The Committee on Public Health, in its first year of standing-committee status, is chaired by Howard Koh, M.D., M.P.H., former Massachusetts Commissioner of Public Health, associate dean for public health practice at the Harvard School of Public Health, and an influential and committed advocate for public health. He sat with us recently to discuss the public health challenges facing the Commonwealth.

Q: In terms of public health, where is Massachusetts particularly strong today, and where are we vulnerable?

A: Massachusetts deserves its reputation as a leader in medicine and public health. Aspiring physicians and young public health professionals flock to Massachusetts to receive world-class education and training. I am grateful to have received my house officer training and formal public health education at leading teaching institutions here. Also, as recently as 2002, when serving as Commissioner of Public Health, I was proud to see Massachusetts rise to among the healthiest states in the country. But our ranking has begun to decline. We are vulnerable because too many view public health as desirable, but not essential. The public health budget has been eviscerated. Because public health protects every life, every day, it requires continuous support.

Q: What are the most important short- and long-term effects of those budget cuts?

A: Cuts in the public health budget represent a major breach in our commitment to the future health of all Massachusetts citizens. In the short term, we are witnessing a destabilizing -- or outright dismantling -- of life-saving systems such as tobacco control, HIV services, substance abuse services, violence prevention, school health, immunization, and access to health care. In the long term, such cuts will exacerbate health disparities and cause an increase in preventable suffering.

Q: What can be done to temper the effects of the budget cuts?

A: First, we must dispel the notion that good public health can be jettisoned in tough economic times and then magically retrieved in good times. Like fire and police services, strong public health is always necessary, especially in this era of bioterrorism and emerging infectious diseases. We can't deliver adequate health protection without sustained commitment and support. Policy makers need to be reminded of this.

Second, we can focus on policy advances that don't involve excessive costs. For example, Massachusetts recently became the sixth state to enact a statewide workplace smoking ban.

Third, our state now receives up to $300 million a year from the landmark 1998 Master Settlement Agreement with the tobacco industry. But that funding is being diverted away from public health. We should insist on an accounting of those funds, so that they are dedicated to health, as initially intended. Otherwise, we will forfeit the opportunity of a lifetime.

Q: What is the most important public health challenge we face over the next year?

A: We must start rebuilding our public health system immediately. There is no other option.

Q: What role should the MMS play in that rebuilding process?

A: MMS has long emphasized the importance of public health, a theme now rearticulated by our new president, Dr. Alan Woodward. All physicians should take a broad view on preventing human suffering. Prevention adds years to all of our lives and quality of life to all of our years. Through the MMS, physicians deliver that message emphatically. While we continue to treat those whom we see, we can also prevent suffering for those we will never see.

koh,public health,budget cuts