I am almost finished reading Daniel Callahan's fine book False Hopes: Why Americans's
Quest for Perfect Health Is a Recipe for Failure, and I would like to take this opportunity to
share some of his thoughts on public health. Callahan is director of International Programs at
The Hastings Center and is the author of five previous books on medicine and medical ethics.
In False Hopes, Callahan summarizes the ideal of public health as follows: "(1) the scientific
view that the key to population health lies in the background educational, social, economic,
and environmental features of society and in the successful deployment of effective
health-promotion and disease-prevention programs;" (2) the social ideal which understand
the struggle against disease, unintentional injury, and illness which requires common effort and
common sacrifice aiming for a common, collective good health; (3) the economic conviction
that only an economically sustainable medicine oriented to population health ought to be
politically acceptable in the future; and (4) the moral ideal that individual/personal health will
significantly determine lifetime health and that people have a social obligation to take care of
themselves for their own sake as well as for the sake of society. (p. 176).

The three elements central to public health, according to Callahan, are: "(1) the field focuses on
the health of populations as a whole, not the health of individuals; (2) the main goals of the field
are, classically, the control of infectious disease and other general hazards to health; health
status surveillance and monitoring; and of late, health promotion and disease prevention; and
(3) a central, but not exclusive, role for insuring public health lies with government." (p. 179).

Callahan stated that one of the reasons that public health has trouble gaining support is because
"public health is interested in everyone in general but no one in particular." Popular thought
favors programs that help me as an individual. That is a main reason why acute-care,
high-technology medicine, by contrast, is publicly supported more than public health. In
addition, medical approaches are generally short-term and public health is more future oriented.
This is why there are television dramas about hospitals and not about public health workers,
despite the heroic public health work that takes place in this country everyday. "ER" on
television can solve problems immediately, a public health worker may take years to show
progress. We all know that society likes quick fixes. I once heard a speaker on the radio say
that it doesn't take a rocket scientist to solve complex social and health problems--it takes much
more!

A key underlying factor about public health is that " . . . public health in the political area is . . .
not well understood, not carefully defined, and thus in the end not well defended."(p. 178).

Callahan offers us much food for thought. We have a long way to go before we are well
understood and well defended, but we are making progress.

If you are interested in reading Callahan's book, it is available from www.amazon.com for
about $17. I have spoken to Callahan on the phone and I am determining if there might be a
time when we could bring him to Nebraska for a presentation sometime this year.
Unfortunately, he is not available for our Sept. 16 conference.

David E. Corbin, Ph.D., ACSE, FASHA
President, NPHA