Taking the Pulse of Public Health.

• Author: Boulard, Garry

As health needs change, lawmakers consider what role public health will play in a new era.

In 1900, people could expect to live to the age of 40. Today, they can expect to live to almost 80," says Jeffrey Koplan, director of the centers for Disease Control and Prevention (CDC). "We've gained 40 years of life in the last century, and most of the gain has been through public health initiatives."

Are these initiatives the fountain of youth we seek? Most people don't even have a ready definition for "public health," let alone a view of it. In fact, public health is nearly invisible when it's working well. But it touches our lives in many forms from the moment we wake until we return to bed. Clean water to drink, clean air to breathe, the balanced breakfast we eat, the seatbelt we wear to drive to our smoke-free workplace, the thoroughly cooked hamburger that goes with the safe salad bar ingredients, the bike helmet our child wears to and from school, the brisk walk we take for exercise and the care we take to wash our hands frequently--all contribute to our health.

In addition, public health initiatives include campaigns to get appropriate health screenings and preventive care, immunize our children and high-risk adults, practice safe sex, avoid tobacco and drugs, and many other efforts that affect us and our health.

Although states play a strategic role in public health initiatives, many legislators are not aware of their full range. Retiring West Virginia Senator Martha Yeager Walker, however, is.

"This is a resilient state with resilient people," she says, "but it is also a state that has a great need for a wide array of public health services, services that in some communities are the link between having a healthy life and not having one."

Walker, an advocate of increased public health services, has studied up close the health of residents in dozens of small valley and mill towns that are still called home by more than half of West Virginia's residents. Although tourism and new light industries have added jobs and boosted the economy in recent years, West Virginia continues to have the lowest median income in the nation and a poverty rate that stubbornly remains at nearly 17 percent, some six percentage points higher than the national average.

"Public health today provides important services to all segments of the national population," says Koplan. "But for smaller states that are more rural and poor, public health programs are absolutely vital."

Not surprisingly, West Virginia's public health budget is significant. After a funding crisis in the early 1990s, the state's Department of Health and Human Resources was given a $1.4 billion budget, of which some 10 percent is dedicated to the growing West Virginia Bureau for Public Health.

Working with the state, local health agencies have a $50 million budget for HIV/AIDS counseling and prevention, family planning, cancer screenings, immunizations, basic pediatric care and other services.

"The county health departments are really the ones that provide the widest system of safety net services," says Henry Taylor, the state commissioner for West Virginia's Bureau for Public Health. "But even with the gradual increases in our budgets over the last five years, that safety net is seriously frayed, taking on more and more burdens for a population that needs even more services."

But in at least one respect, West Virginia is ahead of the game. Beginning in the mid1990s, Senator Walker and others began the arduous process of reviewing hundreds of public health laws, some of which, she says were written in archaic language and were entirely outdated."

HEALTH NEEDS CHANGE

Those laws reach back to the first great advances in American public health, to the era of epidemic cholera, smallpox, yellow fever and typhoid in the late 1800s when most states established public health departments.

"As recently as the 1930s, we had huge epidemics of...