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CHAPTER 3

Powers and Responsibilities of Government

Federal Versus State

U.S. Constitution states that a fundamental purpose of the government is “to promote the general welfare.”

Reserve clause is interpreted to mean that, since health is not mentioned in the Constitution, responsibility for public health primarily belongs to the states.

Interstate commerce provision justifies the activities of the Food and Drug Administration (FDA).

Power to tax and spend is widely used by federal government to control public health policy.

The federal government provides 65% of the funding for Medicaid.

The New Federalism limited Congress’s powers and returned authority to the states.

Branches of Government: Federal, State, and Local

Legislative

Legislature passes statutes.

Executive

Public health agencies carry out the law.

They may issue regulations consistent with statutes.

Judicial

Laws and regulations can be challenged in court.

Local Public Health Agencies

Local county and city health departments are often responsible for:

Day-to-day public health tasks

Core public health functions

Providing medical care for the poor

Funding sources are variable.

City or county legislatures may not understand the importance of core functions.

Mandates may be funded from state or federal governments.

State Health Departments

Coordinate activities of local health agencies and provide funding

Collect and analyze data provided by the local agencies

Provide laboratory services

Manage Medicaid

License and certify medical personnel, facilities, and services

Handle environment, mental health, social services, and aging issues, possibly through separate state agencies

Provide funding to hospitals to reimburse them for treating uninsured patients

Federal Agencies

Department of Health and Human Services (HHS)

www.hhs.gov

Centers for Disease Control and Prevention (CDC)

www.cdc.gov

National Institutes of Health (NIH)

www.nih.gov

Food and Drug Administration (FDA)

www.fda.gov

Centers for Medicare and Medicaid Services (CMS)

www.cms.gov

Agency for Healthcare Research and Quality (AHRQ)

www.ahrq.gov

Indian Health Service

www.ihs.gov

Environmental Protection Agency (EPA)

www.epa.gov

Federal Agencies (cont.)

Occupational Safety and Health Administration (OSHA)

www.osha.gov

Department of Agriculture (USDA)

www.usda.gov

Department of Transportation

www.transportation.gov

Department of Labor

www.dol.gov

Department of Veterans Affairs

www.va.gov

Department of Defense

www.defense.gov

Department of Homeland Security

www.dhs.gov

Centers for Disease Control and Prevention

CDC is the main epidemiologic and assessment agency for the nation.

CDC publishes Morbidity and Mortality Weekly Report (MMWR).

CDC’s National Center for Health Statistics collects data on the U.S. population concerning all aspects of health.

CDC also has centers to address infectious diseases, chronic disease, injury prevention, and other issues.

National Institutes of Health

NIH is the largest biomedical research complex in the world.

Institutes exist for cancer; heart, lung, and blood; diabetes; aging; child health and human development; and other topics.

National Library of Medicine is an NIH institute.

NIH has laboratories in Bethesda, MD and provides grant funding to researchers at universities and research centers.

NIH has a clinical center where medical researchers test experimental therapies.

NIH enjoys strong Congressional support.

Nongovernmental Public Health Organizations

Organizations that focus on specific diseases include:

American Cancer Society

American Heart Association

American Diabetes Association

Alzheimer’s Association

Professional membership organizations include:

American Medical Association

American Nurses Association

American Public Health Association

Organizations that play an important role in defining the future of public health include:

National Association of City and County Health Officers

Association of State and Territorial Health Officers

Association of Schools and Programs of Public Health

Philanthropic Foundations

Rockefeller Foundation

Robert Wood Johnson Foundation

Pew Charitable Trusts

Kaiser Family Foundation

Commonwealth Fund

Bill and Melinda Gates Foundation

Discussion Question 1

Choose a specific health problem.

How might federal, state, and local levels of government divide responsibility for addressing it?

Discussion Question 2

Choose a federal public health agency and visit its website.

Identify an issue that it is currently dealing with and describe reasons for current concern.

Discuss any controversies that may be involved in actions that the agency has taken or might need to take.

Discussion Question 3

Why is it important for nongovernmental organizations to be involved in public health activities?

Discussion Question 4

Choose one of the philanthropic foundations listed on Slide 11 and visit its website to learn more about the foundation’s activities.