Health Care Policies
Helpm31990
9781284151619_SLID_CH05.pptxChapter 5 Public Health Institutions and Systems* *Originally created for Public Health 101 by Richard Riegelman.
Chapter Overview (1 of 3)
Identifies goals of governmental public health
Identifies the 10 essential services of public health
Describes basic features of local, state, and federal public health agencies in the United States
Chapter Overview (2 of 3)
Identifies global public health organizations and agencies and describe their basic roles
Identifies roles in public health for federal agencies not identified as health agencies
Chapter Overview (3 of 3)
Illustrates the need for collaboration by governmental public health agencies with other governmental and nongovernmental organizations
Describes approaches to connecting public health and the healthcare system
Scenarios: Public Health Institutions and Systems (1 of 5)
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 (2 of 5)
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 (3 of 5)
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 (4 of 5)
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 (5 of 5)
A local community health center identifies childhood obesity as a problem. 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 and at 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?
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Ten Essential Public Health Services (1 of 10)
| 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 (2 of 10)
| 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 (3 of 10)
| 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 healthcare 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 (4 of 10)
| 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 on 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 (5 of 10)
| 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 healthcare 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 (6 of 10)
| 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 (7 of 10)
| 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 |
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Ten Essential Public Health Services (8 of 10)
| Essential service | Meaning of essential service | Example |
| ASSURANCE— Core function | ||
| 8. Ensure the provision of a competent public and personal healthcare 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 (9 of 10)
| 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 (10 of 10)
| Essential service | Meaning of essential service | Example |
| ALL THREE IOM— Core functions | ||
| 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 (1 of 7)
| 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 (2 of 7)
| 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 (3 of 7)
| Agency | Roles/Authority | Examples of structures/Activities |
| Food and Drug Administration (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 (4 of 7)
| Agency | Roles/Authority | Examples of structures/Activities |
| Health Resources and Services Administration (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 (5 of 7)
| 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 (6 of 7)
| Agency | Roles/Authority | Examples of structures/Activities |
| Substance Abuse and Mental Health Services Administration (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 (7 of 7)
| Agency | Roles/Authority | Examples of structures/Activities |
| Indian Health Services (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 |
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Global Public Health Organizations (1 of 4)
| 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 healthcare quality, measures of health status | Limited ability to enforce global recommendations, limited funding, and complex international administration |
Global Public Health Organizations (2 of 4)
| Type of agency | Structure/ Governance | Role(s) | Limitations |
| Other UN agencies with focused agenda | UNICEF UNAIDS | Focus on childhood vaccinations Focus on AIDS | Limited agendas and limited financing |
Global Public Health Organizations (3 of 4)
| 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 healthcare 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 (4 of 4)
| 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 Six Sequential Steps of Community-Oriented Primary Care (COPC) (1 of 2)
| Steps in the COPC process | Questions to ask |
| 1. Community definition | How is the community defined based on 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 on objective data and perceived need? |
The Six Sequential Steps of Community-Oriented Primary Care (COPC) (2 of 2)
| 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 on 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 Services and Institute of Medicine’s Core Functions
Source: Centers for Disease Control and Prevention. (2017). The public health system & the 10 essential public health services. Retrieved from https://www.cdc.gov/stltpublichealth/publichealthservices/essentialhealthservices.html
Framework for Viewing Governmental Public Health Agencies and Their Complicated Connections
