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Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population's Wellbeing


Lawrence O. Gostin


Georgetown University - Law Center - O'Neill Institute for National and Global Health Law

Peter D. Jacobson


University of Michigan School of Public Health

Katherine L. Record


Georgetown University - The O'Neill Institute for National and Global Health Law

Lorian Hardcastle


University of Toronto - Faculty of Law; Georgetown University Law Center

March 7, 2011

University of Pennsylvania Law Review, Forthcoming
Georgetown Public Law Research Paper No. 11-24

Abstract:     
The Patient Protection and Affordable Care Act is a major achievement in improving access to health care services. However, evidence indicates that the nation could achieve greater improvements in health outcomes, at a lower cost, by shifting its focus to public health. By focusing nearly exclusively on health care, policy makers have chronically starved public health of adequate and stable funding and political support. The lack of support for public health is exacerbated by the fact that health care and public health are generally conceptualized, organized, and funded as two separate systems. In order to maximize gains in health status and to spend scarce health resources most effectively, health care and public health should be treated as two interactive parts of a single, unified health system.

The core purpose of health reform ought to be the improvement of the population’s health. We propose five criteria that would significantly advance this goal: prevention and wellness, human resources, a strong and sustainable health infrastructure, robust performance measurement, and reduction of health disparities. Although the Patient Protection and Affordable Care Act includes provisions addressing these criteria, population health is not a central focus of the reform.

In order to guide health reform implementation and to inform future health reform efforts, we offer three major policy reforms: changing the environment to incentivize healthy behavioral choices, strengthening the public health infrastructure at the state and local levels, and developing a health-in-all policies strategy that would engage multiple agencies in improving health incomes. Adopting these reforms would facilitate integration and dramatically improve the population’s health, particularly when compared to the health gains likely to be realized from a continued focus on access to health care services.

Number of Pages in PDF File: 51

Keywords: health care reform, public health, health law and policy

JEL Classification: K00, K32, I00, I11, I18

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Date posted: March 7, 2011  

Suggested Citation

Gostin, Lawrence O. and Jacobson, Peter D. and Record, Katherine L. and Hardcastle, Lorian, Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population's Wellbeing (March 7, 2011). University of Pennsylvania Law Review, Forthcoming; Georgetown Public Law Research Paper No. 11-24. Available at SSRN: http://ssrn.com/abstract=1780267

Contact Information

Lawrence O. Gostin (Contact Author)
Georgetown University - Law Center - O'Neill Institute for National and Global Health Law ( email )
600 New Jersey Avenue, NW
Washington, DC 20001
United States
202-662-9038 (Phone)
202-662-9055 (Fax)
Peter D. Jacobson
University of Michigan School of Public Health ( email )
109 Observatory
Ann Arbor, MI 48109-2029
United States
734-936-0928 (Phone)
734-764-4338 (Fax)
HOME PAGE: http://www.sph.umich.edu/~pdj/
Katherine L. Record
Georgetown University - The O'Neill Institute for National and Global Health Law ( email )
600 New Jersey Avenue, NW
Washington, DC 20001
United States
Lorian Hardcastle
University of Toronto - Faculty of Law ( email )
84 Queen's Park
Toronto, Ontario M5S 2C5
Canada
Georgetown University Law Center ( email )
600 New Jersey Avenue, NW
Washington, DC 20001
United States
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