Federal role in public health: Who is in charge?

The federal role in public health is influenced by a combination of popular pressure, health crises, scientific advances, and the presence or absence of public health leadership. The most powerful opponent of progress in public health (in the halls of Congress (the White House) and in the structure of the Federal bureaucracy) is the economic forces inherent to capitalism.

The changing Congressional role in passing national health insurance legislation since the 70's will be described and compared to current proposals by presidential candidates. Given the massive infiltration of market forces, can any of these proposals succeed?

While the role of surgeon generals has, at times, been important in raising public awareness of public health issues (e.g. SG Julius Richman – Smoking Cessation; CE Koop; HIV/AIDS; Jocelyn Elders: Adolescents; Sexual and Family Health; and David Satcher: Mental Health: Dental Health ) , their efforts have been limited by their lack of authority to implement policies. At times, their efforts are actively blocked. The recent case of Richard Carmona is a case in point.

The federal role has been affected most dramatically when popular movements press for change. The Civil Rights movement spawned an amazing improvement in the public health infrastructure. Unfortunately, this was short-lived. There is, however, reason to hope that we may be on the cusp of the resurgence of popular movements for social justice. There may be a convergence of the anti-war and civil rights struggles as in the 60's. The anti-Iraq war movement is certainly not yet comparable to the anti-Viet Nam war movement. And the Jena 6 struggle has barely reached public consciousness. But perhaps both will renew the American sense of social justice.