HSM111

Overview of Public Health in The US

Functions of the Public Health

System

The Public Health System and the 10 Essential Public

Health Services

The Public Health System

The Public Health System

Public health systems are commonly defined as “all

public, private, and voluntary entities that contribute
to the delivery of essential public health services
within a jurisdiction.” This concept ensures that all
entities’ contributions to the health and well-being of
the community or state are recognized in assessing
the provision of public health services.

The public health system includes

Public health agencies at state and local levels

Healthcare providers

Public safety agencies

Human service and charity organizations

Education and youth development

organizations

Recreation and arts-related organizations

Economic and philanthropic organizations

Environmental agencies and organizations

Public Health 101 (PPT[3.15MB]

(https://www.cdc.gov/stltpublichealth/docs/usph10
1.pptx),
Learn about the components of the US public health
system and how they work together to improve the
nation’s health. You may customize and use this
presentation for your own informational and
educational purposes.

The 10 Essential Public Health Services

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The 10 Essential Public Health Services

The 10 Essential Public Health Services describe the

public health activities that all communities should
undertake and serve as the framework for the
NPHPS instruments. Public health systems should

1. Monitor health status to identify and solve

community health problems.

2. Diagnose and investigate health problems and

health hazards in the community.

3. Inform, educate, and empower people about

health issues.

4. Mobilize community partnerships and action to

identify and solve health problems.

5. Develop policies and plans that support

individual and community health efforts.

6. Enforce laws and regulations that protect

health and ensure safety.

7. Link people to needed personal health

services and assure the provision of health
care when otherwise unavailable.

8. Assure competent public and personal health

care workforce.

9. Evaluate effectiveness, accessibility, and

quality of personal and population-based
health services.

10. Research for new insights and innovative

solutions to health problems.

Philosophy of Public Health

Public health is concerned with promoting and

protecting the health of populations. Public health
action occurs at the international, national, state and
local level. Most communities are served by health
departments whose services include the collection
and use of epidemiological data for population
surveillance of disease. Health promotion and
the protection of population health occurs at the
global level, World Health Organization (WHO), and
at the national level under the Centers for Disease
Control and Prevention, the Food and Drug
Administration, the Environmental Protection Agency
and the Consumer Protection Agency as public
health agencies.

Moral foundations and justifications for public health

and the challenges faced due to limited resources
are the ethical issues debated that view public health
as a social justice, poverty and health disparity
concern. Public health policy seeks to balance the
greater health outcomes with individual liberties, for
example, the immunization debate.

Public health has two primary aims, prevention and

health promotion. Prevention is action taken to
prevent the occurrence of an event or to minimize its
effects after it has occurred. Three levels of
prevention are described as

primary prevention – aimed at reducing risk,

such as immunization

secondary prevention- aimed at detecting and

treating disease at early stages, such as
screenings (mammograms)

tertiary prevention – treatment aimed at

modifying risk factors of disease, such as
cardiac rehabilitation

Health promotion refers to strategies that seeks to

eliminate or reduce exposures to risk factors of
disease by modifying human behaviors.

•Incidence –Number of new cases that develop of a

particular disease/injury

•Prevalence –Proportion of people who have the

disease at a specific point in time

•Morbidity –The relative incidence of a particular

disease

•Mortality –The number of deaths that occur at a

specific time, in a specific group, or from a specific
cause

•Birth rate –Number of live births per one thousand

women

•Fertility rate –Number of live births per

one thousand women between fifteen

and forty-four years of age, generally considered a

woman’s prime childbearing years

•Infant Mortality –Number of live born infants who

die before their first birthday per one thousand live
births

•Life expectancy –Number of additional years of life

expected at a specific point in time, such as at birth
or at age 45

•Epidemiology –Study of distribution and causes of

health-related states or events in populations

–Application of the study to control health

•Epidemiology –Study of distribution and causes of

health-related states or events in populations

•Surveillance –Systematic collection, analysis,

interpretation, and dissemination of health data on
an ongoing basis

•Epidemic –Occurrence of more cases of disease

than expected in a given area or among a specific
group of people over a particular period of time

•Pandemic –Epidemic occurring in a wide

geographical area and usually affecting large part of
population

•Endemic –Constant presence of a disease or

infection within a geographic area or population
group.

