Index

A

ABS Immunization Calendar program, 336-337

Academia, xvi-xvii, 15-18, 29, 32-33, 358-395

see also Professional education;

Schools of public health

academic health centers, 239, 250-251, 252

accreditation, 360-361, 368

assessment efforts, 364, 374, 378

Association of Schools of Public Health, 122, 360-361, 394

attitudes, research on200, 392-393

CDC support, 16-17, 99, 368, 371-372, 373, 381, 382-386, 390-392

community-level efforts, 359, 363, 372, 373-374, 375, 377-381, 386-395

community public health degrees, 361

competency-based learning, 33, 363, 419, 422, 437

Council on Linkages between Academia and Public Health Practice, 5, 9, 118, 120, 161

credentialing, 122, 359, 364

curricula, 15, 117, 121, 125-126, 418, 419, 422(n.9), 423

defined, 359

doctorate of public health, 360, 361

epidemiology, 374-375

financing, 16, 111, 367-374, 395

health care delivery system, cooperative efforts, 5, 6, 155-158, 250-251, 360, 365, 375, 381

interdisciplinary approaches, 16, 235, 360, 362, 363-367, 371, 372, 376

international cooperation, 166, 358

leadership training, 5-6, 16, 389, 393

mass media, use of, 324, 388

master of public health degree, 360, 361, 365, 366, 367, 372

obesity prevention, 81-82, 375-376

partnerships, 5, 6, 119, 120, 250-251, 358, 360, 364, 365, 372, 377, 378, 379, 380, 388-392, 394

policy development, 374, 388, 419

population studies and interventions, 360, 375, 376-377

practice scholarship, 393-395

preventive medicine and health promotion, 16, 17, 361, 364, 365, 375

public health agency/delivery system collaboration, 5, 6, 155-158, 250-251, 360, 365, 375, 381

public health worker training partnerships, 119, 120



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The Future of the Public’s Health in the 21st Century Index A ABS Immunization Calendar program, 336-337 Academia, xvi-xvii, 15-18, 29, 32-33, 358-395 see also Professional education; Schools of public health academic health centers, 239, 250-251, 252 accreditation, 360-361, 368 assessment efforts, 364, 374, 378 Association of Schools of Public Health, 122, 360-361, 394 attitudes, research on200, 392-393 CDC support, 16-17, 99, 368, 371-372, 373, 381, 382-386, 390-392 community-level efforts, 359, 363, 372, 373-374, 375, 377-381, 386-395 community public health degrees, 361 competency-based learning, 33, 363, 419, 422, 437 Council on Linkages between Academia and Public Health Practice, 5, 9, 118, 120, 161 credentialing, 122, 359, 364 curricula, 15, 117, 121, 125-126, 418, 419, 422(n.9), 423 defined, 359 doctorate of public health, 360, 361 epidemiology, 374-375 financing, 16, 111, 367-374, 395 health care delivery system, cooperative efforts, 5, 6, 155-158, 250-251, 360, 365, 375, 381 interdisciplinary approaches, 16, 235, 360, 362, 363-367, 371, 372, 376 international cooperation, 166, 358 leadership training, 5-6, 16, 389, 393 mass media, use of, 324, 388 master of public health degree, 360, 361, 365, 366, 367, 372 obesity prevention, 81-82, 375-376 partnerships, 5, 6, 119, 120, 250-251, 358, 360, 364, 365, 372, 377, 378, 379, 380, 388-392, 394 policy development, 374, 388, 419 population studies and interventions, 360, 375, 376-377 practice scholarship, 393-395 preventive medicine and health promotion, 16, 17, 361, 364, 365, 375 public health agency/delivery system collaboration, 5, 6, 155-158, 250-251, 360, 365, 375, 381 public health worker training partnerships, 119, 120

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The Future of the Public’s Health in the 21st Century racial/ethnic issues, 358, 362, 372, 419 rural areas, 250, 376 safety-net providers, 219 service, 373-374, 387-395 service learning, 373-374, 391-392 wages of faculty and staff, 361, 365-366 Access to services, 22, 24, 25, 32, 212, 213-220 see also Health insurance; Managed care organizations; Outreach; Safetynet services community health centers, 153-154, 215, 219 community-level collaborations, 192, 451 federal guarantees, 168 hospitals, 63 minorities, 63, 222-223, 233 obesity, 81 population-level studies and interventions, 71 public health agency/delivery system collaboration, 244, 257 public transportation, 36 race/ethnicity, 62-63 social connectedness, 65 socioeconomic status, 233, 239 transportation, 36, 238 Accidents and injuries, 20-21 community-level collaborations, 192, 198, 253 seat belts, xv, 73-74, 240 teen driving behavior, 386 uninsured, emergency care, 217-218 workplace, 276, 277, 284-288 Accountability, xiv, 4, 7, 33, 34, 101, 444 Department of Health and Human Resources funding, 115, 150 emergency preparedness, 147 federal agency organization, 163 local government, 415 public health agencies, 413 public health leadership and, 121-122 Accreditation of institutions hospitals, 157 public health agencies, 9, 155, 156, 157-158 schools of public health, 360-361, 368 Administration for Children and Families, 114 Administration on Aging, 114 Adolescents, 187, 451, 458 see also School-based interventions Advocates for Youth, 328 alcohol abuse, 278 diabetes management, 386 employment, 203 immunizations, 223 parental expectations and teen behaviors, 386 smoking, 321 teenage pregnancy, 203, 340 Advertising, 307-308, 323-324, 337 alcoholic beverages, 76 community-based collaborations, 196, 197 media advocacy, 338 population-level studies and interventions, 76 professional education, 240 public service announcements, 15, 319-324 social marketing, 14, 117, 125, 201, 282, 299, 319, 326, 333-338 tobacco, 76, 196 Advocacy AIDS, 310 committee study at hand, methodology, xiv community-level collaborations, 190, 192, 202, 255, 458 diet, 340 media, 338-341 obesity, 81 public health infrastructure, 100 public health worker training, 117 Advocates for Youth, 328 African Americans, 61, 62 community-level collaboration, 190, 191, 197-198, 444-449 digital divide, 331-332 health care professionals of African American origin, 235 health insurance coverage and preventive care, 222-223 infant morality, 20, 21 oral disease, 230 poverty, 63 religious influences, 190, 191, 194 Age factors, xii see also Adolescents; Children; Elderly persons; Longevity AIDS, media coverage, 309

