Building healthy communities to promote public health: parting words from APHA's president.

My year as APHA president has flown by quickly and has been extremely invigorating and rewarding. I thank all those who have hosted me at their Affiliate annual meetings and other events both inside and outside of the United States. I am continually impressed by the dedication and commitment of all the public health practitioners and researchers I have met in my travels this year. It makes me hopeful that a strong public health movement is developing at the local, state, national and global levels.

My travels have reinforced several things. On the global front, we continue to be one of the few countries in both the developing and developed world that does not consider health a right for all citizens and acknowledge that health is a key component of economics and development. This is a discussion we need to continue to pursue in our country. As Thomas Jefferson said in 1787, "without health, there is no happiness. An attention to health, then, should take the place of every other object."

On the national level, it is an exciting time as discussions for covering the uninsured are prominent in many states. There are tremendous opportunities for APHA and its affiliated state and regional public health associations to advocate for the role of public health in preventing disease, building healthy communities and promoting and protecting health. Unfortunately, the state discussions to date do not include a commitment to the public health infrastructure. Our goal should be for state legislatures and Congress to include a steady stream of resources for public health as they pass mechanisms to cover the uninsured. Otherwise, the discussion continues to be on coverage and reduction of costs for those who have chronic diseases but not on the prevention of chronic disease. As only 10 percent of the health of the public can be attributed to the medical health care sector and 50 percent can be attributed to behaviors, it is clear that multi-component, multi-sector approaches in every community are necessary to prevent chronic diseases and keep the population healthy. Just as we learned in addressing tobacco use, no single intervention works.

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We need to promote healthy communities and work to obtain resources to address inequalities to access and unhealthy conditions in all communities. We need to focus consistently on where people live and work as well as on the channels of communication that provide information that affect individual behavior. Only the public health system is accountable for the health of all in every community. We need to continue to advocate for this infrastructure. If we do not, no one else will!

Our greatest challenge is to develop the political will to use the evidence we already have and that we can develop and the social strategies we know are necessary to make positive improvements in the health of the public. APHA, its Affiliates and the World Federation of Public Health Associations together have enormous potential to be a driver for change to meet APHA's mission of a "healthy global society."

Deborah Klein Walker, EdD

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