[Congressional Record Volume 148, Number 19 (Thursday, February 28, 2002)]
[Extensions of Remarks]
[Pages E236-E237]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  MILITARY SPENDING AND PUBLIC HEALTH

                                 ______
                                 

                       HON. JANICE D. SCHAKOWSKY

                              of illinois

                    in the house of representatives

                      Thursday, February 28, 2002

  Ms. SCHAKOWSKY. Mr. Speaker, I would like to direct my colleagues' 
attention to an Op-ed in the Chicago Tribune (February 17, 2002), by 
the highly esteemed Dr. Quentin Young, ``President puts military funds 
ahead of those for health.'' As the head of Physicians for A National 
Health Program and the Health and Medicine Policy Research Group, Dr. 
Young reports on the uncertain and frightening future of a 
disintegrating public health system.
  With a $340 million reduction in the Centers for Disease Control and 
Prevention's expenditures not devoted to ``anti-terrorism,'' the Bush 
Administration is abandoning needed support for our public health 
system. Dr. Young highlights how the Bush Administration has 
subordinated public health to military priorities, through $57 million 
slash in the program for chronic disease prevention and health 
promotion, a $10 million cut for infectious disease control, and a $9 
million cut for Medicaid funding.
  We have made great strides in public health over the last 150 years 
with strong focus, and fiscal and political support. Life expectancy in 
our country has doubled, from 40 years to 80 years, through ``. . 
.[t]he separation of sewage from drinking water, mass immunization, 
discovery and elimination of insect vectors of disease, improved 
nutrition, prenatal care, purification of the food supply, addressing 
ambient pollution, and diminishing workplace hazards.''
  But in recent decades, we have neglected critical public health 
needs, eroding our ability

[[Page E237]]

to protect communities and individuals. We cannot allow emerging issues 
to destroy our nation's efforts to enhance the health status of the 
population. If we continue to divert funds from critical investments in 
public health because of short-term goals and a ``military first'' 
attitude, we will inevitably harm our nation's health in many other 
areas. A single-minded focus on bioterrorism that neglects ongoing 
public health needs is a shortsighted and dangerous policy.
  I strongly urge my colleagues to read the enclosed full text of Dr. 
Young's very informative op-ed.

               [From the Chicago Tribune, Feb. 17, 2002]

        President Puts Military Funds Ahead of Those for Health

                        (By Dr. Quentin Young.)

