Professor Gwendolyn Roberts Majette has published PPACA and Public Health: Creating a Framework to Focus on Prevention and Wellness and Improve the Public’s Health in the Fall 2011 issue of the Journal of Law, Medicine, and Ethics. This article is part of a trilogy of articles she is writing on health care reform and was part of a symposium on public health reform.
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA), a major piece of health care reform legislation. This comprehensive legislation includes provisions that focus on prevention, wellness, and public health. Some, including authors in the symposium, question whether Congress considered public health, prevention, and wellness issues as mere afterthoughts in the creation of PPACA. This article argues that they did not. This article documents the extent of congressional consideration on public health issues based on Professor Majette’s personal experiences working on the framework for health care reform – in particular, her experience as a Fellow for a member of the Health Subcommittee of the Senate Finance Committee from 2008-2009.
Professor Majette also includes in this work a review of congressional activity in the United States House of Representatives. Her analysis of the congressional meetings and hearings reveals that Congress had a deep understanding about the critical need to reform the U.S. public health and prevention system. The article illustrates how PPACA will have a positive impact on public health by examining the infrastructure that Congress designed to focus on prevention and wellness, with a particular emphasis on the National Prevention, Health Promotion and Public Health Council; the National Prevention, Health Promotion, Public Health, and Integrative Health Care Strategy; and the Prevention and Public Health Fund. The Council, strategy, and fund are especially important because they reflect compliance with some of the Institute of Medicine’s recommendations to improve public health in the United States, as well as international health and human rights norms that protect the right to health.
Professor Majette begins by addressing the nature of public health in general and setting forth why the U.S. public health and prevention system needs to be reformed. She describes public health as ‘what we as a society do collectively to assure the conditions for people to be healthy.’ Primarily, the system is underfunded and there is insufficient collaboration on public health issues at the state and federal levels. In addition, among other problems, the public health system is cut-off from the health care delivery system, which reduces its effectiveness.
The article sets forth some of the debates and initiatives in the United States Congress regarding reform of the public health and prevention system. Specifically, she addresses the Senate’s framework for health care reform, including the Congressional hearings on prevention leading up to the health care reform legislation, and preliminary legislative proposals with emphasis on prevention, wellness, and public health. With respect to the hearings in both the Senate and the House, she analyzes the testimony of many witnesses who appeared before Congress.
Ultimately, Professor Majette concludes that the National Prevention, Health Promotion and Public Health Council, strategy, and fund fill an important gap in existing federal law by creating a framework that focuses the U.S. healthcare system on prevention and wellness. The comprehensive framework also complies with international norms on human rights by addressing the health care needs of the entire U.S. population; by addressing the intersectoral nature of health issues through adoption of a Health-In-All Policies approach at the cabinet level of the executive branch of the federal government; and by providing desperately needed resources to make financial investments into public health, prevention, and wellness.
You may read the full text of Professor Majette’s article at http://www2.law.csuohio.edu/newsevents/images/39JLME366.pdf