proven to be conducive to achieving optimal health.

While most healthcare experts anticipate the shock to the system caused by the baby boomers, Benjamin said it doesn’t end there. He expects a second wave of need as today’s youth, who are growing up sicker thanks in large part to the obesity epidemic, hit the system like an aftershock.

ACA, he noted, has helped focus efforts toward prevention. However, the will to fund that focus remains in doubt. “The healthcare industry spends $2.7 trillion, approximately, on health (annually) … only about 3 percent of that is on prevention. We’ve always been under the belief that we’ve underinvested in public health,” he said. Adding to the frustration has been the intent in Congress to pay for the temporary ‘doc fix’ by using designated prevention funds. “It’s like neglecting something and then paying to fix it. That doesn’t make sense … to cut prevention to fund acute care,” Benjamin said.

Although stable funding is a key concern, Benjamin was quick to say money alone isn’t the sole answer to the nation’s public health issues. “The challenge we’ve had is how do we invest in public health and prevention in a way that is strategic and begins to address the needs of the public.”

To that end, he said ACA offers a blueprint moving forward with a heavy emphasis on more robust office visits through the Medicare provision to cover annual exams. Now physicians are being given the opportunity not only to engage patients in discussions about tobacco cessation, nutrition, physical activity and alcohol and drug use but also to have a means to receive compensation for that time. The intent, he said, is to view patients more holistically.

Benjamin noted the National Prevention, Health Promotion & Public Health Council, led by the U.S. Surgeon General, is an example of strategically aligning government agencies to coordinate the message and reduce the waste of duplicative activities. The workgroup, which released the National Prevention Strategy last June, included members from beyond the traditional health-oriented government departments, including Transportation, Labor, Education, Agriculture, the Federal Trade Commission and the Environmental Protection Agency. The broad spectrum of representation, noted Benjamin, was in recognition that “health begins long before you get to the doctor’s office.”

Benjamin said there has, at times, been a schism between hospitals, physicians, and the public health system. Instead, he noted, working together has the potential for both cost savings and improved outcomes. A critical component, he continued, is changing social determinants, which is an area where public health officials could really assist their counterparts in hospitals and private practices.

“ACOs will simply become HMOs with another name if we don’t effectively engage the public health system,” he said. “And that means transforming the payment system so that we’re paying for outcomes and not just piecemeal care.”

Benjamin said population-based strategies and community-based solutions are a critical component of improved outcomes. Using the example of increasing physical activity, Benjamin said solutions might include fixing the jungle gym at the local elementary school, opening the high school gym outside of school hours to host an exercise class and having a church bus pick up neighbors to transport them to the class, or paying for a security person to patrol the local mall before the workday starts so people could walk no matter what the weather.

“That’s where public health can help the healthcare community do their jobs better for the patient’s benefit,” he said. “Many medical care people would not see those as health problems, but they are because they are barriers to getting your patients to follow your clinical advice,” he added.

 “This is a nation that pays for what it wants,” Benjamin concluded of finding a way to fund programming and infrastructure despite economic pressures. Whether the will exists to invest in public health and prevention remains to be seen.