The U.S. Public Health Service (PHS) was established more than 200 years ago to support national efforts to assure the health of the American population. Before the advent of the antibiotic era in the first half of the last century, health was largely defined as the control of infectious diseases and accident prevention. Public health policy comprised efforts to confine contagion, prevent epidemics and promote practices that improved public safety.
The availability of antibiotics and widespread vaccination campaigns of the last century diminished the potential of infectious diseases to shorten life expectancy. Since then, Americans have lived longer. And with longer lives we are more likely to suffer the long-term consequences of increasingly common chronic diseases such as hypertension, heart disease, cancer and diabetes. Our Western diet, use of tobacco, and exposure to environmental insults that have resulted from industrialization have increased the prevalence and deleterious impact of these diseases.
In recent years American healthcare providers are awakening to the idea that health is more than the absence of disease. Dr. Lester Breslow was one of the most influential proponents of public health in the United States over the past century. In his nearly 70-year career, he described the evolution of the public health from merely disease and accident prevention to the idea of active health promotion. A career researcher, he demonstrated the importance of simple practices such as getting adequate sleep, exercise, and nutrition, moderating alcohol consumption and maintaining weight within recommended parameters to reduce the impact of chronic disease, increase longevity, and improve overall health.
However, there is a tension between the lifestyle health benefits championed by Breslow and the factors that prevent large sectors of our nation from realizing them. We increasingly recognize the potential adverse effect social determinants have on individual and population health in our communities—factors that include income below the poverty level, inadequate housing, lack of education, low literacy, unavailable transportation, and dangerous environmental conditions. Much work remains to be done. But there are too few to do the work.
The Public Health Service is one of the nation’s seven uniformed services (Army, Navy, Air Force, Coast Guard, Marine Corps and National Oceanographic Association). The uniformed military services include commissioned officers (ensigns, lieutenants, captains, colonels, generals, admirals) as well as enlisted personnel (privates, corporals, sergeants, chiefs). The former are largely college graduates who receive commissions from the President to lead as officers; the latter enlist for a term of service as soldiers, sailors, airmen and marines.
In the military services, officers develop strategy, plan the work and provide professional services as lawyers, doctors, dentists and so forth. But anyone who has ever served in a military uniform knows that it is the enlisted who do much of the on-the-ground, in-the-trenches work needed to execute these overarching strategies, and it is the senior enlisted who directly lead them. The enlisted are the riflemen, sailors, crew members, technicians and support personnel who do the fighting, sailing, outfitting, fixing, and supplying for the military in war and in peace. Their senior enlisted are considered “non-commissioned officers.” They are the sergeants, corporals, petty officers and chiefs who serve alongside the enlisted, direct them and lead them by example.
Unlike the uniformed military services, the PHS has no enlisted corps. All of the physicians, dentists, therapists, scientists and other professionals in the PHS are commissioned officers who are largely focused on the study, treatment and prevention of infectious and chronic diseases.
Forty million Americans live below the poverty level. For many of these men, women and children, enlisting in the uniformed military services has long provided an opportunity to realize educational and economic potential that would not have otherwise been available to them: to counter the adverse impact of the social determinants of health.
Military officers and enlisted in the uniformed services raise their right hands and swear under oath to defend the Constitution of the United States “against all enemies, foreign and domestic.” The PHS has long defended the nation against threats to our health— at home and abroad. A PHS enlisted corps could expand that service to encompass a broader definition of health and at the same time provide greater opportunity for the young men and women from the very communities they would be working to help.
Volunteers who enlist in the PHS could be trained by retired non-commissioned officers from the military services―many of whom are still eager to serve. After basic training that stressed health, nutrition and the acquisition of essential skills necessary to be successful in the uniformed culture and environment, they could be led by PHS commissioned and non-commissioned officers and “deployed” to urban and rural areas of America in need of support. Here PHS units would do the work of creating conditions that could improve the health and well-being of those living in the communities. At the same time, they could learn trades and gain educational opportunities to support their eventual return to civilian life. Vocational training and experience would earn the PHS enlisted credit or tuition reimbursement towards college. During their service they would have steady employment, housing, access to health care and exposure to a culture that like the military, promotes fitness and health.
The work of the PHS could include projects in urban renewal, the creation and maintenance of parks and recreational areas (as the Civilian Conservation Corps did in the 1930’s), as well as the provision of low-risk public safety and work on national infrastructure restoration. The effort would ultimately contribute to the communities where they serve and would develop the PHS enlisted as individuals; improving neighborhoods and creating a pool of experienced young men and women to eventually help lead them.
The development and implementation of the PHS enlisted corps would require a significant national investment. But this expansion of the PHS could provide many citizens from underprivileged backgrounds with a sense of agency, a genuine opportunity to effect meaningful, positive change in the near-countless challenged communities of our nation, and could give the sons and daughters of future generations hope for a better way of life.
Chuck Callahan Henry V 4.3 – Lead from the Front https://henryv43.wordpress.com/
Henry V 4.3 