Amid the vast amount of time the media devoted to last year's anthrax attacks, discussions arose about the previously overlooked problem of America's shaky public health system. With Congress now presenting bills that would authorize billions for bioterrorism preparedness, the public health system overall will likely be strengthened.

However, while more money for bioterrorism research and response may benefit the system as a whole, faith organizations, health professionals, and civil rights groups are raising questions of equity in this new-and-improved public health system.

As people of faith who advocate for quality care for all people, a closer examination of the use of resources and distribution of services is in order.

The U.S. Public Health System

Those who work in or closely with the U.S. public health system do not dispute that it has definite weaknesses. As noted by Michael McGinnis, M.D., senior vice president and director of the Health Group at The Robert Wood Johnson Foundation: "Eighty percent of public health departments lack the information infrastructure necessary to com- municate with their central state health department or with local providers." He estimates that only one-third of the U.S. population is being effectively served by the public health system.

Public health systems monitor disease outbreaks, detect and investigate health problems, conduct research to enhance prevention, and implement prevention strategies, among other activities to promote a healthy population.

The Center for Disease Control (CDC), under the U.S. Department of Health and Human Services, reports that in addition to protecting individuals against emerging infectious diseases (including bioterrorism), it is also working on other health challenges and goals:

• Preventing violence and unintentional injury,
• Promoting credible and accessible health information to the general public,
• Eliminating racial/ethnic health disparities, and
• Improving the wellness of people with disabilities.

New Legislation

The Department of Health and Human Services (HHS) is requesting $4.3 billion for its 2003 bioterrorism budget. This reflects an increase of $1.3 billion, or 45 percent, over last year's budget. From this amount, the Public Health and Social Services Emergency Fund would receive $2.3 billion. It is hoped that these funds would be used to shore up the weakest links in public health systems, strengthen response capacity in rural and local areas, and improve bioterrorism response.

Benefits from Higher Funding

There are further benefits to having a better-funded public health system in other ways than improved bioterrorism preparedness. For instance, more funding, and the requirement that states turn in workplans to improve their public health systems, could improve response to trends in other non-bioterrorism-related outbreaks. All but three states have turned in plans that outline the creation of regional hospital response plans, upgrades in disease surveillance and improvements in laboratory and communications systems.

Better training for health professionals could be another positive result of bioterrorism preparedness funding. Professionals may receive better training in how to report and communicate with the proper authorities when an outbreak of any sort is suspected.

Better reporting systems and communication at local, regional and national levels may also increase the speed and efficacy of multi-level responses to disease.

Ignoring Other Health Concerns?

In our efforts to be vigilant to any new bioterrorism attacks, some believe that other "crises" in the health of the nation may be neglected; the continued spread of HIV/AIDS, the weakening of the Medicare and Medicaid systems, and environmentally-related health problems. Reflecting this possible neglect of other health concerns, Mohammed Akhter, executive director of the American Public Health Association stated, "Prior to 9-11 we were focused on the HIV-AIDS problem, focused on teenage pregnancy, focused on immunizing kids. Those things are now on the back burner."

However, Congress seems to be increasingly willing to address health care legislation this year. For instance, both chambers are now considering an increase in the U.S. contribution to the global AIDS fund (to prevent and treat HIV/AIDS, tuberculosis and malaria). Similarly, both the House and the Senate are debating mental health parity, recently endorsed by President Bush. This legislation would promote greater parity between medical/surgical health coverage and mental health coverage offered by insurance companies.

Supporting legislation related to funding these other important health issues may be reassuring to those concerned that bioterrorism prevention was the only health issue the U.S. government was able to address in the wake of the fall 2001 anthrax attack. Nevertheless, we must continue to ask whether the health care needs of all people are being met, and continue to push Congress toward enacting more equitable health care policies.

"Health Care Systems and medical care delivery require good management and stewardship practices. As disciples and stewards, we are called upon to use our technological and human care skills to provide health for all the peoples of this nation and to do our share in the remainder of the world. Health, healing, and good medical care are a measure of our level of civilization as a nation. For the church, these concerns are absolutely fundamental to our mission. They are a measure of our faithfulness to the central mandate of the gospel enabling the divine Word to dwell among us, expressing a faith that makes us whole" (1988 Minutes, Part I, p.525).