Assessment:

1. monitor health status to identify community health problems

2. diagnose and investigate health problems and health hazards in the community.

Policy Development:

3. Inform, educate, and empower people about health issues

4. mobilize community partnerships to identify and solve health problems

5. develop policies and plans that support individual and community health efforts.

Assurance:

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 a competent public health and personal health care workforce

9. evaluate effectiveness, accessibility, and quality of personal and population-based health services

Serving all functions:

10. Research for new insights and innovative solutions to health problems.

Public Health at the federal level in the US

(some considerations)

-Fragmented, varying levels of responsibility

-Most power rests with states, including legal authority for public health surveillance

-State public health laws are often outdated (40-100 years old)

-Inconsistency from state to state

-Scope of authority, responsibilities and activities vary

-Public health agencies at the state and local levels may or may not be led by individuals with public health training.

-Executive Branch

-White House Agencies include, for example, the Office of Science and Technology Policy and the Office of National Drug Control Policy

-Cabinet-Level Departments include, for example, the Department of Agriculture, DOT, EPA, VA, DOD, DHHS.

DHHS: Director Kathleen Sebelius; manages many organizations including the CDC, FDA, NIH, etc.

The US Public Health Service (PHS) includes some of thes organizations.

Surgeon General: Vice Admiral Regina M. Benjamin, MD, MBA

-Part of the Office of the Assistant Secretary for Health in the Office of the DHHS Secretary.

-Oversees operations of the Commissioned Corps of the US Public Health Service.

-The Commissioned Corps is one of America's 7 uniformed services and has 6500 members.

-Majority goes to financing of personal health care services (eg, Medicaid)

-Example from 2002: $142 billion to Medicaid, $41 billion to PHS, $23.2 billion to NIH and very little went to states for public health agency infrastructure. 

The nation's agency for health promotion and disease prevention

The CDC seeks to:

-monitor health,

-detect and investigate health problems

-conduct research to enhance prevention,

-develop and advocate sound public health policies

-implement prevention strategies

-promote healthy behaviors

-foster safe and healthful environments

-provide leadership and training

Based in Atlanta, GA since 1946

-two-year applied epidemiology training program for health professionals

-started in 1951

-epidemiologic investigations, research, and public health surveillance both nationally and internationally

-examples from 2010: survey of adoptive parents and medical providers on the health status of Haitian orphans entering the US after the Haiti earthquake; investigation of potential HepB virus and HepC virus transmission associated with vessel conduits used for solid organ transplantation; Community-wide assessment of health impact and public health emergency response following extended disruption of drinking water service during an extreme winter freeze in Alabama.

The nation's medical research agency, based in Bethesda MD.

Includes 27 institutes and centers

2010 survey by Ginger D. Fenton published in th Journal of Public Health Management Practice (2011): 27 of 31 states responded. 

Findings:

96% of state boards had all or some members appointed.

board member training was inconsistent.

Sources of public input: 65% public hearlings, 65% public comment at board meetings, 38% board member involvement in public groups, 31% citizen complaints, 8% letters.

Established 1905

Functions include: Monitor the health status of the population; identify and eliminate preventable illness and accidents; reduce the severity of illness and disability; promote healthy behaviors; improve health care quality, access, continuity ad accountability, and lead the development of sound health policy and planning

Examples: Disease surveillance, vital statistcs, inspection of medical facilities, licensing, disease fact sheets, public education, communications

Departments (many)

Services: Healthcare, disease prevention, safety, environment, research, Medical Examiner's office

Examples of services: food regulation, licensing, smokefreephilly.org, air quality tests, lead abatement, TB control, asbestos control, monitoring of waste storage/disposal, inspection of barbershops/body art establishments, IRB.

Philadelphia Community Health Centers

A powerful voice that can affect public health policy

Local chapters have influence on state and regional level

APHA, AMA, APA, ACOG, etc.

90% of privately insured persons under age 65 are insured through employers

Over 60% of employers offer health insurance to employees

Health care coverage for aged and disabled individuals: 65+; under 65 but with certain chronic conditions; any age, with end-stage renal failure.

Benefits:

Part A: Hospital coverage

Part B: medical insurance

Part C: Medicaid Advantage Plans (government approved private insurers, Part A&B coverage included, most plans include part D as well; options include HMO,PPO, PFFS, Special Needs Plans)

Part D: Prescription Drug Plans ("donut hole" coverage gap)

Personal health care coverage for low-income individuals

Administered by states

Federal funding

Each state has its own rules but first must follow CMS regulations

Created in 1997

Health care coverage for low-income children

administered by states

state funding with federal matching of 50% or more

each state has its own rules but first must follow CMS regulations

Largest integrated health care system in the US

152 medical centers

Nearly 1400 outpatient clinics, community living centers, Vet centers and domiliaries

53,000 health care practitioners

Care for >8.3 million veterans per year

Part of DHHS

Direct provision of health care services through IHS to American Indians living on reservations and to Alaska Natives living in villages.

Operation of IHS programs depends on annual discretionary appropriations, which are generally considered inadequate

Some tribes are able to supplement IHS funding but many cannot.

Department of Defense - health care for active duty members of the military

federal program

HEalth care coverage for federal employees.

Federal program.

A safety-net healthcare provider for those without coverage

An entity that has entered into an agreement with the Centers for Medicare and Medicaid Services (CMS) to meet Medicare Program requirements under 42 CFR 405.2434 and:

-is receiving a grant of the Public Health Service Act, or is receiving funding from a grant under a contract with the recipient of such a grant and meets the requirements to receive a grant;

-Based on the recommendations of the Public Health Servce, is determined by the Centers for Medicare and Medicaid Services to meet the requirements for receivign such a grant

-Was treated by CMS for purposed of Part B, as a comprehensive Federally Funded Health Center (FFHC) as of January 1, 1990,or

-Is an outpatient health program or facility operated by a tribe or tribal organizations under the Indian Self-determination Act or by an Urban Indian organization receiving funding under Title V of the Indian Health Care Improvement Act.

Examples: Doctors without Borders, American Heart Association, Susan G Komen for the Cure, Planned PArenthood, American Foundation for AIDS Research, Congreso de Latinos Unidos, PHMC, Philadelphia Food Trust, William Way LGBT Community Center, WOAR

Nonprofit management: 501(c)(3); mission statement; board of directors; executive director; by-laws; budget.

Keys to a successful nonprofit board: mission, strategic planning, implementation, assessment; continuous learning.

fundamental duties of a nonprofit board: duty of obedience (faithful to the mission, protect the public's trust); duty of care (monitor the organization's financial health and programmatic accomplishments); duty of loyalty (faithfulness to organization).

basic responsibilities of a nonprofit board: determining purpose and establishing mission; setting policy; communicating mission and achievements to the larger community; maintaining organizational integrity and accountability; effectively planning; hiring/oversight/assessment and supporting the exec director; cultivating resources, raising funds, and contributing to the bottom line; meeting fiduciary responsibilities; recruiting volunteers and exercising ongoing self-management.

types: donors, foundations, govt grants/contracts, contracts and subcontracts with other entities including universities

types of funds: direct vs indirect / restricted vs unrestricted

Federal grants, state/city grants, foundation grants, grants from for-profit entities, institutional pilot project grants