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The Future of the Public’s Health in the 21st Century employer health promotion/prevention measures, 274 nursing shortages, 236-237 population dynamics, 12, 28, 35 population-level studies and interventions, 75 preventive care, insurance coverage, 222, 230-231, 274 professional training, 367 Agency for Healthcare Research and Quality, 112 Agency for International Development, 165 Agency for Toxic Substances and Disease Registry (ATSDR), 112, 117, 118, 132, 163 Agenda setting theory, 344-345 AIDS, see HIV/AIDS AIDS Federal Policy Act, 310 Air pollution, 54 Alcohol abuse, 228, 278 advertising, 76 cost factors, 228, 229, 276, 278 counseling, 223 employees, 274, 275, 276-277 entertainment television, 324-325, 328-329 media advocacy, 339-341 preventive interventions, 275, 276-277 Ambulatory care, see Outpatient care American Academy of Pediatrics, 328 American Hospital Association, 237, 238, 253 American Indians state program participation, 103 tribal governments, 102-103, 421-422 American Medical Association, 363 American Psychological Association, 328 American Public Health Association (APHA), 122, 156, 363 America’s Children: Health Insurance and Access to Care, 218 America’s Health Care Safety Net: Intact but Endangered, 220-221 Animal studies see also Veterinarians bioterrorism, 139 social isolation, 65 toxic substances, 164 Anthrax, 96, 106, 124, 142, 247, 317-318 Antibiotics drug-resistant pathogens, 1, 21 information systems, 249 Asians community-level interventions, 457-460 health care professionals, 235 Assessment, 32, 411, 412, 413 see also Credentialing; Outcome assessment; Performance standards; Quality of care; Research methodology academic research, 364, 374, 378 accreditation, institutions bioterrorism response, 141-143 community-level efforts, 11, 184, 186, 187-189, 191, 194, 196-197, 198-201, 202-203, 297, 406-409 (passim), 446, 447-449, 452, 456-457 employees, health promotion programs, 279-280, 281-283 of health care professionals, 5, 6, 366 health officials, 7, 113, 150, 163 industrial pollution control, 290 local level, 7, 8, 11, 141-142 mass media interventions, 321, 324-327, 345-347 peer review, 16, 27, 382, 383, 385, 388, 393 professional education, 366-367 public health agencies, general, 141-143, 156-157 public health laboratories, 8, 140 public health worker training, 119, 430 system-wide, 7, 99 Assessment Protocol for Excellence in Public Health, 156, 406 Association of Health Care Journalists, 316-317 Association of Public Health Laboratories, 130, 137, 138 Association of Schools of Public Affairs and Administration, 361 Association of Schools of Public Health (ASPH), xi(n.1), 122, 360-361, 394 Association of State and Territorial Health Officials (ASTHO), 9, 122, 148, 155, 156, 158, 168, 332 Association of Teachers of Preventive Medicine, 361 Association of University Programs in Health Administration, 361

