Public health has never been a popular topic in chiropractic, maybe because to most of us it connotes nothing but microorganisms and sewage treatment.
So what is "public health," and why should DCs care about it?
Public health represents the efforts made by a society to protect, promote and restore health. Public health supports clean water, clean air, and safe communities - certainly something all chiropractors already support. Public health also supports prevention and health promotion - and we certainly support that! Why should we go further than supporting public health in principle? Why should we make the effort to join with our communities to actively support it? First, we can increase our impact on society by adding our skills and knowledge to those of the rest of the public health community; this is one of our main responsibilities as health care professionals. Second, we can help our patients even more by using the extant information on prevention and health promotion. Third, we can help members of the public health community understand how chiropractic supports health and wellness.
Here are some facts we would all like to see change:
- Only 11 percent of Americans use chiropractic, and even less worldwide.
- Most people seek care for spine-related pain, not general health or wellness.
- Insurance does not reimburse for chiropractic wellness care.
Getting involved in the mainstream public health community may be one way to change these facts, by emphasizing that chiropractic is really about health and wellness, and not just pain relief. Getting involved in public health policy-making is another way to work toward new utilization patterns for chiropractic. Both of these involvements can be achieved by joining a powerful public health organization.
The principal public health organization in the U.S. is the American Public Health Association (APHA). APHA is over 125 years old and has over 30,000 members - the oldest and largest public health organization in the world. Although chiropractors have been involved in APHA since at least the 1970s, it wasn't until 1995 that our profession increased its role in the organization with the formation of the Chiropractic Health Care Section.
Membership in the Chiropractic Health Care Section of APHA allows you to:
- influence public health policy;
- network with other health professionals and government agencies; and
- represent our profession's interests to the government, industry, health care system, and public.
"We already have organizations to represent our interests. Why bother with APHA?" you might say. A little reflection will tell you that it can't hurt to have the oldest and largest public health organization in the world on your side - and that being a member of an organization tends to put it on your side. This point is best illustrated by the story of how chiropractic first became involved in APHA.
It started in 1969: The Department of Health, Education and Welfare (DHEW), at the instruction of Congress, had conducted a study of chiropractic and came to several far-reaching conclusions that were subsequently adopted by APHA:
- "Chiropractic theory and practice are not based upon the body of knowledge ... accepted by the scientific community.
- "The scope and quality of chiropractic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment.
- "Therefore, it is recommended that chiropractic services not be covered in the Medicare program."
APHA's response was: "It appears that the practice of chiropractic constitutes a hazard to the health and safety of our citizens." APHA therefore urged that Congress cut Medicaid and Medicare for chiropractic; states exclude it from health programs and consider further restricting or abolishing chiropractic licenses; and that professional and consumer groups educate consumers on the hazards of chiropractic.
This was clearly an emergency situation for us! Action was necessary-but what should it be? Enter Rand Baird,DC,MPH, private practitioner and public health instructor at Cleveland Chiropractic College, Los Angeles (CCC-LA). In 1979, Dr. Baird initiated actions that had a significant impact on both APHA policy and on the future of the chiropractic profession.
He began with these facts:
- Like any organization, APHA wants to gain and keep members.
- Members, even student members, determine APHA policy.
His conclusion was: If you can't beat 'em-join 'em! He proceeded to recruit CCC-LA students and initiate a letter-writing campaign by DC and student APHA members. This was a far more strategic and effective, move than letter writing by nonmembers. Soon afterward, chiropractors were the fastest-growing new membership segment in APHA. Dr. Baird and colleagues were granted place on the agenda of the APHA governing council meetings to dispute the policy statement against chiropractor.
In 1983, APHA issued a new policy statement on chiropractic superseding the previous one, stating that: "...available scientific evidence makes it reasonable to assume that spinal manipulation performed by chiropractors can be a safe and effective service modality in the clinical The $140 annual membership fee ($50 for students) includes: a free subscription to the American Journal of Public Health and to The Nation's Health; and reduced registration to the APHA annual meeting, which features continuing education credits for DCs. For full information on all membership benefits, visit www.apha.org. You can complete a membership application on line or contact me, the membership chair, at hawkcheryl@aol.com for a form or additional information.
Cheryl Hawk,DC,PhD
Membership Chair
Chiropractic Health Care Section of APHA
