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agencies-is eroding.
The symptoms of this erosion were
clearly identified several years ago in the
Institute of Medicine's The Future ofPublic Health.2 Recently, this evidence has
been brought into much starker relief at
the state and local levels-where health
services theory, concepts, and research
results must ultimately have relevance-by well-publicized crises in public
finances, including a $350 billion federal
deficit that is rising.
As we begin 1992, state and local governments across the United States are battling huge budget deficits, cutting services
dys-
functions and premature deaths are preventable through the application of scientifically valid "promotion/prevention"
strategies. But as Sam Thier,4 former
president of the Institute of Medicine,
writes, "health promotion and disease
22 Amencan Journal of Public Health
social services.
5. Long waits (7 hours in some
cases) and overcrowding in public hospital emergency rooms are so severe that
many patients who seek and need emergency care are leaving the hospital without
seeing a physician or other health care
professionals.
6. Almost lOyears after homelessness captured the nation's attention, empathy is turning to intolerance as communities impose harsher restrictions on
homeless people to reduce their visibility.
These changes in local policies are fueled
by a public that has grown increasingly
impatient with a problem that has worsened despite programs aimed at relieving
it.
7. In the summerof 1991, 25 workers died in a chicken processing plant that
had never been inspected for health and
safety compliance-evidence that much
remains to be done in the prevention of
job-related injuries and deaths.
8. Related to job-related injuries
and deaths is the current imiishing role
of labor, which over the years had developed a high degree of sophistication in occupational safety and health training of
workers, in monitoring and surveillance of
work places, and in policy formulation and
analysis. Today labor finds its ranks decreasing, its policy-influencing power
eroded, and its sense of mission in question.
The above milieus are reflected in
modern public health literature, in annual
reports of private foundations, in Morbidiay and Moitaly Weekly Reports, and in
the popular press. They are also evident in
References
1. Rogers DE. A private sector view of public
health today. Am J Public Health.
1974;64:530-533.
2. Institute of Medicine. The Future ofPublic
Health. Washington, DC: National Academy Press; 1988.
3. Clymer A. Politicians take up the domestic
issues: Polls suggest why. The Week in Review. New Yori Tines. Sept 15, 1991: Section 4-3.
4. Thier S. President's Message, Institute of
Medicine Annual Report 1990. Washington,
DC: National Academy Press; 1991.
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