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The Future of the Public’s Health in the 21st Century Assurance, 8, 22, 83, 98, 114, 411, 412, 413-414 academic research, 374 accreditation of public health agencies, 157 environmental safety, 116 privacy, 136 safety-net services, 257 uninsured persons, 154, 247 Asthma, 54, 56, 62, 63, 128, 218, 234, 239, 286, 386, 446 Attitudes and beliefs academic research, 200, 392-393 AIDS discrimination, 310 alcohol and substance abuse, 228 community-level collaborations, 184, 193, 194, 200 companies, public opinion, 298 crime, public opinion, 311 employees, 282 health belief model, 342 health care system decisionmakers, 24 industrial pollution, 291 institutional and organizational, 17 mass media, 307-308, 310, 313-315, 317, 318, 322, 333 minority physicians, 236 oral diseases, 229 parental expectations and teen behaviors, 386 political, 417 professional education, 373-374, 420 public health agency/delivery system collaboration, 244 research methodology, 347 smoking, 76 uninsured persons, 216 B Behavioral risk factors, 21, 24, 39, 50, 57, 275 see also Accidents and injuries; Alcohol abuse; Obesity; Preventive interventions and health promotion; Smoking; Substance abuse academic research, 374, 375, 377 chronic conditions, general, 234 community-level collaborations, 186, 189, 191, 196-198 counseling, 81, 102, 105, 196, 222, 223, 224, 234, 274, 282, 458 employees, 275-281 (passim) health insurance and, 218 mass media, 307-308 race/ethnicity and, 61 social connectedness, 65 socioeconomic status, 60 Biostatistics, 105, 116, 316, 360, 372, 419 Bioterrorism, 1, 3, 7, 21, 27, 40, 234 anthrax, 96, 106, 124, 142, 247, 317-318 assessment, 141-143 CDC response, 124, 134, 143-144, 145 DHHS, 124, 143 diagnosis, 96, 218 Enhanced Surveillance Project, 131 funding for preparedness, 7, 26-27, 137-138, 139, 140, 144-147 health insurance coverage, 218 information/communication systems, 3, 99-100, 124, 132-133, 134, 142 local public health agencies, 96, 137-138, 139, 140, 141-147, 160 mass media, 142, 317-318 physician reports, 247, 248 public health agency response, 96, 100, 137-138, 139, 140, 141-147 state law reform, 106, 107 Bioterrorism Preparedness and Response Initiative, 143 Bioterrorism Preparedness and Response Program, 143 Birth defects, 21, 55 Black persons, see African Americans Block grants, 150-152, 228-229, 245, 444 Body mass index, 48-50 Bureau of Health Professions, 371 C California Public Employees Retirement System, 272 Cancer breast, 197-198 diagnosis and screening, 197-198, 224, 240, 274 international efforts, 20-21 National Cancer Institute, 276 oral, 230 racial/ethnic disparities in treatment, 231

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The Future of the Public’s Health in the 21st Century Cardiovascular disease, 275, 277 see also Hypertension community-level collaborations, 188, 191 occupational status, 66 preventive interventions, 224, 275 race/ethnicity, 62 social connectedness, 64, 65 socioeconomic status, 58 Categorical grants, general, 8, 115, 127, 150, 151-152, 160 Center for Genomics and Public Health, 390, 394 Center for Infectious Disease Research Policy, 139 Centers for Disease Control and Prevention (CDC), 5, 99-101 academia, support of, 16-17, 99, 368, 371-372, 373, 381, 382-386, 390-392 accreditation, institutions, 9, 155, 157-158 bioterrorism response, 124, 134, 143-144, 145 budget, 386 Centers, Institutes, and Offices, 381, 382 communication technology, 128, 131-133, 134, 136 community-level interventions, 188, 386, 390-391 investigator-initiated research, 16, 382-383, 385 mass media, entertainment television, 326 National Center for Environmental Health, 10, 163 National Center for Health Statistics, 114 National Electronic Disease Surveillance System, 128, 132 National Institute for Occupational Safety and Health, 283 National Public Health Performance Standards Program, 150, 155, 157 obesity, 76-77 performance standards, 155 preventive interventions, 16, 55, 74, 76-77, 99-100, 117-121 (passim), 381, 382-386, 390-391 professional education, 12, 16-17, 368, 371, 373, 374, 423 public health laboratories, 137, 138, 140 public health worker training research agenda, 9, 161 smoking, 74 state law reform, 106-107 surveillance, 128, 129, 131-133, 140, 248, 249-250 toxic substances, 55 Centers for Medicare and Medicaid Services, 114 public health agency/delivery system collaboration, 245 Centers for Prevention Research, 99 Centers for Public Health Preparedness, 100, 394 Centers, Institutes, and Offices (CIO-CDC), 381, 382 Certified Health Education Specialist, 122 C. Everett Koop National Health Award, 299 Chemical terrorism, 138, 139, 141 Children, 12, 36 see also Adolescents; Infants; Schoolb ased interventions Administration for Children and Families, 114 community-level interventions, 187, 386, 444, 458 competencies of health care workers, 433-434 dental care, 229-230 Early and Periodic Screening, Diagnosis, and Treatment program, 224-225, 226 employee leave to care for, 288 entertainment television, 328-329 immunizations, 111, 223, 274, 336-337, 362, 386 news media coverage, 311-313 obesity, 78 preventive interventions, 224, 226, 386 public health worker training, 117 toxic substances, 55 uninsured, 216, 217, 218, 220 Cholesterol, 275 Chronic conditions, 12, 20, 21, 27, 212 see also Cardiovascular disease; Diabetes asthma, 54, 56, 62, 63, 128, 218, 234, 239, 286, 386, 446 birth defects, 21, 55 community-level collaborations, 193-194, 444, 449

