Public Health Concepts Article Review Unit 2

PUH 5301, Public Health Concepts 1

Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to:

4. Explain the role of government regarding public health practice and policy. 4.1 Describe a public health agency in your state and the role the agency plays in implementing

public health programs within the community. 4.2 Discuss the role of government in public health practice. 4.3 Discuss the difference between state and federal government authority in public health policy.

Course/Unit Learning Outcomes

Learning Activity

4.1

Unit Lesson Chapter 3: Powers and Responsibilities of Government Article: “The Individual Mandate: Implications for Public Health Law” Video: Profit-Healthcare Conflict Unit II Case Study

4.2

Unit Lesson Chapter 3: Powers and Responsibilities of Government Article: “The Individual Mandate: Implications for Public Health Law” Video: Profit-Healthcare Conflict Unit II Case Study

4.3

Unit Lesson Chapter 3: Powers and Responsibilities of Government Article: “The Individual Mandate: Implications for Public Health Law” Video: Profit-Healthcare Conflict Unit II Case Study

Reading Assignment Chapter 3: Powers and Responsibilities of Government Additional Required Materials: In order to access the following resources, click the links below. Parmet, W. E. (2011). The individual mandate: Implications for public health law. Journal of Law, Medicine

and Ethics, 39(3), 401–413. Retrieved from https://libraryresources.columbiasouthern.edu/login?url=http://search.ebscohost.com/login.aspx?direc t=true&db=a9h&AN=64501048&site=ehost-live&scope=site

Intelligence Squared US (Producer). (2008). Profit-healthcare conflict (Segment 9 of 27) [Video file]. Retrieved

from https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=http://fod.infobase.com/PortalPla ylists.aspx?wID=273866&xtid=58294&loid=268245

To view a transcript of this video, click on the “Transcript” tab near the top right corner of the page.

UNIT II STUDY GUIDE

The Role of the Government in Public Health

PUH 5301, Public Health Concepts 2

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Unit Lesson The Role of the Government in Public Health Law The federal government of the United States of America has passed two major laws regarding health in the last fifty years. The two laws are Medicare and Medicaid in the Social Security Act of 1965 and the Patient Protection and Affordable Care Act of 2010, and it shows that they are involved in implementing public health laws. Governments ultimately are responsible for making sure that they do everything possible to protect the health of their country, town, or state. Their role has to be defined by the law under the federal, state, or local levels of authority. The public health law is eventually decided by the judicial and legislative government branches that work with the public health agencies (Schneider, 2017). When former President Obama and Democrats revealed the Affordable Care Act in 2009, the Senate and the House of Representatives voted, and in 2010, President Obama signed the act into law. After a back and forth argument with several state judges, the Affordable Care Act was sent to the U.S. Supreme Court, a move by 26 states fighting against the Affordable Care Act. In 2012, the Supreme Court upheld the major requirements of the Affordable Care Act. As complicated as this may be, this is a true illustration of how the federal, state, and local governments are involved with the public health. With conservatives in the private sector opposing the Affordable Care Act, it became a task for the federal, state, and local governments to coordinate an appropriate intrusion into the personal liberty and the immense healthcare industry. An operative public health system that can guarantee the health of the nation would require the collective efforts of a multifaceted setup of organizations and people in the private and public sectors, as well as an alignment of practice and policy of public health agencies at the federal, state, and local levels. The United States, for example, has federal, state, and local levels of authority that have specific responsibilities to produce conditions in which the community would be as healthy as possible. For governmental levels to play their role within public health systems, policy makers need to afford the financial and political support needed for effective and strong public health agencies. As seen in October 2013, Republicans led a federal government shutdown and restricted several routine operations after Congress failed to pass legislation for distributing funds for the 2014 fiscal year. One of those funds was meant for the Affordable Care Act. Even with the programs and interventions, the role of the government is making funds available to be able to reach those public health program goals. The government is directly or indirectly involved in public health through advocacy, legislation, and other interventional programs. An example of such programs was former First Lady Michelle Obama’s child obesity project. Mrs. Obama worked to address the national concern of child obesity. She used her political platform to make healthier changes in school lunches and encouraged children to exercise as often as possible in a day. In all fairness, checks and balances are put in place to make sure that the welfare of the people is protected. It is for this reason that a local court’s decision can be overturned by a state court, while a state court’s decision can be overturned by the Supreme Court or a federal court. As discussed previously, morality and individuality have set public health onto a challenging stage. Some state officials, for example, face challenges of legalizing marijuana or cannabis. While in other states, such as Colorado and Ohio, there are fewer restrictions, arguing that it is the individual’s right to decide what goes into his or her body (e.g., junk food, alcohol, cigarettes, medicinal substances).

