The Future of Public Health (1988) / Chapter Skim
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6. Conclusions and Recommendations
6. Conclusions and Recommendations
Pages 138-159
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From page 138... ...
But warnings about these events by public health officials are sometimes seen as self-serving. On the other hand, despite general complacency that the public health job is done, public concern is mounting over new health problems: toxic substances in air, water, and food; cancer and heart disease; drug abuse and teenage pregnancy; AIDS.
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From page 139... ...
In conducting the study, committee members set aside temporarily their individual views-although not their shared concern- in order to take a fresh look at public health and to develop a common understanding of it. The aim of the study has been to produce a report that examines the total range of public health activity, not simply an assortment of tax-supported programs.
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From page 140... ...
THE PUBLIC HEALTH MISSION, GOVERNMENTAL ROLE, AND LEVELS OF RESPONSIBILITY MISSION · The committee defines the mission of public health as fulfilling society's interest in assuring conditions in which people can be healthy. Public health is distinguished from health care by its focus on communitywide concernsthe public interest rather than the health interests of particular individuals or groups.
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From page 141... ...
Nevertheless, each public health agency at every level of government bears the responsibility for ensuring that the assessment function is fulfilled. This basic function of public health cannot be delegated.
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From page 142... ...
However, for a subset of assured services that the society, through government, has decided are so fundamental to the well-being of the population that access to their benefits should be universally available, assurance should become a guarantee. · The committee recommends that each public health agency involve key policymakers and the general public in determining a set of high-priority personal and communitywide health services that governments will guarantee to every member of the community.
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From page 143... ...
It has the obligation to take the initiative in bringing broad public health policy issues to the attention of the nation, to establish a framework within which interstate and national issues can be debated, and to set national health goals and standards of achievement. · The committee recommends the following as federal public health obligations: support of knowledge development and dissemination through data gathering, research, and information exchange;
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From page 144... ...
It is difficult to generalize about what constitutes an adequate operational definition of "a governmental presence at the local level." Clearly, each tiny hamlet in a county whose total population is only a few hundred people cannot maintain an independent free-standing, full-service, local public health unit. Acknowledging this fact, the committee nonetheless finds that: ~ No citizen from any community, no matter how small or remote, should be without identifiable and realistic access to the benefits of public health
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From page 145... ...
· The committee recommends the following functions for local public health units: -assessment, monitoring, and surveillance of local health problems and needs and of resources for dealing with them; policy development and leadership that foster local involvement and a sense of ownership, that emphasize local needs, and that advocate equitable distribution of public resources and complementary private activities commensurate with community needs; and assurance that high-quality services, including personal health services, needed for the protection of public health in the community are available and accessible to all persons; that the community receives proper consideration in the allocation of federal and state as well as local resources for public health, and that the community is informed about how to obtain public health, including personal health, services, or how to comply with public health requirements. FULFILLING THE GOVERNMENT ROLE: RECOMMENDATIONS In order to carry out the public health mission by fulfilling the governmental roles and responsibilities outlined above, a number of enabling steps must
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From page 146... ...
STATUTORY BASE State public health laws are in many cases seriously outdated. Statements of public health agency authority, responsibility, and organizational structure are inadequate to deal with contemporary problems.
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From page 147... ...
But states have the ultimate responsibility for the health of their residents. To fulfill this obligation states must take action to establish a clear, organizational focal point for public health responsibility, one that is accountable to the people through the political process, yet one in which expert professional judgment about issues requiring such input is not confounded or obscured by excessively partisan politics or narrow ideology.
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From page 148... ...
Whatever sound reasons there may be, the committee believes that the disbanding of state boards has meant the loss of an important resource for public health policy. The state health councils should not be means for control of health matters by health professionals, as has occasionally been true of state boards of health in the past.
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From page 149... ...
Such mechanisms include: performance contracting with the state; negotiated local standards (for example, based upon the Model Standards: A Guide for Community Preventive Health Services; and local public health councils. · The committee finds that the need for a clear focal point at the local level is as great as at the state level, and for the same reasons.
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From page 150... ...
· The committee recommends the establishment of a task force to consider what structure or programmatic changes would be desirable to enhance the federal government's ability to fulfill the public health leadership responsibilities recommended in this report. SPECIAL LINKAGES The committee finds that environmental health and mental health activities are frequently isolated from state and local public health agencies, resulting in disjointed policy development, fragmented service delivery, lack of accountability, and a generally weakened public health effort.
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From page 151... ...
The existing interface between core public health disease prevention and health promotion and similar efforts in mental health is inadequate to fulfill either the public health mission or the mission of mental health. · The committee recommends that those engaged in knowledge development and policy planning in public health and in mental health, respectively, devote specific effort to strengthening linkages with the other field, particularly in order to identify strategies to integrate these functions at the service delivery level.
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From page 152... ...
Desirable integration of service delivery at the client level does not mean that organization and policy must be unified. · The committee recommends that public health be separated organizationally from income maintenance, but that public health agencies maintain close working relationships with social service agencies in order to act as effective advocates for, and to cooperate with, social service agency provision of social services that have an impact on health.
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From page 153... ...
Some gather data but lack the ability to analyze it adequately. The committee recommends the following steps to strengthen public health agency technical capacity: · A uniform national data set should be established that will permit valid comparison of local and state health data with those of the nation and of other
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From page 154... ...
The committee recommends the following steps to improve political capacity: · Public health agency leaders should develop relationships with and educate legislators and other public officials on community health needs, on public health issues, and on the rationale for strategies advocated and pursued by the health department. These relationships should be cultivated on an ongoing basis rather than being neglected until a crisis develops.
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From page 155... ...
Although many public health managers display these capabilities, the emphasis in the field on technical competence and professionalism sometimes leads to a neglect of management as a skill in its own right. Management is often assumed to be purely a matter of common sense or innate ability rather than a body of knowledge that can be acquired through training and experience.
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From page 156... ...
Broadening public health emphasis from focus on the individual to consideration of the external factors that influence individual behavior can often result in more costeffective strategies and, in some cases, stronger legal and political support. Public health leadership should consider all of the social, political, economic, psychological, cultural, and physical factors that shape health-related conduct.
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From page 157... ...
The task now is to assist the schools in developing a greater emphasis on public health practice and to equip them to train personnel with the breadth of knowledge that matches the scope of public health. The task also includes ensuring that public health educational efforts include short courses to upgrade that substantial majority of public health professionals who have not received appropriate formal training, as well as ensuring that public health personnel are abreast of new knowledge and techniques.
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From page 158... ...
· In view of the large numbers of personnel now engaged in public health without adequate preparation for their positions, the schools of public health should undertake an expanded program of short courses to help upgrade the competence of these personnel. In addition, short course offerings should provide opportunities for previously trained public health professionals, especially health officers, to keep up with advances in knowledge and practice.
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From page 159... ...
Americans must concern themselves with whether there are adequate public health services in their communities and must let their elected representatives know of their concern. The specific actions appropriate to strengthen public health will vary from area to area and must blend professional knowledge with community values.
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