C. William Keck, M.D., M.P.H., APHA President, 1991

Supporting the Public Health Infrastructure

An important element of APHA activity, which has largely been hidden from view over the years, has been the impact that APHA has had on services delivered at the local level, particularly in local health departments. At the same time, APHA has been very active in trying to educate Congress about global public health issues. APHA has arranged hearings in front of Senate and House committees, dealing with such things as the re-emergence of tuberculosis and other infectious diseases and the emergence of new diseases. It is very important to help members of Congress understand what public health is and how the profession responds to emergencies. APHA brought the medical community into the early, very emotional, debate about HIV and helped to transform that debate into one that produced policies that, by and large, made some sense.

I think that many of us don’t realize how much APHA did to support funding for activities of local health departments. A categorical program can sometimes get a bad name, but in many ways it is APHA that allowed the Reagan block-grant proposals in the early 1980s to succeed and continue. It was APHA that eventually succeeded in requiring mandated reporting of results of those block-grant expenditures to the degree that it was increasingly difficult for Congress to stop them B- which is what we thought the intent of that approach was at the beginning. Dr. Tony Robbins, who served as APHA President in 1980, had a great deal to do with model standards. He managed to get Congress to implement model standards through CDC and to require that APHA be involved in their development, an effort that has been very important for APHA and local health departments.

The effort that we put into public health issues in the Clinton health plan, though not successful, created a national stage on which public health importance was at least recognized in some areas. And I think it set the stage for doing what we might now try to think about doing next.

It has been encouraging to meet and hear our new Executive Director (Dr. Mohammad Akhter) and Executive Board describe their interests in dealing with local health issues and we certainly are going to need to do a great deal to build the capacity of our local health departments back up to a reasonable level. And I am encouraged that we might expect to see APHA continue to make some impacts in that regard.

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