National health care reform minus public health: a formula for failure.

Universal access to medical services will not address all important health needs. Impending health care reform, guided by public health strategies, could achieve many previously unattainable health goals. However, such a public health role seems unlikely. Public health reaches beyond the current popular notion of prevention focused on individual lifestyle, yet attention to public health authority has waned. The history of immunization, a personal health service effective only within a public health strategy, illustrates the dilemma. Britain required 40 years of National Health Service before it invoked a public health strategy to assure effective immunization. Reformed health care must perform certain functions systematically that in the past were optional for medical practitioners or left to health departments by default. Reformers must rebuild public health authority in states, to assure that medical services we will pay for under health care reform accomplish functions critical to the health of the public.