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<br />Future Trends Affecting Public Health:
<br />Challenges and Opportunities
<br />Ross C. Brownson and Matthew W. Kreuter
<br />Many accomplishments of public
<br />health can be cited, yet public health
<br />professionals face unprecedented
<br />challenges and opportunities in the
<br />coming decades. To assist public
<br />health practitioners, researchers, and
<br />educators in preparing for current and
<br />future changes affecting the
<br />population's health, the authors
<br />describe several important "macro -
<br />level" trends. These trends include:
<br />the aging of the population, changing
<br />patterns in the U.S. racial /ethnic
<br />composition, changes in health care
<br />delivery systems, the explosion of
<br />information technologies, changing
<br />needs in the public health work force,
<br />the growth in health - related
<br />partnerships, and anti- govenunent
<br />sentiment and polarization. A series of
<br />implications for each of the major
<br />trends is provided. It may be
<br />important for public health leaders
<br />and policy makers to take these trends
<br />and implications into account as they
<br />plan and prioritize future approaches
<br />to disease prevention and health
<br />promotion.
<br />Key words: demographic, health care, policies,
<br />prevention
<br />I Public Health Management Practice, 1997, 3(2), 48-60
<br />0 1997 Aspen Publishers, Inc.
<br />If you don't know where you are going, you might
<br />wind up somewhere else.
<br />—Yogi Berra
<br />UBLIC HEALTH involves organized com-
<br />munity efforts aimed at prevention of dis-
<br />ease and promotion of health.' As illustrated
<br />in Figure 1, health is a complex continuum
<br />in which a variety of social and environmental fac-
<br />tors determine individual well- being.' Public health
<br />has traditionally taken a population -based approach
<br />to disease prevention; whereas clinical medicine has
<br />taken an individually oriented approach toward
<br />treatment of disease. The Institute of Medicine de-
<br />fined the core functions of public health as assess-
<br />ment, policy development, and assurance.' Other
<br />suggested core functions have included communica-
<br />tion, training, and generation of new knowledge (Gil-
<br />bert Omenn, personal communication, February 14,
<br />1996) .3 These public health functions are addressed
<br />by public agencies, private organizations, universi-
<br />ties, and individuals .4
<br />The philosophical basis for public health is the
<br />application of scientific knowledge for social justice,
<br />Ross C. Brownson, PhD, is Professor of Epidemiology and
<br />Chair of the Department of Community Health at the
<br />Saint Louis University School of Public Health, St. Louis,
<br />Missouri.
<br />Matthew W. Kreuter, PhD, MPH, is Assistant Professor
<br />of Behavioral Science and Health Education,of the
<br />Department of Community Health at the Saint Louis
<br />University School of Public Health, St. Louis, Missouri.
<br />The authors are grateful for the assistance from numerous experts
<br />in public health who provided valuable insights on the issues:
<br />Robert Harmon, Martha Katz, Coleen Kivlahan, Jeffrey Koplan,
<br />James Marks, and Mr. Charlie Stokes were involved in key infor-
<br />mant interviews; Barbara Arrington, John Bagby, Elizabeth Baker,
<br />Sharon Homan, Richard Kurz, Jeffrey Mayer, Anthony Moulton,
<br />Gilbert Omenn, and Ms. Linda Hillemann reviewed the initial
<br />trends.
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