health care policies week 3
Chapter 5:
Public Health Institutions and
Systems*
* Originally created for Public Health 101 by Richard Riegelman.
Introduction
• What are the Goals and Role of Governmental
Public Health Agencies?
• What are the Ten Essential Public Health
Services?
Introduction
• What are the Roles of Local and State Public Health Agencies?
• What are the Roles of Federal Public Health Agencies?
• What are the Roles of Global Public Health Organizations and Agencies?
• How Can Public Health Agencies Work Together?
Introduction
• What Other Government Agencies Are Involved in Health Issues?
• What Roles Do Nongovernmental Organizations Play in Public Health?
• How Can Public Health Agencies Partner with Health Care to Improve the Response to Health Problems?
• How Can Public Health Take the Lead in Mobilizing Community Partnership?
Scenarios Public Health Institutions and Systems
A young man in your dormitory is diagnosed
with tuberculosis. The health department
works with the student health service to test
everyone in the dorm as well as those in his
classes with a TB skin test. Those who are
positive for the first time are advised to take a
course of a medicine called INH. You ask: Is
this standard operating procedure?
Scenarios Public Health Institutions and Systems
You go to a public health meeting and learn
that many of the speakers are not from public
health agencies but from the Departments of
Labor, Commerce, Housing, and Education.
You ask: what do these Departments have to
do with health?
Scenarios Public Health Institutions and Systems
You hear that a new childhood vaccine was
developed by NIH, approved by FDA,
endorsed for federal payment by the CDC,
and recommended for use by the American
Academy of Pediatrics. You ask: Do all these
agencies and organizations always work so
well together?
Scenarios Public Health Institutions and Systems
A major flood in Asia leads to disease and
starvation. Some say it is due to global
warming, others to bad luck. Coordinated
efforts by global health agencies assisted by
nongovernmental organizations (NGOs) and
outside governmental donors help get the
country back on its feet. You ask: What type of
cooperation is needed to make all of this
happen?
Scenarios Public Health Institutions and Systems
A local community health center identifies childhood obesity as a problem in their community. They collect data demonstrating that the problem begins as early as elementary school. They develop a plan that includes clinical interventions at the health center but also includes the elementary school. They ask the health department to help them organize an educational campaign and help evaluate the results. Working together, they are able to reduce the obesity rate among elementary school children by half. This seems like a new way to practice public health, you conclude. What type of approach is this?
Ten Essential Public Health Services
Essential service
Meaning of essential service
Example
ASSESSMENT— Core function
1. Monitor health
status to identify
and solve
community
health problems
This service includes accurate diagnosis of the community’s health status; identification of threats to health and assessment of health service needs; timely collection, analysis, and publication of information on access, utilization, costs, and outcomes of personal health services; attention to the vital statistics and health status of specific groups that are at a higher risk than the total population; and collaboration to manage integrated information systems with private providers and health benefit plans.
Vital Statistics
Health Surveys
Surveillance,
including reportable
diseases
Ten Essential Public Health Services
Essential service
Meaning of essential service
Example
ASSESSMENT— Core function
2. Diagnose and
investigate health
problems and
health hazards in
the community
This service includes
epidemiologic identification of
emerging health threats; public
health laboratory capability
using modern technology to
conduct rapid screening and
high-volume testing; active
infectious disease epidemiology
programs; and technical capacity
for epidemiologic investigation
of disease outbreaks and patterns
of chronic disease and injury.
Epidemic
Investigations
CDC–Epidemiology
Intelligence Service
State Public Health
Laboratories
Ten Essential Public Health Services
Essential service
Meaning of essential service
Example
POLICY DEVELOPMENT— Core function
3. Inform, educate,
and empower
people about
health issues
This service includes social
marketing and media
communications; providing
accessible health information
resources at community levels;
active collaboration with
personal health care providers to
reinforce health promotion
messages and programs; and
joint health education programs
with schools, churches, and
worksites.
Health education
campaigns, such as
comprehensive state
tobacco programs
Ten Essential Public Health Services
Essential service Meaning of essential
service Example
POLICY DEVELOPMENT— Core function
4. Mobilize
community
partnerships and
action to identify
and solve health
problems
This service includes convening and facilitating community groups and associations, including those not typically considered to be health-related, in undertaking defined preventive, screening, rehabilitation, and support programs; and skilled coalition- building to draw upon the full range of potential human and material resources in the case of community health.