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The Future of the Public’s Health in the 21st Century defined, 232 demographic factors, general, 35 disabled persons, 215, 232 educational attainment and, 21, 59 elderly persons, 35, 232-236 health care delivery system, 212, 229, 231, 232-234, 236-237 health insurance, 214, 216, 234-235, 240 historical perspectives, xii, 79 managed care, 240 National Center for Chronic Disease Prevention and Health Promotion, 100 nursing shortages, 236-237 oral diseases and, 229 quality of care, general, 232-234 surveillance, 128, 130 Clinical Laboratory Improvement Amendments, 137 Coalitions, see Community partnerships, coalitions, and collaboration; Partnerships, coalitions, and collaboration Cognitive theory, 343-344 Collaboration, see Partnerships, coalitions, and collaboration Colleges and universities, see Academia Communication, xiii, xiv, 4, 6, 10, 15, 34, 37, 131-134 see also Information systems; Internet; Mass media bioterrorism response, 3, 99-100, 124, 132-133, 134, 142, 144 CDC, technological innovation, 128, 131-133, 134, 136 community-level, 11, 14, 184, 189, 299-300 corporate/community, 299-300 Health Alert Network, 99-100, 124, 132-133, 134, 143, 144, 146 health care delivery system, 213 health officials’ role, 6, 124, 125, 132, 135, 168 infrastructure costs, 136, 139, 243, 256 local public health agencies, 134, 143, 159-160 National Information Infrastructure, 134-135 partnerships, 6, 34, 392 professional training, 123-126, 367 schools of public health, 132, 333 standards, 39, 130, 132, 139, 144, 242-243 technical assistance, 139, 242-244, 307 technological innovations, 35, 37-38, 39, 131-133, 134, 136 Community and Migrant Health Centers, 111 Community-based factors and interventions, xv-xvi, 2, 11, 22, 178-204 see also Community partnerships, coalitions, and collaboration; Local factors academia, 359, 363, 372, 373-374, 375, 377-381, 386-395 academic health centers, 239, 250-251, 252 access to services, 192, 451 accidents and injuries, 192, 198, 253 African Americans, 190, 191, 197-198, 444-449 Asians, 457-460 assessment, 11, 184, 186, 187-189, 191, 194, 196-197, 198-201, 202-203, 297, 406-409 (passim), 446, 447-449, 452, 456-457 children, 187, 386, 444, 458 committee study at hand, methodology, 441 communication, 11, 14, 184, 189, 299-300 community health centers, 153-154, 215, 219, 251 definitional issues, 160-161, 178-180, 387, 394 demonstration projects, 13, 204, 253 determinants of health, 179, 188, 447-448, 456, 457 ecological models, 51-53, 68-71 employer/business role, 13, 187, 188, 193, 201, 203, 253-254, 255, 268, 290, 292-300 entertainment media, 327 environmental factors, 54, 186, 187, 188, 192-196, 386 epidemiology, 200-201 essential services, 32, 33, 160, 161, 179, 185, 460 ethical issues, 200-201 funding, 11, 183, 201, 203, 204, 253, 254, 444, 449, 454, 456, 457 globalization and, 180 governance, 184-186

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The Future of the Public’s Health in the 21st Century health care delivery system, 213, 251-252 Healthy People 2010, 19 Hispanics, 457-460 historical perspectives, 178, 179 hospitals, 182, 187, 202, 251, 252-253 information systems, 184, 189 intersectoral models, 52 leadership, 11, 184, 196, 201, 204, 254, 292, 293, 297-298, 389, 393 media interventions, 81, 338, 339-340 obesity, 80, 81, 82, 187, 197, 198 outcome assessment, 11, 198-199 outreach, 111, 192, 202-203, 394, 445, 447, 450, 458 participatory research, 201, 346, 359, 377-378, 380-381, 393, 427 performance standards, 156, 160, 186, 193-196, 409-420 prevention and health promotion, 17, 80, 81, 183, 187, 190, 191, 192-194, 196-197, 198, 204, 253, 292, 327, 373, 378, 386-387, 389, 392-393, 407-408, 445-460 (passim) professional training, 202, 203, 235, 362, 371, 373-374, 449 private sector, 182-183 public goods, 22-23 public health agency involvement, 181, 182, 246 public health function of state, 98 public health worker training, 117, 119 religious influences, 190-191 safety-net services, 153-154, 215, 219, 446 small and remote communities, 98, 108, 134, 160, 161, 188, 250, 415 state law, 106 taxation, 182, 253 technical assistance, 388, 393, 394 Turning Point initiative, xiii, xiv(n.3), 4(n.1), 106, 107, 121, 182-183, 184, 185, 203, 337, 442, 443, 451, 452, 454 Community health centers, 153-154, 215, 219, 251 Community Health Improvement Process (CHIP), 409-410 Community Health Status Indicators Project, 332-333 Community partnerships, coalitions, and collaboration, xi, 33, 34, 99, 142, 180, 181-182, 183, 185, 187, 204, 254, 255, 299, 377, 378, 379, 387, 388-391, 394, 441, 444-460 see also School-based interventions advertising, 196, 197 advocacy, 190, 192, 202, 255, 458 African Americans, 190, 191, 197-198, 444-449 Asians, 457-460 attitudes affecting, 184, 193, 194, 200 behavioral risk factors, 186, 189, 191, 196-198 cardiovascular disease, 188, 191 CDC role, 188, 386, 390-391 chronic conditions, 193-194, 444, 449 crime, 70, 71, 180, 339-340, 445, 447, 458 cultural factors, 194-195, 197, 198, 200, 204, 458-459 diagnosis and screening, 197-198 elderly persons, 187, 458 employers and businesses, 187, 188, 193, 201, 203, 253-254, 255, 268, 290, 292-300 environmental health factors, 54, 186, 187, 188, 192-196, 386 epidemiology, 200-201 exercise, physical, 187, 188, 191, 194, 197 federal role, general, 11, 188, 203 food and nutrition, 187, 188, 191, 194, 197, 458 gender factors, 183-184, 191, 197-198, 446-447, 458 health insurance, 254, 458 health officials’ role, 179, 181, 272-273, 298 health workers, 191-192, 194, 427 Hispanics, 457-460 HIV/AIDS, 183-184, 444, 449, 458 information systems, 184, 189 Internet, 189 language factors, 178, 180 leadership, 11, 196, 201, 204, 254, 292, 293, 297-298, 389, 393 local public health agencies, 181, 185-186, 187, 191-192, 202, 203, 204, 408, 454, 458, 459-460

