The current issue of the Journal of Public Health Management and Practice, provides a definitive analysis of the Patient Protection and Affordable Care Act (PPACA), which is now under fire as an unconstitutional exercise of federal power.
According to the authors of "Swimming Upstream? Patient Protection and Affordable Care Act and the Cultural Ascendancy of Public Health," the act provides the first true opportunity to elevate the nation's commitment to the most critical elements of public health - disease prevention, wellness promotion, and population-based interventions.
The observations are based on a comprehensive review of the PPACA, along with recent literature and related commentary, appearing in the March/April issue of the Journal of Public Health Management and Practice, published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.
"The inclusion of dozens of public health initiatives in PPACA and a definite public health orientation suggest a change in society's attitude and support of prevention," said lead author and public health professor Kenneth DeVille, PhD, JD. "But such change will require social real conversion."
The article explains how the eventual magnitude of the impact of PPACA on prevention is linked to a number of societal and financial factors, making the final result uncertain.
"While the PPACA potentially represents the largest infusion of capital into the public health infrastructure in U.S. history, the real world impact of this act will depend on how funds are actually appropriated, which has not yet been determined," said DeVille and coauthor Lloyd Novick, MD, MPH.
The authors also suggest that the ultimate success of the effort will depend on the level of public support, and unfortunately attacks on the public health provisions have already been attempted. Last November, the Johanns Amendment in the Senate proposed to eliminate nearly all of the preventative and public health funding from the act. The amendment ultimately failed, but illustrates the risk created by partisan disagreement about the intent and value of the PPACA.
The authors assert that the act will only meet its promise if government and social leaders shift the focus to a broader vision of preventative public health issues, and if more Americans embrace the idea that healthcare is more than just medical care for the sick.
"While opinion shifted enough for the act to include a public health focus, I am concerned about its future because U.S. culture remains focused on what is good for individuals vs. the public as a whole, and on limiting the role of government," said Novick.
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