The Clinton health care plan: what's in it for environmental health?

I recently had the pleasure to serve on a panel with presidents of several allied health organizations, including the National Rehabilitation Association, the American Occupational Therapy Association and the American Physical Therapy Association, as well as Dr. William Darity, Professor of Public Health Emeritus, University of Massachusetts. The occasion was a conference entitled The Future of Allied Health: Reform, Resources, and Roles, sponsored by the School of Allied Health Sciences, East Carolina University in Greenville, North Carolina. The keynote address was given by Dr. Claudia Baquet, Deputy Assistant Secretary for Minority Health, who coincidentally happens to be on the Clinton Health Care Reform Task Force.

The Clinton Health Care Reform is probably one of the most important pieces of legislation that this country will see for many years, since it will not only affect the delivery of health care systems, but if implemented in its intended fashion, will stress disease prevention and health promotion. So what's in it for us as a profession?

First of all, we must keep in mind that all environmental laws and regulations are predicated and promulgated primarily to protect the health of the public -- environmental protection comes second. In considering control of rising health care costs, improving overall health care and improving the overall quality of life, we must remember that prevention of environmental problems which affect the public's health is much cheaper than treating the diseases caused by bacterial and viral infections, or by volatile organic compounds, asbestos or heavy metals.

It was said by someone that only 10 percent of the cost of the health care system is due to "the system," with the other 90 percent being incurred as actual treatment costs. Whether or not those figures are exact is irrelevant, since the premise is still valid. The proposed health care reform asks individuals and employers to share in the cost of implementing and maintaining the system. If this is to work, we as individual and as an organization must do two things:

* strengthen our basic environmental health activities which are designed to educate the public to preventive measures which include basic sanitation, and

* have an active enforcement of existing regulations concerning health and sanitation as well as environmental management concepts.

Individuals should be responsible for their particular lifestyle and the health which emanates from that lifestyle--government should not shoulder the responsibility. However, government should make an effort through existing regulations to control those influences over which individuals have no control. For true health care reform -- in addition to health reform -- to take place in the United States, we must address basic environmental health needs of our own "third world countries" existing in our inner cities as well as in rural areas such as Appalachia.

For the environmental professional, the outlook is good. The President's health care plan places emphasis on disease prevention and health promotion -- exactly what the holistic approach to environmental health and environmental protection entails. If there is a weak spot, it may be funding. The majority of environmental health and protection officials are employed in governmental agencies, which may or may not see additional funding for enforcement. The American public is a curious creature -- it wants less governmental involvement, yet still wants more services with no increase in tax liability.

This health care plan has only been introduced. It will go through many revisions and will be subjected to attacks from special interest groups before being adopted. As individuals committed to disease prevention through good, sound environmental health practices, we need to be aware of the progress of this legislation and let our elected representatives know that environmental health involves disease prevention and health promotion, not simply enforcing regulations.