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The Future of the Public’s Health in the 21st Century mass media, 188, 196, 197, 202, 253, 254-255, 311-313, 388 mental health, 193, 451, 458 models, 186-199, 203, 393-394, 406-410 monitoring, 33, 408 nonprofit organizations, 181-182, 194, 252-253, 449, 451, 457, 459 obesity, 187, 197, 198 organizational factors, 22, 179, 180-199, 202, 203 outreach, 111, 192, 202-203, 394, 445, 447, 450, 458 performance standards, 409, 410 personal health, 449 political influences, 192, 195-196 population studies and interventions, 198-199, 378, 387 public education, 191, 192, 194, 197, 449, 458 racial/ethnic factors, 184, 190, 191, 197-198, 201, 444-449 religious influences, 190, 191, 454 risk factors, 186, 191, 193-198 sexually transmitted diseases, 183-184, 444, 449, 458 smoking, 188, 196 social factors, 184, 188, 204, 451 substance abuses, 203, 445 technical assistance, 11, 184, 202, 203, 388, 393, 394 toxic substances, 312-313, 390 Turning Point initiative, xiii, xiv(n.3), 4(n.1), 106, 107, 121, 182-183, 184, 185, 203, 337, 442, 443, 451, 452, 454 urban areas, 187, 374, 444-460 Community Voices, 184, 442-459 (passim) Competencies of health workers, 15, 100-101, 154, 418, 422, 423-440 see also Credentialing academia’s responsibilities, 33, 363, 419, 422, 437 accounting, 425 bioterrorism/emergency response, 426-427, 428 child care, 433-434 communication skills, 126, 417 community-level health, 191-192, 194, 427 computer applications, 433 core, 7, 120, 125, 363, 372, 424, 425-426, 432, 435, 437 cultural, 36, 125-126, 192, 194, 212, 236 emergency response, 143 epidemiology, 329-430 essential services, 5, 116, 422 multidisciplinary, 122-123, 235 training, competency-based, 5, 16, 33, 116-120, 122, 125-127, 143, 363, 366, 393-394, 422 Computer applications, 117 see also Information systems; Internet competencies of health care workers, 433 diagnoses, 249 diffusion theory, 367 educational materials, computer generated, 336 employee training programs, 293 health care settings lacking, 242 medical records, standards, 242-243 National Health Information Infrastructure, xii, 7, 134-136, 244 personal computer use, 7, 307, 333 physician orders, 242, 253 professional education, 367, 424 Confidentiality, see Privacy and confidentiality Congress see also Legislation bioterrorism, 143, 144, 317 CDC investigator-initiated funding, 385 community health centers, 154 DHHS budget, 113 fragmentation of services, 112 Homeland Security Department, 143(n.13) immunization programs, 149 information infrastructure, 7, 134, 136 international health activities, 165, 166 National Health Information Infrastructure, 7, 136 National Public Health Council, 10, 169 prevention research, 16 public health education funding, 16 safety belts, 73 workforce preparedness funding, 5, 120 Congress of National Black Churches, 190 Continuing education, 15, 120, 251, 358, 361, 367, 371, 372, 373, 419, 422, 454

