Claudewell S. Thomas, MD, MPH, DLFAPA, is an established psychiatrist currently retired and living in Rancho Palos Verdes, California. He received his medical degree in 1956 at SUNY Downstate College of Medicine and specializes in social psychiatry, public health psychiatry, and forensic psychiatry. Dr. Thomas was board... more
Previous postings have outlined relationships between health and disposable income, health and environment, etc. A public health/epidemiologic approach to identification of factors involved in ill health, death, and disability has been presented as the most logical and productive approach. Despite this, the utilization of public health facilities and practitioners has been declining since the 1970s. The principal cause appears to be the creation of Medicare and Medicaid, transporting the poor into the category of paying customers. Gone are the "house cases" of the 50s and the sanitoria (sanitoriums) of the 20s and 30s. However, the battle still rages, perhaps with greater intensity, as to whether Healthcare is a right or a perk/privilege.The political party that can deliver health care as part of its program will have enormous leverage; and so the attempts to remove it from the dialogue.
There is another specter haunting the public health/epidemiologic approach to need and treatment assessment, and that is the collection of and collation of huge amounts of data that can interrelate such things as gun ownership, gender, addiction, homicide, suicide, residence, etc. This is the specter of a huge authoritarian/socialist government wielding power over this huge fact finding structure. Aside from the fact that such systems already exist (Echelon) in the service of national security, there is little likelihood that such a structure could be operational centrally but would much as our federal judicial system, operate regionally with state by state participation in a regional system. There would still be City and County health departments but the major gain would be quick access to information.
It has been noted that this public health healthcare as a right approach is the province of socialist countries. Scandinavian countries and Central American and Latin American countries are given as examples. The fact is that there is no necessary association between these and socialism. The Latin and Central American countries have been for the most part emergent from cruel dictatorships and carry the impetus toward autocracy forward into new and often equally despotic regimes. The Scandinavian countries register as some of the happiest places on earth and relief from worry about the future coupled with the ability to enjoy the present without necessarily narcotizing self or others seems to be involved.
As women become more assertive in politics and industry (and their suicide/criminality rates are increasing) their concern for the wellbeing of offspring and family may interdict the traditional political instinct to avoid or minimize the healthcare issue as a political concern.
Claudewell S. Thomas, MD, MPH, DLFAPA, is an established psychiatrist currently retired and living in Rancho Palos Verdes, California. He received his medical degree in 1956 at SUNY Downstate College of Medicine and specializes in social psychiatry, public health psychiatry, and forensic psychiatry. Dr. Thomas was board certified by the American Board of Psychiatry and Neurology.