The question posed by the title of this year's Alumni Day was "Can Public Health Survive In Our Changing Health Care System?" The answer emerging from the May 30 event was not "yes, it will," or "no, it won't," but "yes, it should."

About 70 people attended the event, which was held at the School. The day started with a panel discussion of public health and managed care by four alumni. Smaller roundtable discussions on a variety of topics led by faculty followed. This year's Alumni Award of Merit winners were also recognized at a lunch.

"It was such a good program," said Rita Pope, S.M.'67, of Petersham, Massachusetts, a consultant to primary care and family planning agencies. "I like to get updated. I really left with more knowledge about the current issues and where public health is going."

The moderator of the panel discussion, Barry Levy, M.P.H.'70, referred to the definition of public health in the Institute of Medicine's landmark 1988 publication, The Future of Public Health, which says that "public health is what we, as a society, do collectively to assure the conditions in which people can be healthy." Levy declared "public health not only will survive, it must survive."

Panelist George Annas, M.P.H.'72, Edward R. Utley Professor of Health Law at Boston University Schools of Medicine and Public Health, was less sanguine. Responding to Acting Dean Ware's statement that people involved in public health share "an aspiration to do something for others," Annas said the emergence of market-driven health care works to undercut this altruism. "It is so fundamentally wrong" when patients become customers, said Annas. "Consumers can make decisions in their own right. But patients are sick people who literally are not themselves and who need to trust their physicians to help them."

Mark Rapoport, M.P.H.'73, medical director for Medicaid Programs for Oxford Health Plans in Norwalk, Connecticut, countered that managed care has achieved some public health goals, chiefly in the area of prevention. Rapoport said managed care companies have cut costs because there are long-term financial benefits, as well as health gains, to be realized from vaccinations against infectious disease, screening programs for lead exposure among children, and self-help programs for asthmatics and diabetics. Moreover, he argued that those savings get reflected in lower health insurance premiums that make more employers willing to cover their employees. "Managed care has done what it was created for: it has kept down costs," said Rapoport, "and so it won't go away."

Kathleen Toomey, M.P.H.'79, director of the Georgia Division of Public Health, however, referred to the Institute of Medicine report, which described public health as being "in disarray" and said public health in her state continues to suffer from a lack of cohesiveness. She mentioned organizational challenges, citing as an example Georgia's 159 counties each having its own board of health, but also a kind of public health identity crisis. "We haven't been able to define for ourselves what public health is and that is being mirrored in the way the public perceives us," she said.

Nancy Valentine, M.P.H.'78, chief consultant for the Nursing Strategies Healthcare Group for the U.S. Department of Veterans Affairs, offered the VA as having discovered some antidotes to what ails the larger health care delivery system. Valentine explained that the department has gained considerable experience in providing complete health care to some specific populations, such as the aged and the mentally ill. Valentine also reported that over the past couple of years, the VA has successfully transformed itself from being a centralized, hospital-based system to one that is increasingly dependent upon community health centers.

Topics covered in the roundtable discussions included the ethics of HIV prevention trials in developing countries; women, gender, and health; and the biostatistics of A Civil Action, the nonfiction book about the legal case arising from contaminated water in Woburn, Massachusetts.