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54 JOURNAL OF PuBLic HEALTH MANAGm iENT AND PRAcncE /MARcH 1997
<br />is little research on the "hows" and "whys" of effec-
<br />tive academic - community collaboration.so
<br />Trend
<br />Anti- government sentiment and polarization.
<br />Evidence
<br />The current trend, particularly at the federal level,
<br />is toward smaller government and lower taxes.
<br />Trends over the past several decades indicate that
<br />the U.S. population is increasingly dissatisfied with
<br />government. Since the 1960s, the percentage of
<br />Americans expressing trust in Washington has de-
<br />creased from around 70 percent to near 20 percent si
<br />The current movements toward decreasing the fed-
<br />eral deficit and cutting taxes are likely to continue.
<br />Similarly, the present trend of shifting many govern-
<br />mental responsibilities in public health from the fed-
<br />eral to state and local levels is likely to continue.
<br />In addition to skepticism and distrust about gov-
<br />ernment in general, the governmental role in public
<br />health is poorly understood. Both focus group data
<br />and population -based surveys suggest that despite
<br />people's general knowledge of the importance of
<br />care access, the scope and significance of public
<br />health is not understood.0 Common misperceptions
<br />include exclusive associations of public health with
<br />health care to the poor, misplaced confidence that
<br />governmental public health functions can be per-
<br />formed by others, concern about the intrusiveness of
<br />lifestyle messages, and resentment of public health's
<br />regulatory role. 52
<br />Impact
<br />Current trends, in government will place increas-
<br />ing stress on the resources available for public health
<br />and health care. Funding may decline in several ar-
<br />eas including Medicare, Medicaid, and Public
<br />Health Service training grants. It is likely that re-
<br />search funding from the federal government will re-
<br />main relatively level, with declines in certain areas,
<br />and that state public health agencies may have
<br />greater latitude to make decisions about resource al-
<br />location for public health.
<br />■ ■ ■
<br />Perhaps more so than at any other time in history,
<br />public health currently faces unprecedented chal-
<br />lenges and opportunities. In many respects the
<br />threats and possibilities in the coming decades are
<br />paradoxical. At the time when technological ad-
<br />vances provide public health with more tools than
<br />ever before, the political climate may make those ad-
<br />vances more difficult to implement, evaluate, and
<br />maintain. It is hoped that awareness of these chal-
<br />lenges and addressing them within the context of the
<br />trends presented in this article will benefit public
<br />health professionals and the overall health of the
<br />public.
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