Preventing environmental exposures that threaten human health remains among the best but least attended to opportunities to improve everyone’s health. For more than a decade, medical care concerns, exacerbated by voracious competition among medical empires and the implacably growing number of uninsured, have often been misconstrued as constituting a complete agenda for health system reform. The authors explain the predicament from an historical perspective — how defining events moved U.S. health policy away from protecting the public against dangerous exposures toward unrealistic expectations that doctors will fix whatever goes wrong, at least for individuals with ample medical insurance. They explain how environmentally oriented public health is uniquely suited to help organized medical care with its biggest headache: how to restrain expenditures while producing health. The authors provide specific examples of what has been lost and a prescription for how the U.S. could become the first among nations to strategically link public health and increasingly organized medical care to improve population health.



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