Public health needs constant attention. The problem is that when it works, fickle politicians turn quickly to the next big problem. That's what happened in the early 1980s, when such old diseases as tuberculosis, syphilis, and measles seemed to have been defeated--and AIDS was still unknown. Then the budget for the federally funded Centers for Disease Control got flattened out, so the agency pared spending for preventative-care programs such as immunization and infectious-disease tracking. Many state-houses also cut back their public-health departments.
The result has been a startling increase in the incidence of measles, sexually transmitted diseases, AIDS, and infant mortality. And to those in the field, it has been an unnecessary and costly shame. The U.S. has the capacity to mount effective public-health programs--look at the eradication of polio and smallpox. It's just a matter of convincing Washington that the proverbial ounce ef prevention pays off in dollars and cents. As Health & Human Services Secretary Dr. Louis W. Sullivan often points out, prevention costs far less. The cost of AIDS is a staggering $10.3 billion this year, but in 1991, prevention programs cost about $580 million. Each dollar spent on a measles vaccination saves $14 in medical costs. An $850 course of drugs to treat a latent infection of the new, multidrug-resistant variety of tb can save as much as $100,000 in hospital and treatment costs. For syphilis, diagnostic testing and antibiotics to treat the disease cost a few dollars. But a baby born with congenital syphilis--a sharply rising occurrence--can rack up $200,000 in hospital costs alone.
Sullivan has presented an admirable plan in his "Healthy 2000" report. Now the time has come for the Administration and Congress to back up the rhetoric and provide enough funding to achieve the primary care goals he has outlined.