The Future of Public Health (1988) / Chapter Skim
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Appendix A: A Summary of the Public Health System in the United States
Appendix A: A Summary of the Public Health System in the United States
Pages 163-202
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From page 165... ...
FEDERAL The federal government plays a large role in the public health system in the country. It surveys the population's health status and health needs, sets policies and standards, passes laws and regulations, supports biomedical and health services research, helps finance and sometimes delivers personal health services, provides technical assistance and resources to state and local health systems, provides protection against international health threats, and supports international efforts toward global health.
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From page 166... ...
the Health Resources and Services Administration; (5) the Alcohol, Drug Abuse, and Mental Health Administration; and (6)
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From page 167... ...
Both the Health Resources and Services Administration and the Alcohol, Drug Abuse, and Mental Health Administration establish and support health services through grants and contracts to state and local government agencies, private health care institutions, and individuals. They also act as coordinators and technical assistants to recip ients of contracts and grants.
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From page 168... ...
For example, assessment is a major responsibility of the Centers for Disease Control and the National Center for Health Statistics, but also takes place in the Health Resources Administration, which collects data on health manpower; the Food and Drug Administration, which inspects foods, drugs, and other products; the Office of Disease Prevention and Health Promotion, which collects statistics on prevention activities and the population's health status; the National Institute of Mental Health, which collects data on inpatient and outpatient mental health services; and the Health Care Financing Administration, which collects information on use of health services. Biological research is mainly the task of the National Institutes of Health, and epidemiologic research is mainly the task of the Centers for Disease Control.
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From page 169... ...
Most contracts to states and localities were initially offered as "categorical" grants, focusing on particular health issues or populations, for example, research training grants for education, nutrition information programs, substance abuse and mental health programs, and family planning programs. In the early 1980s, the federal administration grouped numerous categorical grants to states into four major "block" grants: one in preventive health, one in maternal and child health, one in primary care, and one in alcohol, drug abuse, and mental health.
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From page 170... ...
In 1984, about $1 billion of the total departmental budget was spent in contracts to state health agencies; another half billion was contracted directly to local areas for health programs. (See Figures A.2 and A.3; Public Health Foundation, 1984)
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From page 171... ...
Federal spending on health increased dramatically between the 1960s and 1980s, to the extent of several hundred percent in some programs. (Bureau of Data Management and Strategy, Health Care Financing Administration, U.S.
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From page 172... ...
State health agencies collect and analyze information; conduct inspections; plan; set policies and standards; carry out national and state mandates; manage and oversee environmental, educational, and personal health services; and assure access to health care for underserved residents; they are involved in resources development; and they respond to health hazards and crises. (Hanlon and Pickett, 1984; Public Health Foundation, 1986b)
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From page 173... ...
Fourteen state health departments are also the main environmental agency in their state; fifteen are the mental health agency; and eleven are also the state Medicaid agency. (Public Health Foundation, 1986b)
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From page 174... ...
33 10 6 Number of States (n = 46) 25 8 10 3 TABLE A.2 Annual Salanes: Principal State Health Officials, 1986 State or Other Annual State or Other Annual Jurisdiction Salary ($)
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From page 175... ...
Some local health agencies operate completely independently of the state health agency, but in most states state agencies are semicentralized, operating some programs completely, sharing some with locals, and acting as an adviser on some programs. (Miller and Moos, 1981)
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From page 176... ...
Despite differences in program content, the similarities that do exist allow state activities to be generally categorized into the functions of public health outlined in Chapter 2, if it is kept in mind that the activities within these functions do vary. The best source of data on state health agency activities is the Public Health Foundation, which collects information from states on an annual basis.
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From page 177... ...
EPIDEMIOLOGY Communicable Disease Control Health Screeninga Vision Nutntion Heanng Hypertension Cervical Cancer Diabetes Sickle Cell Trait Lead Poisoning Speech and Language Disorders Alcohol and Drug Abuse Laboratory Analyses Clinical Services Support Environmental Services Support Toxicologic, Forensic Services Support C RESEARCH Participate in Research Projects Laboratory Research 44 24 39 38 32 19 28 22 20 35 31 8 46 46 39 44 40 44 40 34 31 27 29 14 45 43 40 35 42 13 These are selected examples from the more than 30 types of health problems screened by state health agencies.
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From page 178... ...
As a group, the 46 state agencies reporting to the Public Health Foundation spent nearly $6 billion for their public health programs in 1984 (Public Health Foundation, 1986b)
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From page 179... ...
In 1984, about 54 percent of the states' total spending was derived from state funds; 37 percent came from federal contracts and grants; 5 percent were from fees and reimbursements; about 2 percent came from local funds; and 2 percent from other sources. Of the federal contract and grant money for states, 1.5 percent was designated for general administration purposes or TABLE A.6 Assurance Activities of State Health Agencies, 1984 Number of States (n = 46)
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From page 180... ...
It is also important to note that decreases in federal financing are not apparent when percentages of sources of money are considered. Many state TABLE A.7 Sources of State Health Agency Funds in Percentages, 1980, 1984 Percentage 1980 1984 45 28 20 State Federal Contracts and Grants Local Fees and Reimbursements Other 54 37 2 s 2 SOURCES: Public Health Foundation, 1986b, vol.
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From page 181... ...