       Americans, still on the threshold of the 21st Century, 
     confront an uncertain, even frightening, future, not least 
     because their public health system is diving headlong into 
     errors of the past.
       On Feb. 4, President George W. Bush presented his FY 2003 
     budget to Congress.
       Its health provisions repeat the dangerous errors of the 
     past, especially with its focus on defense. To truly 
     strengthen the public health system, millions should have 
     been added to the budget of the Centers of Disease Control 
     and Prevention. Instead, CDC would take a $340 million 
     reduction in expenditures not devoted to ``anti-terrorism.''
       A sampling of the reductions indicates a $57 million slash 
     in the program for chronic disease prevention and health 
     promotion, $10 million for infectious disease control, $9 
     million for Medicaid funding. On the other hand, there is a 
     33 percent increase in funding for abstinence-only-until-
     marriage education. The decision to increase community health 
     center support by $114 million was helpful; it probably 
     should have been more.
       Our public health system needs serious invigoration based 
     on adequate funding at all levels. The president, however, 
     has debilitated the system by removing support for programs 
     with proven success and doing nothing to rally independent 
     public support for the mission of public health. Finally, he 
     has moved a long way toward repeating the 1950s blunder: 
     subordinating the public health system to military 
     priorities.
       The nation may pay dearly for this strategy.
       A good way to approach an understanding of the place of 
     contemporary public health is to look backward a century and 
     a half. Such an examination will define our current situation 
     and how we got there. It can illuminate the wisest decisions 
     we can make based on science and practice.
       In the past 150 years, life expectancy in our country has 
     doubled, from 40 years to nearly 80 years. This astounding 
     extension of life in such a brief time has no precedent in 
     the human experience.
       It was achieved fundamentally by public health triumphs: 
     the separation of sewage from drinking water, mass 
     immunization, discovery and elimination of insect vectors of 
     disease, improved nutrition, prenatal care, purification of 
     the food supply, addressing ambient pollution, and 
     diminishing workplace hazards. The public valued these gains. 
     The decline in the perils to life was palpable. A grateful 
     citizenry accepted the rules and regulations that the 
     preventive discipline required. Fiscal and political support 
     were there for the array of measures--from compulsory 
     immunization to meat inspection--needed to improve the 
     nation's health.
       Until the 1950s.
       Then, three powerful currents emerged and converged to 
     undermine the vigor and the readiness of the public health 
     establishment. The recent panicky response to the anthrax 
     letters and the legislative fixes being proposed will achieve 
     the necessary safeguards only if we recognize how we 
     blundered in midcentury and if we resolve not to repeat 
     history's mistakes.
       The first blow came, paradoxically, from the success of the 
     system.
       In a recent article, Lawrence Gostin and M. Gregg Bloche 
     captured this turnaround: ``Americans saw these [public 
     health] activities as vital to their security, no less so 
     than military force or police and fire protection. Taxpayers 
     supported the needed spending. Lawmakers empowered local 
     health authorities to move robustly when contagion 
     threatened. Destruction of buildings, killing of infected 
     animals and even restraints on the movement of infected 
     people were provided for by law and widely accepted by 
     citizens.''
       ``But after World War II, American public health fell 
     victim to its own success. Thanks to city-planning and 
     sanitation campaigns of the early 20th Century and the 
     antibiotic revolution of the 1940s, fear of infectious 
     disease waned. The conquest of polio through vaccination in 
     the 1950s delivered the coup de grace for public health's 
     middle-class constituency.''
       Despite awesome accomplishments, public health was now the 
     Cinderella--nay the Caliban--of our health system. Although 
     exploding health expenditures reached $1.4 trillion by 1999, 
     less than 2 percent was allocated to all activities in public 
     health. The workforce, the facilities, the technology--all of 
     the basics--fell behind.
       The second undoing of progressive growth of public health 
     was essentially political. This derived from the hard fact 
     that it is a governmental function, totally dependent on 
     fiscal and legislative policies. Because the designated 
     leaders--from the local and state health department directors 
     on up to the surgeon general--are all political appointees 
     who serve at the pleasure of an elected chief executive, an 
     effective independent professional advocacy did not and 
     perhaps could not develop.
       These health chieftains were locked into a loyalty to their 
     sponsors. They cannot question the budgetary and policy 
     devolution openly and expect to keep their jobs. At the 
     local, state and federal levels, the reward for public health 
     successes was reduction of support from the public treasury.
       The third major element in the decline in U.S. public 
     health over the past half-century is a cautionary tale. It is 
     quite pertinent to the re-emergence of concern with 
     bioterrorism, which is the deliberate use of lethal pathogens 
     on your opponents. It was Alexander Langmuir, chief 
     epidemiologist at the CDC, who was the architect of the 
     dramatic shift in research and funding to look at what was 
     called biological warfare in the midcentury realpolitik.
       The irony of the resource shift lies in the reality that we 
     have not developed reliable defenses against hostile use of 
     organisms. We have a gigantic capacity to create these 
     weapons, but the option to use them is illusory. Nor do our 
     weapons offer deterrence to enemies who are not powerful 
     nation-states but an elusive network of terrorists who claim 
     to welcome death in the service of injury to us.
       An unintended consequence of Sept. 11 is an overdue 
     appreciation and enthusiasm for the vital functions of public 
     health. We have not been at all steadfast in this regard in 
     the past five decades. Indeed, we have been heedless. In all 
     quarters the question arises: Can we now build a public 
     health capability that is robust and responsive, independent 
     of volatile political swings?
       Above all, can we avoid the trap of reducing our focus to 
     garrison state protection functions? The system should be 
     developing defenses against all threats to the public's 
     health, including bioterrorist ones. However, we should 
     recognize the folly of neglecting or abandoning the great 
     array of other crucial functions.
       Public health has been defined as those things society as a 
     whole does together to enhance the health status of the 
     population. This tradition grows out of premises that include 
     equity, social justice, confidence in government capability 
     in a democratic society, and reliance on observation and 
     scientific validity to guide practice in the community. When 
     the system works efficiently and compassionately, it 
     generates the solidarity and confidence much needed in a time 
     of confusion and polarization.
       To achieve the benefits of a vigorous, fully developed 
     public health system, our strategy should not repeat the 
     major errors of the past: Do not abandon sustained support of 
     public health because of short-term achievements; Decouple 
     the subordination of public health leadership to politicians; 
     introduce a tradition of independence from partisan politics 
     by developing an informed citizenry acting as public health 
     advocates; Do not let the system become simply an auxiliary 
     to the military.

     

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