Public Health in the Market

Can the public health enterprise assure the conditions in which people can be healthy in an aggressively profit-oriented environment? This book examines the challenges and dilemmas, and presents potential solutions for those who work for better health in the face of competition, tight budgets and widening gaps in health and wealth. Public Health in the Market draws on research, the media, opinion polls, and extensive on-site interviews with practitioners and policymakers to document the problems of our health-care system. It includes an historical account and report of the current status of national and local public health systems; uniquely detailed case studies supplemented with lessons gleaned from a comparative analysis; and an interpretive summary of the prospects and possible directions for public health. It raises the question of whether public health is to be a commercial enterprise or an enterprising and universal public service. Chapters examine policy effectiveness, suggest options for action to influence policy change, and discuss the real-world dilemmas in the information/education vs. policy action debate in the public health community. Nancy Milio addresses issues that are central to public health disciplines, institutions, and policymakers, and of critical concern to systems and professions that are tangentially related to health care, including school systems, health centers, womens' and social services, and especially nurses moving out of downsized inpatient facilities to work in local communities. Corporations, now part of the mix of organizations that must find ways to work together to support population health, will benefit from this book. The legal and moral leadership resides in public health systems--health departments and allied groups--to develop ways to protect and promote health for the entire community, as well as engage the public and the media in the process. Nancy Milio is Professor of Health Policy and Administration and Professor of Nursing at the University of North Carolina, Chapel Hill. She has worked in the United States and other countries in community health organizing, in academia, and in public arenas on policy issues.