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The Future of the Public’s Health in the 21st Century Contraceptives, 223, 325-326 Core public health functions, 5, 98, 120, 123, 157, 185, 363, 411, 452 see also Assessment; Assurance; Policy development communications, 6, 125 professional education, 7, 120, 125, 363, 372, 424, 425-426, 432, 435, 437 Corporate Investment in Health Award, 14, 300 Costs and cost-benefit factors, 12, 46, 255-257 alcohol abuse, 228, 229, 276, 278 childhood and adolescent immunizations, 223 chronic diseases, 128, 233-234 communications/information infrastructure, 136, 139, 243, 256 depression, treatment of, 227 elderly persons, treatment of, 36 employee illness and injury, 272, 275-285 (passim), 298 essential public health services, 152-153 health care delivery system, capacity, 234 health care delivery system, state regulation, 213, 214 health insurance, 269-271, 273, 275, 277 health-related expenditures, 20, 213, 215, 232, 255-257 industrial pollution, 291 laboratory diagnostic tests, 248 local public health agency infrastructure, 144, 148 managed care, 241 mental illness, 225, 277, 278 National Health Information Infrastructure, 136 obesity, 77-78 pharmaceuticals, prescription drugs, 256, 269 population-level studies and interventions, 72, 75 preventive measures, 73, 74 primary care practice costs, 239 public health infrastructure, general, 147-148 public health laboratories, 137(n.10) state public health agency infrastructure, 144 substance abuse, 228, 229, 276, 278 underinsured persons, 218 Council of State and Territorial Epidemiologists, 130, 139 Council on Linkages between Academia and Public Health Practice, 5, 9, 118, 120, 161 Counseling, 81, 102, 105, 196, 222, 223, 224, 234, 274, 282, 458 Coverage of the Quality of Care—A Resource Guide for Journalists, 317 Credentialing, 372, 454 see also Accreditation of institutions academic programs, 122, 359, 364 Certified Health Education Specialist, 122 Graduate Certificate Program, 371 public health workers, 6, 122-123, 158 Crime and violence, 54, 180, 253 community-based interventions, 70, 71, 180, 339-340, 445, 447, 458 mass media, 311, 328-329, 345 public opinion, 311 Crossing the Quality Chasm, 212, 213, 231, 233-234, 235, 240, 242 Cultivation theory of mass media, 344 Cultural factors, 23, 39, 40, 62 see also Immigrants; Language factors; Race/ethnicity; Social factors academic research, 374, 390 community defined, 178-179, 180 community-level collaborations, 194-195, 197, 198, 200, 204, 458-459 faith community, 179, 181, 190, 191, 194, 355, 454 health worker competency, 36, 125-126, 192, 194, 212, 236 institutional, 24, 195, 202 mass media, 318, 334-335 obesity, 76, 81, 82 professional education, 118, 125, 180, 194, 233, 236, 362, 367, 372, 374, 458 religious influences, 190, 191, 454

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The Future of the Public’s Health in the 21st Century D Definitional issues academia, 359 chronic conditions, 232 community, 160-161, 178-180, 387, 394 disparities in health care, 231 essential public health services, xi-xii, 31, 32 population studies and interventions, 377, 378 prevention, 221, 376 public health, 28, 30, 98, 411, 453, 456 public service announcements, 320 safety-net services, 219 Demographics, xii, xv, 1, 35, 70-71 see also Age factors; Educational attainment; Gender factors; Population studies and interventions; Race/ethnicity; Socioeconomic status professional training, 362 Demonstrating Excellence, 394 Demonstration projects, 13 community-level, 13, 204, 253 health care financing and delivery, 257 hospital/community collaboration, 253 Dentistry, see Oral health care Department of Agriculture, 101, 114 food labeling, 82 Department of Commerce, 300 Department of Defense, 215 Department of Health and Human Services (DHHS), 6, 7, 111-115 see also Centers for Disease Control and Prevention; National Institutes of Health accreditation, institutions, 9, 158 Administration for Children and Families, 114 Administration on Aging, 114 Agency for Healthcare Research and Quality, 112 Agency for Toxic Substances and Disease Registry, 112, 117, 118, 132, 163 bioterrorism response, 124, 143 budget, 113 Centers for Medicare and Medicaid Services, 114, 245 communication training, 125 community health centers, 153-154 Corporate Investment in Health Award, 14 demographic disparities in care, 233 dietary guidelines, 79, 80 Food and Drug Administration, 56, 112, 114, 163 Health Resources and Services Administration, 5, 16, 112 international efforts, 115, 165, 166 Internet interactive communications, 329, 332 local governments, cooperation with, 112, 167-168 mass media relations, 317-318 National Committee on Vital and Health Statistics, 7, 135, 136, 143, 244 National Health Information Infrastructure, xii, 7, 134-136, 244 National Institutes of Health, reporting to, 387 National Public Health Council, 10-11, 169 oral health, insurance coverage, 229 organizational factors, 9-10, 112-115, 161-166, 168, 318 performance standards, 160 professional education, 118, 119, 120, 366-367, 368, 374 public health agency/delivery system collaboration, 245 public health financing, 147 public health function, general, 98, 112, 150-151 public health laboratories, 7, 8, 140 Public Health Service, 112, 113, 114 regionalization, 162, 168 regulatory authorities of agencies, 9-10, 113-114, 164-165, 169 state government relations with, 10-11, 112, 167-169 Substance Abuse and Mental Health Services Administration, 112 surveillance, 113, 128 Department of Homeland Security, 143(n.13) Department of Justice, 167 Department of State, 38 Agency for International Development, 165

