Public Health Magazine: Winter 1995, Vol.5, No.1
Dean's Message

After the failure of the Clinton health care reform efforts and the dramatic political changes resulting from the November elections both in Washington and the states, the health and social needs of the underserved are seriously threatened. With an agenda that includes tax cuts and dramatic cuts in governmental discretionary budgets, the public health community will be called upon to assess the impact of what appear to be potentially disastrous effects on the poor. As Medicaid is moved to a managed care system, possibly funded through a block grant which may remove federal safety net guidelines, issues relating to health care access and quality assume even greater importance. The number of people with no insurance, already thought to be about 40 million people, is expected to increase. Internationally, there is a similar expectation that the new Congress will significantly decrease investment in development efforts generally and, more specific to population, programs aimed at improving women's reproductive health.

Women and children will be particularly affected by such changes. This issue of the Chronicle focuses on CSPH's programs in areas relating to the health and well- being of women. Attention is given to family planning and reproductive health, the control of sexually transmitted diseases, the empowerment of women, and female genital mutilation. An article on patient education materials under development at CSPH, for example, demonstrates that well-informed women are able to make appropriate health care decisions for themselves. And, as the article on the U.N. International Conference on Population and Development in Cairo explains, providing women with the full array of family planning and reproductive health options has resulted in successful outcomes of global significance. Locally, the Alumni Profile on Anne Nolon details the success and efficiency of community care and a local, non-profit Medicaid managed care plan.

Expanding options for women's health and empowering women to make their own decisions is an important expression of human rights. Clearly, female genital mutilation is a clear example of a human rights affront to women, but one that has complex cultural factors that must be understood. The Long Island Breast Cancer Study Project article describes the process of women organizing and demanding governmental attention to a serious, understudied problem. Finally, here and abroad, when a teenage girl's education, access to health care and economic prospects improve, that's a success not just because she delays pregnancy, but also because the improvement in status is an end in itself.

I believe the issues covered in this issue are of particular importance and that you will find them stimulating and informative.

Allan Rosenfield, M.D.

Dean