Introduction

In the early years of the last century the life expectancy of most Americans was approximately forty-five years of age. The length of life has increased for men and women in this country by over thirty years since then. A large portion of this longevity is the direct result of public health activities associated with immunizations, health education programs, and various prevention programs developed by state and local public health departments. This represents a success story for public health in the United States.

The activities of public health departments, which focus on the prevention of health problems before they occur, make up one of the most important components for achieving better population health in every community in the United States. If we are ever to improve the health of the population, there is a very real need for public health interventions within every community population. This will not happen until the public health system's infrastructure is rebuilt, an endeavor that must include leadership training for those placed in charge of this area of health care services delivery in our country.

Improvement of the Health of the Population

When we think about the U.S. health care system, the process of curing and treating diseases is usually the only idea that pervades our thought process. Turnock (2009) points out that activities dedicated to maintaining and promoting health are not usually considered health services by our current medical care system, which has always left the prevention and promotion of health to public health agencies primarily funded by the government. Over time, however, the interest in and funding for these public health activities have been reduced, and it seems that public health activities only become visible in times of crisis.

According to Mays et al. (2004), the public health system in the United States has been receiving growing attention because of emerging health dangers, trends in health policy, and developments in the health care marketplace. In recent years, primarily due to threats of bioterrorism, the epidemic of obesity, and type 2 diabetes, a great deal of attention has been given to the role of prevention in our health care system. The new health care reform bill, signed by President Obama in April 2010, mentions the need to prevent chronic diseases and their complications. Prevention is the major responsibility of public health departments, so a great deal of attention has recently been given to the potential role of public health as our health care system is being reformed.

According to the April 2010 issue of the Nation's Health (“Q&A with Surgeon General Benjamin”), the eighteenth surgeon general of the United States, Regina Benjamin, wants to “transform our sick care system into a wellness system.” Benjamin believes that although the public health system is the cornerstone of the U.S. population's health, it has not received the resources that it deserves. She advocates reversing this trend, pointing out that Congress has appropriated $1 billion for prevention and wellness programs as part of the American Recovery and Reinvestment Act. This money will be used to increase the number of public health workers and continue the expansion of prevention and wellness efforts in U.S. communities.

The increase in life expectancy in the United States can in large part be directly attributed to the many public health accomplishments that were made possible by dedicated workers. Work directed toward reduction of tobacco use, efforts to encourage better nutrition and more physical activity, proper immunizations, and health education programs are just a few of the services that public health departments developed and implemented during the last twenty years. These accomplishments in the area of preventive health care occurred despite the depleted public health infrastructure.

Chronic diseases—such as heart disease, cancer, and diabetes—are the leading causes of death and disability in the United States. As the burden of chronic diseases in the United States continues to increase, public health departments should make greater efforts to identify and implement interventions that successfully reduce disease risk, especially in the workplace. According to the Florida Department of Health (2011), these diseases account for seven of every ten deaths and affect the quality of life of ninety million Americans. Although chronic diseases are among the most common and costly health problems, however, they are also among the most preventable.

The public health challenge has moved way beyond defeating organisms that cause communicable diseases and into the new world of preventing community populations from developing chronic diseases that cannot be cured. These chronic diseases are caused by high-risk health behaviors that result from lifestyle choices that can be changed. Altering lifestyle behaviors may very well serve to increase longevity as well as quality of life in older years. In order to meet this challenge, public health departments need strong leadership and empowered followership to unite the community.

Opportunities for Public Health Departments

The primary role of public health is to prevent illness or disease from ever occurring. Because practitioners in this field prevent things from happening, public health has never been given the respect that it deserves—we are often unable to understand the value of something that did not happen. Because most of medical care encompasses very visible efforts to cure disease, most of the credit for medicine success usually is reserved for the medical care system. This is unfortunate because the increase in the length of life since the early 1900s resulted from such public health services as immunizations and health education programs.

Hemenway (2010) argues that public health is constantly underfunded due to the fact that the benefits of public health activities usually show visible results in the future rather than the present. Unfortunately, most people do not seek medical care until they have become very ill, whereas public health is performing its magic before illness occurs. This is the main reason why the leaders of public health departments need to spend more time communicating what they do and why they do it. Public health has always been one of the best-kept secrets of our health care system. It is time for public health leaders to spend less of their time fighting undeserved budget cuts and more time publicizing their success stories. It is time to raise public health to the stature that it has earned with its various triumphs over the years.

Health care services delivery in this country is undergoing rapid change in structure, process, and required outcomes. The recently enacted health care reform bill has included $500 million a year to be allocated to “comparative effectiveness research,” which is designed to reduce the cost of health care by requiring the health care system to become more efficient in its use of resources. It is becoming the norm to compare various treatment options in order to ascertain the least expensive method of producing the required outcome without sacrificing quality. It is indeed a time of change for the delivery of health care in the United States.

This change will also produce great opportunities for the improvement of Americans' health, as the nation slowly begins to realize the necessity of preventing very expensive health problems from occurring in the first place. This reform in our health care system is producing a great opportunity for public health departments to increase their relevancy in the delivery of health care services to millions of Americans. According to Beerel (2009), relevancy is engaged power that can be used to achieve goals. This is clearly the opportunity that has presented itself to public health departments in our country. Americans are starting to realize the relevancy of population-based medicine, health promotion, and disease prevention—especially in relation to the current epidemic of chronic diseases.

Even though they have high costs at the start, chronic disease and injury prevention programs do very well when cost-benefit analysis is applied to the outcomes associated with their implementation. Public health departments need to expand their success with identifying the causes of chronic diseases into an effort to prevent the occurrence of these diseases or, at the very least, to postpone the onset of their complications until later in life.

We wrote this book in order to discuss the need for new skill development for our public health workforce, leadership training for those responsible for public health programs, along with empowerment of public health employees to expand prevention efforts for the population. Among the skills that public health workers require are change management and conflict management techniques, culture-building abilities, quality improvement skills, communication skills, and team-building and collaboration skills.

There is no question that developing a strong public health infrastructure is one of the most important things we can do to improve the health of our population. It is also critical to note that this infrastructure needs strong leaders dedicated to the achievement of public health goals, which must focus on pursuing outcomes rather than activities that are not producing measurable results. This is going to require profound change in the way public health departments are organized and led.