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The Future of the Public’s Health in the 21st Century Depression, 67, 125, 225, 227, 234, 277, 278 suicide, 70, 275 Determinants of health, xiv, 2, 11, 21, 28, 31, 41, 135, 196, 245 see also Access to services; Behavioral risk factors; Genetic factors; Risk factors community-level, 179, 188, 447-448, 456, 457 ecological, xv, 6, 37, 51, 53, 68-71, 196 employment and workplace, 268 health care delivery system, 214, 240, 245, 417 physical environment, 53-56, 188 population-level, 4, 11, 25, 33, 46-84 social, xv, 36, 56-71, 188, 338, 346, 456 socioeconomic, 39, 57-61 Developing countries, research on diseases affecting, 40, 165 Diabetes, 77, 78-79, 275, 388 family-to-child management transfer, 386 Internet, 243 outpatient care, 239 preventive interventions, Medicare coverage, 224 Diagnosis and screening, 32, 99, 222 see also Public health laboratories alcohol abuse, 278 bioterrorism response, 96, 218 cancer, 197-198, 224, 240, 274 cardiovascular disease, 227 children, Medicaid coverage, 224-225, 226 community-level collaborations, 197-198 counseling, 221-222, 223, 224 Early and Periodic Screening, Diagnosis, and Treatment program, 224-225, 226 genomics, 37, 140 health insurance coverage, 214, 216, 218, 239, 248, 274 hospital emergency response, 238 mental disorders, 227 neglected, 221 obesity, clinical guidelines, 81 oral diseases, 230 public health laboratories, 136, 137, 138, 139, 140 racial/ethnic factors, 197-198, 232 sexually transmitted diseases, 274 state law, 104(n.3), 105, 106 surveillance and, 248-250 toxicity, 100 Diet, see Food and nutrition Diffusion of innovation theory, 39, 342-343 Disabled persons, 215, 232 employees, 275, 285 Distance learning, 117, 243, 359, 367, 368, 454 Doctor of public health (DrPH), 360, 361 Drugs, see Alcohol abuse; Pharmaceuticals; Substance abuse E Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, 224-225, 226 Ecological models, xv, 6, 37, 51, 53, 68-71, 196 Economic factors, 21, 24-25 see also Costs and cost-benefit factors; Employers and businesses; Funding competency requirements, 428, 431, 432 globalization, 38-41, 180, 362, 430 health determinant models, 57, 403-405 health-related expenditures, 20, 213, 215, 232, 255-256, 422 incentives and disincentives, 23, 32, 75, 104, 155, 213, 222, 233, 241 National Health Information Infrastructure, 136 pharmaceuticals, intellectual property, 165 professional training, 362 public service announcements, 320, 321, 323-324 university students, 15, 16 Education, see Academia; Professional education; Public education Educational attainment, 57, 58, 69 chronic diseases, 21, 59 quality of care, 231 Elderly persons, 35-36, 234 see also Medicare Administration on Aging, 114 chronic conditions, 35, 232-236

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The Future of the Public’s Health in the 21st Century public health agencies, 96, 121, 417-418 public health leadership, 121, 417 social marketing, 335 Pollution Prevention Act, 284 Population growth, 35-36, 53 minorities, 36 Population studies and interventions, xii, xiii, 46-84, 417 see also Demographics; Epidemiology; Surveillance academia, 360, 375, 376-377 community-level collaborations, 198-199, 378, 387 cost factors, 72, 75 definitional issues, 377, 378 Department of Health and Human Services, 115 determinants of health, 4, 11, 25, 33, 46-84 diet, 72 employer efforts, 269 health care financing and delivery, demonstrations, 257 local health agencies, 111, 153, 154, 417 managed care, 240, 241, 246-247 mass media, 333-341 Medicaid, 246-247 personal health care and, 46, 47, 53 preventive interventions, 17, 47-48, 71-84, 376-377, 387 professional training, 362 public health agency/delivery system collaboration, 251, 422 public health worker training, 117 Poverty see also Medicaid; Safety-net services advertising of tobacco and alcohol, 76 employer insurance not provided, 273 environmental factors, 54, 60 ethical issues in indigent care, 416 federal responsibility, general, 416 health status, general, 50, 54, 60, 69 housing, 252 news media coverage of, 311, 313 oral disease, 229-230 primary care access, 239 race/ethnicity and, 61 State Children’s Health Insurance Program, 215 Women, Infants and Children program, 82 Preparedness bioterrorism, 3, 21, 27, 40, 141-143, 234, 247, 317-318 centers for public health preparedness, 100 emergency, xvi, 3, 5, 7, 100, 107, 115, 116, 124, 125, 134, 135, 138, 140, 141, 143-144, 212, 234, 449 funding for, 7, 26-27, 137-138, 139, 140, 144-147 public health, 100, 107 Prevention Priorities: Employers’ Guide to the Highest Value Preventive Health Services, 273 Prevention Research Centers, 383-385 Prevention Research Initiative (CDC), 382 Preventive interventions and health promotion, 25-26, 32, 414, 418 see also Behavioral risk factors; Diagnosis and screening; Exercise; Outreach; School-based interventions; Smoking; Vaccines academia, 16, 17, 361, 364, 365, 375 alcohol abuse, 275, 276-277 biomedical interventions vs, 24 cardiovascular disease, 224, 275 CDC, 16, 55, 74, 76-77, 99-100, 117-121 (passim), 381, 382-386, 390-391 Centers for Prevention Research, 99 children, immunizations, 111, 223, 274, 336-337, 362, 386 community-based, 17, 80, 81, 183, 187, 190, 191, 192-194, 196-197, 198, 204, 253, 292, 327, 373, 378, 386-387, 389, 392-393, 407-408, 445-460 (passim) cost factors, 73, 74 counseling, 81, 102, 105, 196, 222, 223, 224, 234, 274, 282, 458 definitional issues, 221, 376 diabetes, Medicare coverage, 224 elderly persons, 35 employers, 3, 13-14, 25, 193, 222, 223, 268, 271-274, 275-289, 292, 293, 294-300 Environmental Protection Agency, 386 environmental risk factors, 25-26, 377 evidence-based policy, 272 health care delivery system, 212