In terms of general program content area, in 1984 states spent about 74 percent of their funds on personal health services (including some programs otherwise categorized above as assessment such as screening, epidemiology, laboratories, and immunizations) , 8 percent on environmental services, 8 percent on health resources, 6 percent on general administration, and 3 percent on laboratories (Public Health Foundation, 1984~.
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From page 182... ...
State health agencies that are also the mental health agencies or the environmental health agencies for their state, or state health agencies that operate institutions, tend to have larger staffs. The mean number of employees for states acting as mental health authorities and/or operating institutions was 3,800, while the mean for agencies not having these responsibilities was 1,100.
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From page 183... ...
Local Local health departments are the "front line" of public health agencies. They are generally responsible for direct delivery of public health services to the population.
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From page 184... ...
"Such a delegation of rule-making powers is, of course, quite common in the public health field, with numerous local legislative bodies such as city councils and boards of aldermen and state and local boards of health being authorized to promulgate public health ordinances or health codes, or other species of rules and regulations relating to public health." (Grad, 1981) Local health departments are traditionally viewed as empowered by the state with delegated authority.
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From page 185... ...
Directors of local health agencies are generally appointed by the leaders of the jurisdiction for which they work, county supervisors, city and town councils, or the mayor. Some local health directors are employees of or appointed by the state health department.
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From page 186... ...
The data gathered by this survey have not been replicated in recent years. Data on local health departments are also available from the Public Health Foundation, but these TABLE A.13 Jurisdictions of Local Health Agencies by Percentage, 1974 Jurisdiction Percentage of Local Health Agencies 48 9 14 9 20 Single County Multi-County Cities Towns City-County SOURCE: Miller et al., 1977.
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From page 187... ...
Activities Despite tremendous variation in services rendered, there are some similarities in local health department programs. Local health departments can be characterized as mainly involved in providing health education, environmental health services, and personal health services and in conducting inspections.
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From page 188... ...
(See Table A.16; Association of State and Territorial Health Officials, National Public Health Program Reporting System, 1981; Public Health Foundation, 1986b) Of course, sources for a particular agency differ from one agency to another.
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From page 189... ...
In terms of program area, in 1984, as a group, local health departments spent 58 percent of their funds on personal health services, including maternal and child health, communicable disease control, dental health, chronic disease control, and mental health services, to name a few. They spent 12 percent of their total funds on environmental health services, including sanitation programs, water and air quality, and waste management.
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From page 190... ...
TABLE A.17 Local Health Agency Areas of Expenditure in Percentages, 1980, 1984 Percentage Area of Expenditure 1980 1984 Personal Health Services 76 58 Environmental Services 13 12 Health Resources 3 9 Laboratory 3 2 General Administration 5 6 Not Allocated to Program Area 14 SOURCES: Association of State and Territorial Health Officials, 1981; Public Health Foundation, 1986b, vol.
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From page 191... ...
The following section briefly describes the range of actors other than the public health agencies that are important contributors to the public health system. A few representatives of health-related government agencies those dealing with the environment, mental health and substance abuse, social services and human development, and financing health care-and a few examples of private organizations professional associations, nonprofit organizations, and consumer groups are highlighted.
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From page 192... ...
Some of these programs are direct federal activities, and some provide assistance to state environmental departments and state health agencies. The Agricultural Department has services for food safety and inspection, sanitation, and assessment of both plant and animal diseases.
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From page 193... ...
(Hanlon and Pickett, 1984) Some of these programs relate to social service agencies in the states, some to educational departments, and some to health departments.
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From page 194... ...
There are professional membership organizations for almost every type of health professional and every type of health care organization. Examples include the American Medical Association, the American Nurse's Association, the National Social Workers Association, the American Public Health Association, the National Association of Community Health Centers, the American Hospital Association, and the Association of State Mental Health Agency Directors.
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From page 195... ...
This figure does not, however, include private grants for health services, membership dues, expenditures of agencies other than health agencies, and tremendous amounts of volunteer time. Public health manpower is also present in all of these arenas.
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From page 196... ...
Nearly all of the states also have units within their health departments devoted to environmental health concerns, such as sanitation, inspection, water supply, pollution control, and sometimes occupational safety and hazardous materials control; and most state health agencies take the lead responsibility in a state for one or more environmental health services. In some states, these functions are combined.
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From page 197... ...
State mental health agencies handle programs of both a public health nature, such as prevention of mental illness, alcoholism and drug abuse prevention, research, and manpower training, as well as personal health services such as treatment of mental illness, rehabilitation for substance abusers, and services for the mentally retarded and developmentally disabled. In 44 states, public health agencies report that they operate programs for the mentally retarded and developmentally disabled; 37 operate mental health programs; 33 have alcohol abuse programs; and 29 have drug abuse programs.
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From page 198... ...
The operation of health programs and the financing of health services are connected, particularly in states in which the state health agency concentrates its efforts on personal health services. In most states, the state Medicaid budget is equal to or far exceeds the public health budget.
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From page 199... ...
The local health department may monitor an individual's water supply, while a local environmental agency monitors industrial or agricultural water supplies. The local health department may have a substance abuse prevention program, while inpatient mental health services are provided by another agency.
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From page 200... ...
1984. State Health Departments.
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From page 201... ...
1981. "The Program Implications of Administrative Relationships Between Local Health Departments and State and Local Government." American Journal of Public Health 71(10)
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From page 202... ...
1986b. Public Health Agencies 1984, vole.
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