Lead control
programs: testing and
follow-up of
children, reduction of
lead exposure,
educational follow-
up, and addressing
underlying causes
Ten Essential Public Health Services
Essential service
Meaning of essential service
Example
POLICY DEVELOPMENT— Core function
5. Develop policies
and plans that
support
individual and
community
health efforts
This service requires leadership development at all levels of public health; systematic community- and state-level planning for health improvement in all jurisdictions; tracking of measurable health objectives as a part of continuous quality improvement strategies; joint evaluation with the medical health care system to define consistent policy regarding prevention and treatment services; and development of codes, regulations, and legislation to guide public health practice.
Newborn screening
program for PKU
and other genetic and
congenital diseases
Ten Essential Public Health Services
Essential service Meaning of essential
service
Example
ASSURANCE— Core function
6. Enforce laws and
regulations that
protect health and
ensure safety
This service involves full enforcement of sanitary codes, especially in the food industry; full protection of drinking water supplies; enforcement of clean air standards; timely follow-up of hazards, preventable injuries, and exposure-related diseases identified in occupational and community settings; monitoring quality of medical services (e.g. laboratory, nursing home, and home health care); and timely review of new drug, biological, and medical device applications.
Local: Fluoridation
and chlorination of
water
State: Regulation of
nursing homes
Federal: FDA drug
approval and food
safety
Ten Essential Public Health Services
Essential service
Meaning of essential service
Example
ASSURANCE— Core function
7. Link people to
needed personal
health services
and ensure the
provision of
health care when
otherwise
unavailable
This service (often referred to as “outreach” or “enabling” service) includes ensuring effective entry for socially disadvantaged people into a coordinated system of clinical care; culturally- and linguistically-appropriate materials and staff to ensure linkage to services for special population groups; ongoing “care management”; and transportation.
Community Health
Centers
Ten Essential Public Health Services
Essential service
Meaning of essential service Example
ASSURANCE— Core function
8. Ensure the
provision of a
competent public
and personal
health care
workforce
This service includes education and training for personnel to meet the needs for public and personal health services; efficient processes for licensure of professionals and certification of facilities with regular verification and inspection follow-up; adoption of continuous quality improvement and lifelong learning within all licensure and certification programs; active partnerships with professional training programs to ensure community-relevant learning experiences for all students; and continuing education in management and leadership development programs for those charged with administrative/executive roles.
Licensure of
physicians, nurses,
and other health
professionals
Ten Essential Public Health Services
Essential service
Meaning of essential service
Example
ASSURANCE— Core function
9. Evaluate
effectiveness,
accessibility,
and quality of
personal and
population-
based health
services
This service calls for ongoing
evaluation of health
programs, based on analysis
of health status and service
utilization data, to assess
program effectiveness and to
provide information
necessary for allocating
resources and reshaping
programs.
Development of
evidence-based
recommendations
Ten Essential Public Health Services
Essential service
Meaning of essential service Example
ALL THREE IOM— Core function
10. Research for
new insights
and innovative
solutions to
health
problems
This service includes
continuous linkage with
appropriate institutions of
higher learning and research
and an internal capacity to
mount timely epidemiologic
and economic analyses and
conduct needed health
services research.
NIH, CDC, AHRQ
other federal
agencies
Key Federal health agencies of the
Department of Health and Human Services
Agency Roles/Authority Examples of
Structures/Activities
Centers for
Disease Control
and Prevention
(CDC)
And
Agency for
Toxic
Substances
and Disease
Registry
(ATSDR)
The lead agency for prevention, health data, epidemic investigation, and public health measures aimed at disease control and prevention
The CDC administers ATSDR, which works with the Environmental Protection Agency to provide guidance on health hazards of toxic exposures.
The CDC and ATSDR work
extensively with state and
local health departments.
The CDC’s Epidemiology
Intelligence Service (EIS)
functions domestically and
internationally at the request
of governments.
Key Federal Health Agencies of the
Department of Health and Human Services
Agency Roles/Authority Examples of
Structures/Activities
National
Institutes of
Health (NIH)
Lead research agency. Also
funds training programs and
communication of health
information to professional
community and the public.
17 institutes in all—the largest being the National Cancer Institute. The National Library of Medicine is part of NIH Centers. The Centers include the John E. Fogarty International Center for Advanced Study in the Health Sciences. NIH is the world’s largest biomedical research enterprise with intramural research at NIH and extramural research grants throughout the world.
