Describe and discuss the structure of organized public health in the United States.

What will be an ideal response?

• Organized public health efforts in the United States are organized on three levels: federal, state, and local governments.
• Governmental efforts in public health are focused on three goals (assessment, policy development, and assurance), and each of the three levels of government plays a different role in these three activities.
• The federal government’s role in public health was relatively limited until the passage in 1913 of the national income tax; after the passage of the national income tax, the resources of the federal government became so overwhelming that federal authority in all aspects of life became the dominant aspect of governmental activity.
• The federal government’s activities are carried out through the Department of Health and Human Services, a cabinet-level department of the federal government. This department has two major subdivisions—one related to health activities and one related to human service activities. The department is really composed of a series of relatively separate super agencies that have comparatively little interaction with each other and that relate to quite separate constituencies.
• The major activities of the federal Department of Health and Human Services are the following:
• Documenting health status in the United States.
• Sponsoring research on basic and applied sciences.
• Formulating national objectives and policy.
• Setting standards of performance of services and protection of the public.
• Providing financial assistance to state and local governments to carry out predetermined programs.
• Ensuring that personnel, facilities, and other technical resources are available to carry out national priorities.
• Ensuring the public access to health care services by the creation of special health insurance programs,.
• Providing limited direct services to certain subgroups of the population such as Native Americans, seamen, and other groups with specialized needs.
• The major portion of the federal government’s health activities are conducted through contracts and grants to states, localities, and the private sector.
• State governments are the principal governmental entity responsible for the active protection of the public’s health in the United States. The states carry out these responsibilities through their police powers—the power to enact and enforce laws to protect and promote the health and safety of the people. Compared with the federal Department of Health and Human Services, state health departments are more compact and tightly organized. Although they may have large subunits, they are more likely to be managed by a single leadership that directs the daily operations of all the individual units.
• The standard functions and activities of state public health agencies are the following:
• Collecting and analyzing health statistics to determine the health status of the public.
• Providing general education to the public on matters of public health importance.
• Maintaining state laboratories to conduct certain specialized tests that are required by state law.
• Establishing and enforcing public health standards for the state as a whole.
• Granting licenses to health care professionals and institutions through the state and monitoring their performance.
• Establishing general policy for local government public health units and providing them with financial support to carry out their responsibilities.
• State public health agencies receive a comparatively large proportion of their funds from the federal government and, in turn, must carry out federal mandates in the use of those funds.
• In general, whereas federal agencies focus their energies on the identification of major health problems of the country and the establishment of national policies to attack those problems, state public health departments concentrate on translating national health goals and objectives into state policies. The federal agencies also spend a considerable amount of time ensuring that policy is being carried out, either by the state itself or by local government.
• Local government public health departments are the front line of public health services in the United States, and it is here in the local government where the policies and strategies of the federal and state governments are actually carried out.
• The local government public health functions are: (1) vital statistics, (2) commu-
nicable disease control, (3) environmental sanitation, (4) maternal and child health, and (5) health education of the public. During the period after the passage of the national health planning legislation in 1974, there was a hope that local government public health agencies might become more directly involved in the comprehensive planning of health care resources, but that hope never materialized, and the legislation was eventually allowed to lapse. Most local public health agencies are not actively involved in matters relating to the distribution and financing of health services in their communities.
• Overall, one of the most serious problems of public health work in the United States is the complete imbalance between responsibility for directly carrying out public health activities and the financial resources to do such work. Local governments are directly responsible for conducting the daily work, but they have the least ability to generate financial resources; the federal government, on the other hand, has the least responsibility for direct public health work and has the greatest financial resources at its command.