Source: (CDC Glossary)

Levels of Public Health

Three general levels of public health – local, state, federal

Most – but not all – states are associated with a

network of local or county health departments
state and local health departments diagram

Public health infrastructure provides communities,

states, and the Nation the capacity to prevent
disease, promote health, and prepare for and
respond to both acute (emergency) threats and
chronic (ongoing) challenges to health. Infrastructure
is the foundation for planning, delivering, evaluating,
and improving public health. All public health
services depend on the presence of basic
infrastructure. Every public health program—such as
immunizations, infectious disease monitoring, cancer
and asthma prevention, drinking water quality, injury
prevention—requires health professionals who are
competent in cross-cutting and technical skills, up-to-
date information systems, and public health
organizations with the capacity to assess and
respond to community health needs. While a strong
infrastructure depends on many organizations, public
health agencies (health departments) are considered
primary players. Federal agencies rely on the
presence of solid public health infrastructure at all
levels to support the implementation of public health
programs and policies and to respond to health
threats, including those from other countries.

Public health infrastructure can best be described by

what it is and what it does. It includes three key
components:

A capable and qualified workforce

Up-to-date data and information systems

Agencies capable of assessing and responding

to public health needs

Public health infrastructure provides the necessary

foundation for undertaking the basic responsibilities
of public health, which have been defined as the 10
Essential Public Health Services:

essential services of public health

1. Monitor health status to identify and solve

community health problems.

2. Diagnose and investigate health problems and

health hazards in the community.

3. Inform, educate, and empower people about

health issues.

4. Mobilize community partnerships and action to

identify and solve health problems.

5. Develop policies and plans that support

individual and community health efforts.

6. Enforce laws and regulations that protect

health and ensure safety.

7. Link people to needed personal health

services and assure the provision of health
care when otherwise unavailable.

8. Ensure competent public and personal health

care workforces.

9. Evaluate effectiveness, accessibility, and

quality of personal and population-based
health services.

10. Research for new insights and innovative

solutions to health problems.

essential services described

Changes in the health system and other factors are

prompting new roles for public health agencies, a
growing focus on the integration of public health and
primary care, a deeper examination of financing
options for foundational or core services, and new
strategies to deliver services more efficiently and
effectively. One such example is cross-jurisdictional
sharing, which can range from supporting informal
collaborations to sharing defined services such as
laboratory testing, to more formal changes in
structure, such as consolidating public health
agencies.

federal ph responsiblities

Public health data must be accurate, relevant, and

timely to inform public health action. National
surveys, such as those sent to epidemiologists,
laboratories, and health departments, play an
important role in understanding the public health
infrastructure. National surveillance and reporting
systems also play a vital role. Efforts are underway to
improve the content of surveys, data collection for
major population groups, and timely access to data
through public reports and data files. These national
surveys and monitoring systems should be
sustained, strengthened, and harmonized.

Continuing to strengthen the evidence base for

effective community interventions and for the
effective organization, administration, and financing
of public health services is critical to the future
development of public health infrastructure. Public
health services and systems research plays an
important role in the development of this evidence
base; support should be expanded over the decade,
with a strong focus on translating research into
practice.

https://www.healthypeople.gov/2020/topics-
objectives/topic/public-health-infrastructure

10 Essential Public Health Services

Progress in Public Health

Public health in the US works in the public interest.

Consider the positive impact in daily life attributed to
public health policy and action: food
safety/restaurant inspections, fluoridated water,
seatbelt use, unleaded gasoline, influenza vaccine
programs, trans-fats and other nutritional information,
public health response to the most recent disaster.

•Since 1900, the average life expectancy for

Americans has increased about 30 years; 25 of
those years are attributed to public health initiatives
•1950 – in anti-tuberculosis efforts, more than 2
million X-ray examinations were made by the Public
Health Service
•1977 – Worldwide eradication of smallpox (as
recently as 1958, two million people a year die from
smallpox)
•1990’s – only 4.4% of US children have elevated
blood lead levels (in the 1970’s, 88.2% had elevated
blood lead levels)
•A combination of medical progress and public
health efforts have nearly eliminated deaths from
previously-rampant childhood diseases such as
–Measles
–Diphtheria
–Scarlet fever
–Whooping cough

In recent years, a series of different public health

threats emphasized the context of public health in
the US. These events required responses from more
than one geographic area and more than one
agency.

