Health Reform and the Health of the Public

REGARDLESS of the direction or timing of the reform of the health care financing system, the nation's health status may not substantially improve without simultaneous reform of the public health system. Reducing administrative complexity and redundancy and, most important, assuring that all US citizens have access to quality medical care will do little to influence the true determinants of ill health: unsafe environments, unhealthy personal behaviors, and biologic, genetic, and socioeconomic factors.1-3These determinants account for more than 1 million deaths per year and untold levels of preventable morbidity and expensive (avoidable) health care in the United States.4Thus, the concept of health system reform should not be restricted primarily to medical care; it should also encompass strengthening the practice of public health and stimulating new systems of integration among all organizations within a community whose missions have an impact on the health of the public, many of