In The Future of Public Health (2002) and later, Healthy People 2010, three basic core functions for public health were developed to assist in understanding the role and needs of public health. These functions, states Dr. Lloyd Novick (DVD, 2008), became 10 Essential Services that define public health. These functions, Assessment, Policy, and Assurance are critical to the well being of a quality health care system. Policy is an essential service function which is a challenge to fulfill.
Presently our healthcare science has advanced far beyond the scope of our legislators, and often times, policy advocates. Typically, this is couched in terms such as: “Not enough funds”, or “They just don’t care”. However, such uncaring is unlikely. It is also not that the funds are unavailable; rather it is about the way we use these funds. This is evident. In the book Who Killed Healthcare (2007), Herzinger states that the U.S. spends 2 trillion dollars a year in healthcare, more than China’s entire economy, while enjoying a lower quality of care than they. Additionally, Cuba has made strides in healthcare to the point that they are models for outsourcing healthcare and healthcare education. (Salud!, 2006) And yet, as we see in the recent Congressional debates, we have an unnerving unwillingness to break from our brokenness to move towards what research has shown is more effective. Why don’t we get it? The cost of healthcare has been crippling us financially, and consequently strangling high quality medical services.
While this policy stumbling block is a challenge to healthcare, there are stages to change; these come with time, thought, and awareness. Miller and Rollnick (2006) in their work on Stages of Change names these as Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance. They basically move a person from not knowing there is a problem (Pre-Contemplation), knowing there is one but not knowing if we will do anything about it (Contemplation); to considering the options (Preparation); to trying some of the options, fine-tuning, etc (Action); and finally, to integration of this change into every day life (Maintenance).
Now, granted, these were written about how people work through problems to become motivated and begin problem-solving. And, admittedly, these were written in regards to mental health and addictions treatment. But when exploring policies and their general acceptance by the general public, legislators, policymakers, “stages of change” fit. In addictions treatment, counselors would historically tell a client s/he was in denial, refusing to understand. Over time, treatment has changed to incorporate Miller’s work in their best practices, understanding that when a client was in the Pre-Contemplation Stage of Change: S/he just did not know she had a problem.
Perhaps we do not know yet fully understand our problem with healthcare. Perhaps it is not that we don’t want to get it, but that we truly do not understand the fullness of our dilemma. As in addictions treatment programs, perhaps we have been caught in insanity, thinking we can keep doing the same things over and over, expecting different results. And now, as before, perhaps we are only able to move forward in small incremental steps, not because policies are good or bad, but because we are simply not that far in the stages of change; we want to get, but we just aren’t there yet.
Like Miller and Rollnick’s work suggest, the answers lie in continuing the discussions, entertaining new information and considering new ideas, allowing the media to create a forum for lively debate. It is a nerve-wracking and long process. It is also the way to change. Open discussions, complaints and quarrels, in all we move along in our growth path. Each step a step closer to the planning and programs which will improve the effectiveness and efficiency of our nation’s healthcare.
CDC, Healthy People 2010. As retrieved January 12, 2010 from www.healthypeople.gov
CSAT (1999). TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment. SAMHSA: MD
Field, C. and Reed, G. (2006) Salud! (DVD)
Herzinger, R. (2007). Who Killed Healthcare? McGraw-Hill: NY
Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People for Change. NY: Guilford Press, 2002.
Novick, L. 2008. Health Policy & Management, DVD. Laureate Education, Inc: MD.
Novick, L, Morrow, C. and Mays, G. (2008). Public Health Management: Principles for Population-Based Management. Jones and Bartlett: MD.
Shroeder, S. A. (2007). We can do better—improving the health of the American people. New England Journal of Medicine, 357(12), 1221–1228.