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M. Joycelyn Elders The Politics of Health Care DESPITE ALL OF OUR SCIENTIFIC PROGRESS IN THE AREAS OF HEALTH and biological sciences, we still have a huge unfinished agenda and m ultiple problems that m ust be addressed. We confront problems with health care access for all of our citizens. Ours is a health-illiterate soci­ ety, yet we refuse to provide com prehensive health education for all children. Scientists have unraveled the secret of the cell, explored and m apped the hum an genome; they have developed methodology for controlling hum an reproduction, created lasers that can read license plates in Japan, designed scanning images for every part of the body, carried out stem cell research that can cure diseases. Yet, we have health policies that lim it optimal benefit for our population. We deny com prehensive health education and support abstinence -only education w hen we know that m ore than 50 percent of our children are not abstinent. We have one of the highest teenage pregnancy rates in the industrialized world; 50 percent of all of the 1.9 million sexually transm itted diseases (STDs), including hum an im m u­ nodeficiency virus (HIV), occur annually in young people less then 24 years of age. We downplay the value of condoms w hen scientific data support their use in the prevention of unplanned pregnancy and certain sexually transm itted diseases, including HIV and hum an papil­ loma virus (HPV). The illogical nature of these circumstances often is the result of short-term political gain by some who capitalize on the sensationalism of the word “sex” brought up in any context. The hum an population continues to increase exponentially; it doubled from 2.5 billion to 5 billion between 1950 and 1989, reaching 6 billion in 1996 and, if trends continue, could reach 12 billion by 2050. social research Vol 73 : No 3 : Fall 2006 805 Almost nothing is being done in m ost nations to prom ote effective family planning programs. Instead, there is widespread ideological, political, and religious resistance to contraception. This is aggravated in m any developing countries by female illiteracy and restrictions on the rights of women. The United States has been complicit in this gender inequity by cutting family planning budgets, both foreign and domes­ tic, while supporting abstinence-only education. There is major political debate about a recently developed vaccine against the HPV. Now Supreme Court judges are appointed based on their stand on abortions and pharmacists are allowed to deny women emergency contraceptives pills, which have been ordered by their physician, based on their moral stands (Gee, 2006). Politics and health care are strangely entan­ gled with little regard for the healthy outcome of the populace. We have m any crises to overcome in trying to create a healthy society for the twenty-first century. The first is a crisis of vision. W hile we have the best doctors, nurses, hospitals, support staff, and cuttingedge research, we do not have the visionaries to design the system to serve all of our people. Our present system costs too much, delivers too little, is not comprehensive, coherent, or cost effective, does not allow choice, is not equitable, and is not universal. Our second crisis is a crisis of anticipation. We are not look­ ing to the future, not using all available resources, not realizing that prevention is far better th an intervention or th at if a school nurse prevents one girl from getting pregnant or one boy from using drugs, that she has saved her state m ore than she is paid. The third is a crisis of creativity. We in medicine m ust learn to think out of the box and develop a health care system that is available, affordable, assessable, high quality, and culturally competent. There are m any social and behavioral problem s that affect the health of our people: smoking, poor dietary habits, lack of exercise, alcohol abuse, the use of illicit drugs, abuse of prescription drugs, and violence. These determ ine up to 50 percent of our health status, but receive only 4 percent of our national health expenditures. At the same time, access to care influences...


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