Key Federal health agencies of the
Department of Health and Human Services
Agency Roles/Authority Examples of
Structures/Activities
Food and
Drug
Administrati
on (FDA)
Consumer protection
agency with
authority for safety
of foods and safety
and efficacy of drugs,
vaccines and other
medical and public
health interventions
Divisions responsible
for food safety, medical
devices, drug efficacy
and safety pre- and
post- approval
Key Federal health agencies of the
Department of Health and Human Services
Agency Roles/Authority Examples of
Structures/Activities
Health
Resources
and
Services
Administra
tion
(HRSA)
Seeks to ensure
equitable access to
comprehensive
quality health care
Funds community
health centers,
HIV/AIDS services,
scholarships for
health professional
students
Key Federal health agencies of the
Department of Health and Human Services
Agency Roles/Authority Examples of
Structures/Activities
Agency for
Healthcare
Research
and Quality
(AHRQ)
Research agenda to
improve the
outcomes and
quality of health
care, including
patient safety and
access to services
Supports U.S.
Preventive Services
Task Force, Evidence-
based medicine
research, and
Guidelines
Clearinghouse
Key Federal health agencies of the
Department of Health and Human Services
Agency Roles/Authority Examples of
Structures/Activities
Substance
Abuse and
Mental
Health
Services
Administrati
on
(SAMHSA)
Works to improve
quality and
availability of
prevention,
treatment, and
rehabilitation for
substance abuse and
mental illness
Research, data
collection and funding
of local services
Key Federal health agencies of the
Department of Health and Human Services
Agency Roles/Authority Examples of
Structures/Activities
Indian
Health
Service
(IHS)
Provides direct
health care and
public health
services to federally-
recognized tribes
Services provided to
550 federally-
recognized tribes in 35
states;
Only comprehensive
federal responsibility
for health care, plus
public health services
Global Public Health Organizations
Type of agency
Structure/ Governance
Role(s) Limitations
World
Health
Organization
United Nations
Organization
Seven “regional”
Semi-independent
components, e.g.,
Pan American
Health
Organization
covers North and
South America
Policy development,
e.g., tobacco treaty,
epidemic control
policies
Coordination of
services, e.g., SARS
control, vaccine
development
Data collection and
standardization, e.g.,
measures of health
care quality,
measures of health
status
Limited ability
to enforce
Global
Recommendation,
Limited funding
And complex
International
administration
Global Public Health Organizations
Type of
agency
Structure/
Governance Role(s) Limitations
International
Organizations
with focused
agenda
UNICEF
UNAIDS
Focus on
childhood
Vaccinations
Focus on AIDS
Limited
agendas
and limited
financing
Global Public Health Organizations
Type of agency Structure/
Governance Role(s) Limitations
International
financing
organizations
The World Bank
Other multilateral
regional banks,
e.g.,
InterAmerican
and Asian
Development
Banks
World Bank is
largest international
Funder;
Increasingly supports
“human capital”
projects and reform
of health care
delivery systems and
population and
nutrition efforts;
Provides funding and
technical assistance
primarily as loans
Criticized for
Standardized
approach with
few local
modifications
Global Public Health Organizations
Type of agency Structure/
Governance Role(s) Limitations
Bilateral
governmental aid
organizations
USAID;
Many other
developed
countries have
their own
organizations and
contribute a higher
percentage of their
gross domestic
product to those
agencies than does
the United States
Often focused on
specific countries
and specific types
of programs, such
as the United
States’ focus on
HIV/AIDS, and
maternal and child
health
May be tied to
domestic
politics and
global
economic,
political, or
military
agendas
The 6 Sequential Steps of Community-
Oriented Primary Care (COPC)
Steps in the COPC process Questions to ask
1. Community
definition
How is the community defined based upon
geography, institutional affiliation, or other
common characteristics, e.g., use of an Internet
site?
2. Community
characterization
What are the demographic and health
characteristics of the community and what are
its health issues?
3. Prioritization What are the most important health issues facing the community and how should they be
prioritized based upon objective data and
perceived need?
The 6 Sequential Steps of Community-
Oriented Primary Care (COPC)
Steps in the COPC process Questions to ask
4. Detailed assessment of
the selected health
problem
What are the most effective and efficient
interventions for addressing the selected health
problem based upon an evidence-based
assessment?
5. Intervention What strategies will be used to implement the
intervention?
6. Evaluation How can the success of the intervention be
evaluated?
Essential Public Health and IOM
Core Functions
Reprinted from Public Health in America. Essential Public Health Services. Available at:
http://www.health.gov/phfunctions/public.htm Accessed April 4, 2009.
Figure 5-1:
Essential
Public
Health
Services and
IOM Core
Functions