Benefits of the Affordable Care Act (Vaeenma, n.d.)

PUH 5301, Public Health Concepts 3

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Local Versus State Versus Federal The Tenth Amendment posits that laws not in the U.S. Constitution have to be initiated by individual states. However, it also explains in the Preamble that the government needs to promote the general welfare of its constituents, including collecting taxes and providing common defense (Schneider, 2017). This is seen in the work done by the Food and Drug Administration (FDA) that provides federal regulations on the distribution of drugs, cosmetics, food, and medical devices. These regulations make knowing what is safe easy, economical, and efficient because they are governed by one law under the federal government. The involvement in the public health system varies by level of government, and these levels of government have different responsibilities. The examples below provide an insight into the different roles and responsibilities of the levels of government.

These public health agencies have completely different levels of responsibilities, but their ultimate objective is ensuring a healthy public. Every state has its own sets of laws on various public health issues, laws that could not be obstructed by the federal government (Schneider, 2017). Some of these laws concern controversial issues like immunization before entering a school, the use of firearms in public, and road safety rules and regulations. In some instances, counties may also have different laws. In Texas, some counties have penalties for violating stoplights while others do not. Legally and conventionally, states are the primary authorities for implementing public health laws. States have extensive freedoms in defining this authority through the depth and breadth of governmental services to be organized, financed, and delivered. Federal policies could influence these laws, but most of the time these policies cannot control local and state practices in implementing public health. It is for this reason that laws, such as domestic violence statutes, in California are different from those of Texas. From the federal law perspective, an abuser convicted of a qualifying domestic violence offense forfeits his or her rights to ever transport or possess a firearm or ammunition. Violation of the law is subject to federal penalties. However, how a person is convicted as a domestic violence offender would differ from state to state. Financing Public Health Local, state, and federal agencies are not in the business of making profits, especially if they are generally funded by taxes and government assets. The federal government provides some funding to states but requires certain guidelines be followed. A good example is Medicaid, which provides funding to lower socioeconomic status individuals in some states. It is the largest source of health coverage in the United States of America. However, in order to receive the 50 to 80% of Medicaid funding, the recipients must follow certain guidelines (Schneider, 2017). The Affordable Care Act, for instance, increased the coverage for the poorest individuals by creating a Medicaid eligibility opportunity for states as of January 2014. The individuals’ income had to be at or below 133% of the federal poverty level. This mandatory eligibility criterion was created especially for pregnant women, children, individuals with disabilities, and seniors (U.S. Department of Health & Human Services, 2015). States have other options for foster care children who may not be otherwise eligible, people with a certain income level, or people who receive community-based services. Most state funding is derived from local sales taxes, property taxes, fees and fines imposed on services within the state, Medicare, and Medicaid, and federal funds (Centers for Disease Control and Prevention [CDC], 2013).

Different roles and levels of government

PUH 5301, Public Health Concepts 4

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Role of Non-Governmental Organizations Public health responsibilities are carried out principally by governmental public health and environmental protection agencies at all levels. However, some non-governmental organizations (NGOs) carry out public health programs in collaboration with or with the assistance of governmental agencies, usually through technical or financial assistance. NGOs are effective in fighting for public health funding from the government through research grants, lobbying, and educational programs. Such NGOs include the American Heart Association (AHA), the American Public Health Association (APHA), the American Diabetes Association (ADA), and the American Cancer Association (ACA) who go after Congress, lobbying them to implement policies and resources to benefit their organizations (Schneider, 2017). Some other NGOs, like the Bill and Melinda Gates Foundation, the Chan Zuckerberg Initiative, and the Clinton Foundation, focus on assisting public health initiatives. Conclusion Public health is the primary responsibility of government; however, the U.S. Constitution gives legal authority to states that provide the majority of the public health initiatives. It will be important to understand the roles of the government in public health, but most importantly, the difference between the federal government and the various states.

References Centers for Disease Control and Prevention. (2013). Public health financing [PowerPoint slides]. Retrieved

from https://www.cdc.gov/stltpublichealth/docs/finance/public_health_financing-6-17-13.pdf Schneider, M.-J. (2017). Introduction to public health (5th ed.). Burlington, MA: Jones & Bartlett Learning. U.S. Department of Health & Human Services. (2015). Who is eligible for Medicaid? Retrieved from

https://www.hhs.gov/answers/medicare-and-medicaid/who-is-eligible-for-medicaid/index.html Vaeenma. (n.d.). Benefits of Affordable Care Act. Medicine, marketplace (ID 85630792) [Graphic]. Retrieved

from https://www.dreamstime.com