Of all the determinants of an individual's health (health care, genetics, environment, personal behaviors, etc.) it is believed that health care makes up the smallest proportion, estimated to contribute, on average, 10 percent to one's total health and well-being.

While health care reform is undoubtedly an important issue on both individual and societal levels, system-wide cost savings will not be achieved in anywhere near the desired amounts if these other determinants of health are not taken into account accordingly. If we truly wish to improve our nation's health, a renewed emphasis and investment in public health will be required.

The benchmarks of societal health that frequently are used to show how poorly our country is doing in relation to the rest of the world (infant mortality rates, obesity rates, life expectancy, etc.) are more a reflection of a society's habits, priorities and attitudes toward public health than the robustness or effectiveness of its health care delivery system.

The biggest effecters of health in this country, and the issues that cause many of our racial, ethnic and socio-economic disparities, are things such as pollution, lack of education, lack of accessibility to, and excessive cost of, fresh produce and other healthy foods; lack of knowledge of healthy living, overall safety, and lack of cohesive social units such as families, to name but a few.

The exorbitant cost of "prevention" has been loudly acclaimed recently, with the media seemingly portraying to the public that any efforts at preventing disease are not cost-effective. It is true that giving people certain treatments to prevent a given disease, or various methods of screening people for various cancers, are not always the most cost-conscious way to do things. But true prevention begins further back, as an individual takes initiative to eliminate or prevent risk factors for various diseases.

For example, true efforts at preventing colon cancer, when possible, do not begin with a colonoscopy performed on every individual at 50 years of age, as is currently recommended, but with the individual consuming a low-fat, high-fiber diet and engaging in exercise to maintain a healthy weight.

Which brings us back to the major determinants of health. Individuals often do not control the things that are most needed to ensure good health. If we wish to truly prevent disease in greater numbers, consequently improving all aspects of society, then large-scale reform in many areas of society needs to be undertaken. This should begin with more funding and emphasis on the public health infrastructure.

Having achieved monumental gains during the 20th century, public health has faced a very difficult transition over the past few decades due to a shift in emphasis from mainly infectious diseases to more complex and large-scale chronic diseases. Shifting paradigms has come at a time when public health has received less financial support in relation to its Herculean task.

A greater investment now in public health would yield greater nationwide health education, greater awareness of how our surroundings impact us in various ways, and consequently would reduce many of our current societal flaws, thus impacting our health, our economy and our overall sense of well-being.

If we hope to achieve improved and sustainable health at a lower societal cost, the only way to enable individuals to take greater initiative in their lives is by increasing our emphasis on the things that impact a greater portion of the majority of our citizens' health. This needs to accompany health care reform if any real and long-lasting impact is to be had.

Dr. Kyle Bradford Jones is a family medicine resident at the University of Utah.