December 14, 2010

Spurred by poor health indicators that show a need for Georgia to re-evaluate its public health priorities, the Public Health Commission recently concluded that an independent Department of Public Health should be formed, and its primary charge would be overseeing the health of all Georgians. The commission, a nine-member panel of industry professionals, was convened through an act of legislation passed in 2009, and its recommendations were presented through a report to the governor, lieutenant governor and state General Assembly.

Georgians remain near the bottom in national measures of overall health, as they have for the past forty years. Thirty Georgia counties have a life expectancy lower than 73 years, which is younger than that of individuals living in the Gaza Strip, El Salvador, the Dominican Republic and Thailand. Smoking and obesity is common among Georgians, both of which contribute to the shorter life expectancy. Georgia infants are faced with high infant mortality rates and are more likely than babies born in 45 other states to be born at a dangerously low weight.

Effective public health campaigns would address these issues; however, efforts are stymied by a cumbersome bureaucracy and shrinking budgets. Even though the state population has increased by 20 percent since 2000 and health care expenditures have increased by 100 percent, the state’s public health budget has declined by 20 percent. As it stands, the Division of Public Health is housed within the Georgia Department of Community Health, a department that to a large extent is concerned with issues of health insurance and financing. Consequently, core public health functions of assessment, policy development and assurance are not being implemented effectively.

The commission’s report included the following recommendations:

• The Division of Public Health should become an independent state agency – the Georgia Department of Public Health, which would be led by a commissioner who reports directly to the governor and would act as the state’s chief health officer. This person should be a physician, and should have extensive public health knowledge.
• The Office of Health Improvement should become part of this department, as should the Office of Emergency Preparedness and the Georgia Trauma Care Network Commission, with the last of which being an attached agency, while the other two would be wholly contained within the Department of Public Health.
• A Public Health Study Commission should be appointed every three years to study the effectiveness of public health efforts in the state. This commission will provide to the governor and the Georgia General Assembly progress reports on the health of Georgians.

Through this restructuring, public health professionals will be granted greater autonomy, enabling them to respond more quickly to crisis situations, rather than having to obtain layers of approvals in order to act. This autonomy will also allow the Department of Public Health to set appropriate priorities and craft a comprehensive mission, distinct from issues of health care finance and Medicaid. By directly reporting to the governor and having significant access to the legislature, the state health officer will have a better chance of achieving the agency’s goals. Greater visibility as an independent agency will both raise awareness of the importance of public health, as well as increase transparency.

It has often been difficult for public health to get the attention and resources necessary to raise the health indicators of all Georgians. State budgets are always tight, especially during a recession, and health care costs are escalating, including those related to Medicaid and the State Children Health Insurance Program, or PeachCare as it is known in Georgia. Most importantly, when prevention is successful, the mechanisms which safeguard public health become invisible, reducing the sense of urgency.

For example, when food remains safe, the activities involved in monitoring food supplies and enforcing safe food regulations becomes invisible. It is only when the function fails and a salmonella outbreak occurs that we remember the importance of public health functions. This “out of sight, out of mind” approach can, in turn, lead to a false reality in which both citizens and the lawmakers who represent them wrongly believe that the state of public health in Georgia is much better than statistics indicate.

But public health touches all areas of our lives, and through efforts that emphasize prevention and wellness, health will improve and disparities will decline. Effective assessment will provide for the surveillance of new or potential health concerns (such as emerging flu strains) as well as the evaluation of causes of illnesses and death (such as HIV infection and cancer), and lead to effective prevention strategies. When assessment is done well, policy recommendations that improve the health of citizens are developed. Once sound policy is proposed and, ideally, implemented, public health agencies are able to assure that our state is working to the best of its ability to ensure good health for all Georgians.

The Public Health Commission believes this is possible primarily through the establishment of the Department of Public Health. It is now up to the governor, lieutenant governor and General Assembly to agree.