The Future of Public Health (1988) / Chapter Skim
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2. A Vision of Public Health in America: An Attainable Ideal
2. A Vision of Public Health in America: An Attainable Ideal
Pages 35-55
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From page 35... ...
These traditional and ongoing accomplishments have demonstrated the value of public health efforts, and exemplify the kind of success that is possible as a result of organized effort on the basis of technical knowledge. If they demonstrate the best of which public health has been capable, they also underscore the urgency of rescuing this vital public capacity from its current decline.
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From page 36... ...
The committee's vision of public health includes the following conceptual elements: A definition of "public health" that the committee believes is consistent with key American values. This definition sets forth the committee's view of what the term "public health" should mean and what values are implied by that understanding.
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From page 37... ...
In contrast to functions that are specific to the role of the public agency, responsibility for the provision of basic services is shared by public and private sectors. Figure 2.1 is a diagram of how the conceptual elements of the public health vision relate to one another.
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From page 38... ...
By separating the organizational expression of public health from understandings of its mission and subject matter, the committee intends to emphasize that the goals and concerns of public health can and should be addressed not only by health departments, but also by private organizations and practitioners, other public agencies, and the community at large. The governing role of the official public health agency in assuring that the overall system works is, however, indispensable.
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From page 39... ...
The common themes that run through these interpretations are reflected in the words "public" and "health." What unites people around public health is the focus on society as a whole, the community, and the aim of optimal health status. Clearly, public health is "public" because it involves "organized community effort." It is not simply the outcome of isolated individual efforts.
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From page 40... ...
; their focus on disease prevention and health promotion; their prospective approach in contrast to the reactive focus of therapeutic medicine (Draper et al., as quoted in Hanlon and Pickett, 1984~; and their common science, epidemiology: Each "profession] brings to the public health task the distinctive skills of a primary professional discipline; but, in addition, each shares a distinctive and unique body of knowledge .
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From page 41... ...
There appears to be a gap between popular support for public health concerns and public confidence in the value and effectiveness of current health department activities. People tend to be positive about public health values, but negative about the present public health agency.
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From page 42... ...
But it also requires a change in the American dialogue about the necessity and worth of public sector activity of governance. In summary, the committee defines the organiza~nalframework of public health to encompass both activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals.
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From page 43... ...
THE FUNCTIONS OF GOVERNMENT IN PUBLIC HEALTH The committee sees the government role in public health as made up of three functions: assessment, policy development, and assurance (see Figures 2.2 and 2.3~. These functions correspond to the major phases of public problem-solving: identification of problems, mobilization of necessary effort and resources, and assurance that vital conditions are in place and that crucial services are received.
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From page 44... ...
In addition, the government has an important responsibility to develop a broader base of knowledge in order to ensure that policy is not driven by purely short-range issues constrained by current knowledge. Public sector assessment activities should include supporting and conducting research into fundamental determinants of health behavioral, environmental, biological, and socioeconomic as well as monitoring health status and trends.
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From page 45... ...
Assurance A core public sector function is to make sure that necessary services are provided to reach agreed upon goals, either by encouraging private sector action, by requiring it, or by providing services directly. The assurance function in public health involves seeing to the implementation of legislative mandates as well as maintaining statutory responsibilities.
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From page 46... ...
On the contrary, recognition of the shortcomings or indifference of the market with respect to certain crucial needs should act as the rationale and catalyst for government action. Such action can take various forms: encouraging the development of private sector financial incentives where none now exist, so that, for example, the care of the uninsured could be made attractive to private providers; building helping relationships between public and private personnel, as when public health
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From page 47... ...
At any level of government, the public sector responsibility for the health of the people must have a focal point in one agency charged with taking the lead in assuring that necessary obligations are fulfilled. Although it may sometimes be appropriate for public health-related responsibilities to be allocated among more than one public agency in addition to the health department the committee believes that fulfilling the assurance function adequately requires that there be one place of ultimate responsibility and accountability.
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From page 48... ...
While meeting 100 percent of the need for Assured Services should remain the ultimate public health objective, only part of this need will be met at the present time because of resource constraints or other limitations. State Governments Under the Constitution, the states are the repositories of powers not specifically delegated to the federal government.
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From page 49... ...
Today, despite increased state activity and despite considerable efforts in the states to reform governance processes, according to the Advisory Commission on Intergovernmental Relations, "it does seem that improvements in state governmental performance have not been matched by a commensurate increase in their role as independent polities and policymakers." (Advisory Commission on Intergovernmental Relations, 1985) Yet their constitutional role and accumulated responsibilities guarantee that states will continue to be the "pivotal actors in our federal system." (Advisory Commission on Intergovernmental Relations, 1985)
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From page 50... ...
Despite the relative Reemphasis on national government action, the federal role remains crucial. A primary activity is overall health policy development for the nation, including a variety of efforts to focus nationwide attention on major public health problems and encourage action on the part of other levels of government and of private groups.
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From page 51... ...
During this period, public health was aimed at preventing illness by improving living conditions, and care of individual patients was left to private physicians. With the discovery of bacteria and the development of immunization techniques, however, disease prevention could no longer be so easily defined solely as a communitywide affair.
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From page 52... ...
In the same ideal, public health would emphasize specialized personal health services uniquely needed for fulfilling the assurance function of the public health mission. The committee notes that care of the poor and the uninsured has indeed become an issue in the private sector, in the form of concern over "uncompensated care." The slow starvation of classic public health activities offers an additional compelling reason for finding what one public health official interviewed in the study called a "medical home" for poor Americans, one that makes sense in terms of patient needs and professional capabilities, not simply a place that has to take them in.
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From page 53... ...
Model Standards: A Guide for Community Preventive Health Services is a set of standards for organizing local health services. It was developed by the American Public Health Association, the national organizations for state health officers, county health officials, local health officers, and the U.S.
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From page 54... ...
In the ideal health system, the substance of basic services will entail adequate personal health care for all members of the community, the education of individuals about healthy life-styles and the education of the community-atlarge, the control of communicable disease, and the control of environmental hazards-biological, chemical, social, and physical. Explicit priorities will be set in each community and at each level of government so that clear objectives guide organized community efforts.
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From page 55... ...
1985. Model Standards: A Guide for Community Preventive Health Services.
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