Three Eras That Led To Health Promotion Policy
The Era of Resource Development. The postwar years are sometimes called the era of resource development. In Europe and Japan this was a period of reconstruction in all sectors, whereas in the United States its chief product was legislation to build three types of health resources: scientific knowledge, medical facilities, and health personnel.
Knowledge was developed through inauguration of the National Institutes of Health and massive investments in biomedical research. Facilities were developed through the Hill-Burton Act. mandating the building of hospitals and clinics in virtually every community. Personnel to staff these facilities came with the Health Manpower Act, renewed periodically to finance the professional training of physicians, nurses, dentists, veterinarians, and a modest number of public health and allied health personnel.
This momentous investment in health resources produced an infrastructure that was primarily biomedical rather than health in its orientation. Eventually the question arose: Are these vast resources for medical care equitably distributed?
The Era of Redistribution. In the 1960s the United States entered an era of redistribution of resources with the New Frontier initiatives, the Great Society and the War on Poverty of Presidents Kennedy and Johnson. The emphasis was on the equitable redistribution of resources, particularly with the development of neighborhood health centers and the introduction of Medicare and Medicaid in 1966. These new laws were designed to put health authority and medical purchasing power in the hands of consumers, especially the elderly and the poor.
Health education during this era was devoted largely to increasing the public`s use of health services. Programs were designed with behavioral objectives and community organization strategies to reduce the delay in seeking medical care in response to symptoms, to increase participation in mass screening and immunization programs, and to increase attendance at well-child and family planning clinics.
The initiatives of the 1960s achieved greater equity in the distribution and use of resources. The poor now gad greater access to medical services, and their rates of use of those services increased almost to the levels of the affluent. But though the gap between the “haves” and the “have-nots” was significantly reduced in terms of access to medical services, morbidity and mortality indicators continued to reflect strong socioeconomic and racial disparities. The nation now had to ask whether it was paying for unnecessary services rendered by physicians and hospitals eager to tap into the Medicare and Medicaid wellsprings or excessively consumed by patients uneducated to the newly accessible services.
The Era of Cost Containment. The overutilization question came as the cost of medical care was rising rapidly in many countries. Most countries were entering a period of austerity in the 1970s. In the United States, this took the form of cost containment initiatives in gonernment-sponsored programs, especially medical care programs. It also opened a new opportunity for health education and public health, placing disease prevention and health promotion back on the policy agenda after decades of national preoccupation with medical care resources and services.
The era of cost containment began with efforts to trim the pricing of medical care itself, but more basic solutions began to be sought on the demand side with the appoinment of the President`s Committee on Health Education. The Committee report proposed several possibilities for the organization of federal and private sector initiatives to control costs. These included education of the public in self-care and appropriate use of health services (primarily to reduce utilization) and a fundamental strengthening of health education in schools, worksites, and communities.
The Health Maintenance Organization Act of 1973 provided incentives for the medical care system to practice preventive medicine to keep patients out of expensive hospital beds. It made health education services mandatory for those health maintenance organizations (HMOs) receiving federal certification. This requirement was subsequently removed, but HMOs continued to develop health education services.
The National Health Planning and Resource Development Act of 1974 specified public health education as one of the nation`s health planning priorities and made it a requirement of state and regional plans. Self-care education initiatives in health services research and policy gained notable prominence during this period. Note that all of these initiatives of the cost-containment era were designed to reduce the public`s use of health services, whereas in the earlier era health education`s role had been to increase use.
References :
L. A. Aday, R. Andersen, and G. V. Fleming, Health Care in the U.S.: Equitable for Whom?, Beverly Hills: Sage, 1980.
J.H. Abramson, R. Gofin, J. Habib. Et al., “Indicators of Social Class: A Comparative Appraisal of Measures for Use in Epidemiological Studies”, Social Science and Medicine 16, 1982.
Report of the President`s Committee on Health Education, New York : Public Affairs Institute, 1973.
S. G. Deeds and P. D. Mullen, “Managing Health Education in HMOs : Part II”, Health Education Quarterly 9, 1982.
Focal Points (Atlanta : Bureau of Health Education. Centers for Disease Control, U.S. Department of Health, Education, and Welfare, July 1977).
L. W. Green, R. A. Goldstein, and S. R. Parker, eds., “Research on Self-Management of Childhood Asthma”, Journal of Allergy and Clinical Immunology 72, 1983.
L. W. Green, M. W. Kreuter, Health Promotion Planning An Educational and Environmental Approach, Mayfield Publishing Company, Mountain View, California, 1991.
