MMA Viewpoint
The Most Important Field
Throughout history, the greatest improvements in health have come through the strides we have made in public health. Better sanitation, cleaner water, vaccination against disease, and cleaner air have prolonged people’s lives and improved their health.
That’s why the MMA has made public health one of the bedrocks of its vision for health care reform. Public health initiatives often occur behind the scenes but have a tremendous impact. When food-borne illness strikes, the health department tracks down the cause and prevents more people from getting sick. Newborn screening catches diseases in time to prevent lifelong illness or death. Efforts to increase vaccination rates prevent disease. The list goes on.
The state’s budget deficit could pressure lawmakers to make funding cuts that would erode these and other core public health efforts. For that reason, we must be vigilant and make sure the gains of the past are sustained. The MMA will urge legislators to take a long-term approach and continue support for the state’s disease-prevention and surveillance programs and for health promotion initiatives that have helped make Minnesota one of the healthiest states in the nation.
As part of the 2008 health care reform legislation, lawmakers earmarked $47 million for grants to be given to community health boards and tribal governments to fight obesity and tobacco use. Now we fear that they may back away from this commitment before the grants are scheduled to become available in July.
Considering the impact of obesity and tobacco on health, this would be short-sighted. During the last few years, the incidence of obesity and diabetes accompanied by the development of insulin resistance and dysmetabolic syndrome has skyrocketed. In my own practice, I have witnessed a marked increase in the number of children with diabetes, especially type 2 diabetes. Type 2 diabetes in children was virtually unheard of in the 1970s and ’80s but is now fairly common.
Obesity contributes to the insulin resistance that often presages the development of diabetes. But it is not the sole cause. As long as I’ve been in practice, I’ve seen obese children. What is different today is the increase in insulin resistance, and we don’t know exactly why that’s happening. There is much speculation about diet and other possible triggers, which is why this problem cries out for scientific study that can help us discern the etiology of insulin resistance and find ways to avoid the triggers. Preventing obesity is certainly part of the solution.
The public health challenges associated with obesity today are very similar to those the health profession faced 50 years ago with smoking. Only through sound scientific research have we been able to pinpoint the relationship between smoking and lung cancer. Now we need a similar public health emphasis on the importance of weight control in preventing diabetes.
I hope you will join me in supporting the public health initiatives that are part of the MMA’s health care reform vision. For all the progress we have made in treating disease, an ounce of prevention is truly worth a pound of cure.