ardous waste management was covered by the Resource Conservation Recovery Act of 1976. Title IV of the Health Services and Centers Amendments of 1978 requires the secretary of the Department of Health and Human Services to submit a national disease prevention profile to Congress every three years, and the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 established a controversial federal superfund to clean up chemical dumps and toxic wastes.
In 1992, William Jefferson Clinton was elected United States president, and he made health care reform the major issue of the first year of his administration. The administration effort to reform U.S. health care generated widespread discussion and input but was largely unsuccessful. Clinton administration officials cited many problems with the health care system, including rising insecurity, growing complexity, rising costs, decreasing quality, declining choices, and growing irresponsibility. Of the 37 million Americans who lacked insurance at that time, 85 percent were in families that included an employed adult, reflecting a trend toward reduced or no employer-provided health care benefits for employed workers. Of the dollars paid in health care premiums, one out of two went to administrative costs. The large number of insurance providers increased costs. Health care costs were rising. State spending on health care outstripped spending on education. The United States spent more on health care than its competitors, including Canada, Denmark, France, Germany, Greece, Japan, and the United Kingdom, but a lower proportion of Americans had health security, and the indicators of health status for United States citizens, including infant mortality and morbidity rates, were less favorable. Traditional delivery systems have not produced the information most valuable to doctors, nurses, or consumers. As employers reduced health care benefits, fewer choices were available. The growth in medical malpractice fostered irresponsible behavior.
The Clinton administration proposed a Health Security Act that emphasized five principles: security (guaranteeing comprehensive benefits to all Americans), simplicity (simplifying the system and cutting red tape), savings (controlling health care costs), quality (making the world's best care better), choice (preserving and increasing the options for consumers), and responsibility (making everyone responsible for health care). The Clinton plan emphasized expanded mandatory employer provision of health care benefits, with increased copayments and cost sharing by consumers and workers. Elaborate hearings around the nation, led by Hillary Clinton and Ira Magaziner, were held. Eventually, a coalition of insurance companies and health care providers opposed the plan, running numerous television ads to reach the public with its message. The opposition prevailed, and many of the issues that the National Health Security Act sought to remedy remain unresolved.
MARCIA LYNN WHICKER
Judis, John B., 1995. "Abandoned Surgery: Business and the Failure of Health Care Reform". American Prospect, no. 21 ( Spring): 65-73.
Kendall, David, and Will Marshall, 1995. "Health Reform, Meet Tax Reform". American Prospect, no. 21 ( Spring): 74-79.
Kronenfeld, Jennie Jacobs, 1993. Controversial Issues in Health Care Policy. Newbury Park, CA: Sage.
Kronenfeld, Jennie Jacobs, and Marcia Lynn Whicker, 1984. U.S. National Health Policy. New York: Praeger.
White House Domestic Policy Council, 1993. The President's Report to the American People. New York: Touchstone.
HEALTH PROMOTION. According to the World Health Organization (WHO), health promotion enables people to gain control over their health, but a slightly narrower definition is any combination of educational, organizational, economic, and environmental support for actions leading to health. Health promotion represents a growing area of public administration.
Health promotion is a comparatively new field, coming into existence as a field of public policy in the early 1970s with the 1974 Lalonde report in Canada and given wide currency with the 1976 Healthy People 2000 project in the United States. It had its genesis in a growing realization that medical services by themselves did not cover the majority of the most important determinants of population health.
During the twentieth century, Western nations have undergone an epidemiological transition -- from high rates of death and disease because of infections such as tuberculosis and cholera to the situation in which the main causes of death are cancers and heart disease, diseases that are closely woven into the fabric of the western culture. The medical model of intervention that had worked well to reduce mortality and morbidity from infectious diseases was found to be inadequate for people unable to cope with threats to their health stemming from patterns of lifestyle, pervasive pollution, poverty, or discrimination.
Health promotion thus developed as an intersectoral enterprise, involving the professions of public health, medicine, health education, epidemiology, sociology, and social work, among others. Its mandate is to improve the health of the population in the widest sense of the word "health," a state of physical, mental, and social well-being.
Health promotion is a form of empowerment, and it involves the community at every stage of the process, whether that is working through the community's particular aspirations for health, consulting it throughout the implementation of any project, or enlisting it in the evaluation of that project.