•Hurricane Sandy: hit the US in October 2012; was

the largest Atlantic hurricane on record; approx.
$71 Billion in damages; affected 24 states, but most
severe damage in New Jersey and New York, with
sea water flooding streets, tunnels, and subway
lines.

•Salmonella contamination of peanut butter: in 2011,

the US Food and Drug Administration (FDA), the
CDC, and state and local public health officials
investigated a multistate (20) outbreak of salmonella
infections linked to peanut butter, of special concern
because many children eat peanut butter. The
collaborative work identified the origin and shut it
down quickly. (Source: FDA)

•H1N1 Epidemic: the H1N1 flu virus caused a

worldwide pandemic in 2009 as a new strain of
swine origin. It caused about 17,000 deaths by the
start of 2010.

•Hurricane Katrina in 2005

•9/11 attacks on the US in 2001

•The second-strongest hurricane ever recorded in

the United States, covered most of Gulf of Mexico

•The most deaths occurred in New Orleans,

Louisiana, which flooded as the levee system
catastrophically failed. Eventually 80% of the city and
neighboring parishes became flooded, and the
floodwaters lingered for weeks.

•The worst property damage occurred in coastal

areas, such as all the beachfront towns in
Mississippi, which were flooded over 90% within
hours, with waters reaching 6–12 miles inland (10–
19 kilometers) from the beach.

•Due to these events, much federal funding and

focus was placed on preparedness and emergency
response.

•However, state and local health departments are still

responsible for addressing those population-based
health issues in their communities.

•Two planes crashed into the north and south towers

of the World Trade Center in New York.

•A third plane crashed into the Pentagon in

Washington DC (the headquarters of the US
Department of Defense).

•The fourth plane crashed into a field in Pennsylvania

after the passengers tried to overcome the
hijackers. It had originally targeted the US Capitol in
Washington DC.

•Over 3,000 people were killed during the attacks in

New York City and Washington, DC, including more
than 400 police officers and firefighters.

•The attacks fundamentally changed the attitude

toward terrorist attacks in the US and prompted
increased planning and funding for preparedness.

Current life expectancy in 2013 is 78.7 years

Life expectancy has been extended (in part) by these

achievements:

Vaccination—There are now 50,000 fewer cases of

smallpox than occurred in 1900; 900,000 fewer
cases of measles than occurred in 1941; 21,000 fewer
cases of polio than occurred in 1951. Programs of
population-wide vaccinations resulted in the
eradication of smallpox; elimination of polio in the
Americas; and control of measles, rubella, tetanus,
and diphtheria in the US and other parts of the world.

Motor vehicle safety—Since 1925, the annual death

rate from motor vehicle travel has decreased 90%.
Seat belts have saved approximately 85,000 lives;
child safety seats have reduced risk of infant death
by 69%. Community awareness and DWI (driving
while intoxicated) regulations have helped reduce
alcohol-related deaths by 32%.

Control of infectious diseases—Infections (such as

typhoid and cholera), major causes of illness and
death early in the 20th century, have been reduced
dramatically by improved sanitation. Also, the
discovery of antimicrobial therapy has been critical
to successful public health efforts to control
infections such as tuberculosis and sexually
transmitted diseases.

Decline in deaths from coronary heart disease and

stroke—Deaths from coronary heart disease and
stroke have declined due to risk-factor modification,
such as smoking cessation and blood pressure
control. Since 1972, death rates for coronary heart
disease has decreased 51%.

Recognition of tobacco use as a health hazard—

Recognition of tobacco use as a health hazard in
1964 has resulted in reduced use and reduced
exposure to secondhand tobacco smoke.

Healthier mothers and babies—Healthier mothers

and babies are a result of better hygiene and
nutrition, antibiotics, access to health care,
technology in maternal and neonatal medicine, and
immunizations. Since 1900, infant mortality has
decreased more than 90%, and maternal mortality
has decreased 99%.