[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
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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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