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The Future of the Public’s Health in the 21st Century health insurance coverage for, 12, 73, 216, 218, 221, 222-223, 235, 240 historical perspectives, 222 information technology, 244 interdisciplinary research, 376, 386 managed care, 222 mass media, xvi, 15, 319-348 Medicaid, 224-225, 226, 230 Medicare, 223-224, 226, 230 minority access to quality care, 63, 222-223, 233 National Center for Chronic Disease Prevention and Health Promotion , 100 National Institutes of Health, 17, 82, 386-387 nation-wide programs, 154 neglected, 221-225 obesity, 80-82, 279, 290, 292 physicians, 222, 223-224, 364 population-level studies and interventions, 17, 47-48, 71-84, 376-377, 387 public health agency/delivery system collaboration, 244, 253 research recommendations, 16-17, 387, 422 risk reduction models, 48-51 seat belts, xv, 73-74 socioeconomic status, 25-26 standards, 272 technological innovations, 35 Primary care see also Diagnosis and screening; Physicians access to, 239-242, 255 health insurance, 218 managed care, 153, 239 public health agency provision, 246 shortage of personnel, 239 World Health Organization guidelines, 239 PRISM Awards, 328 Privacy and confidentiality epidemics, measures taken, 24 genomics, 37 health insurance, 214 information technology, general, 243, 244 Internet interactive communication, 332 National Health Information Infrastructure, 136 public health laboratories information/communication systems, 139 surveillance, 13, 248 Private sector, 2, 3, 4, 22-23, 28 see also Employers and businesses; Health insurance; Nonprofit organizations and foundations community-level interventions, 182-183 funding, 11, 12, 14, 17, 136, 170, 182-183, 204 health care delivery system, 212-213, 214-215, 218, 225, 228, 229, 245, 247 hospitals, 137 information systems, 132, 136, 139 infrastructure, 97, 102, 111, 127-128, 132, 136, 137, 139, 153, 170 laboratories, 137, 139 public goods, 22-23 public-private partnerships, general, xi, 132, 182, 194, 245, 247, 417, 449 regulation of, 23 safety-net services, 153 surveillance, 127-128 Professional education, 3, 5, 27, 33, 34, 99, 116-122, 154, 252, 359, 360- 374, 419-420 see also Academia; School-based interventions advocacy, 240 age factors, 367 assessment, 367-374 attitudes and beliefs about, 373-374, 420 CDC, 16-17, 368, 371, 373, 374, 423 communication skills, 123-126, 367 community-level efforts, 202, 203, 235, 362, 371, 373-374, 449 competency-based, 5, 16, 33, 116-120, 122, 125-127, 143, 363, 366, 393-394, 422 computer applications, 367, 424 continuing education, 15, 120, 251, 358, 361, 367, 371, 372, 373, 419, 422, 454 core public health functions, 7, 120, 125, 363, 372, 424, 425-426, 432, 435, 437 cost factors, 123-126, 367

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The Future of the Public’s Health in the 21st Century cultural factors, 118, 125, 180, 194, 233, 236, 362, 367, 372, 374, 458 curricula, 15, 117, 121, 125-126, 418, 419, 422(n.9), 423 dentistry, 81, 229 DHHS, 118, 119, 120, 366-367, 368, 374 diet and nutrition, 81, 362 distance learning, 117, 359, 367, 368, 454 employee training, general, 294 employment opportunities, student awareness of, 420 environmental factors, 117, 118, 159 epidemiology, 118, 129, 365, 372, 374-375 ethical issues, 116 funding, 5, 16, 111, 367-374, 395 Health Resources and Services Administration, 118, 119, 120, 366-367, 368, 374 historical perspectives, 116, 117, 362, 368-371, 420 information systems, 367 integrated/interdisciplinary, 16, 235, 360, 362, 363-367, 372, 376 lacking among public health workers, 361, 366-367 leadership, 5-6, 7, 118, 119, 120-122, 367, 371, 374, 418, 433 local public health agencies, 144, 146, 159, 368, 374, 419 mass media relations, 15, 315-317, 319 minority representation, 235-236, 358, 418 nonprofit organizations, general, 368, 369 nursing, 236, 362, 364, 365, 366 obesity, 81 outreach workers, 192 partnerships and collaborations, 118, 250-251 personal health care, 419 physicians, 366 policy development, 368, 372, 374 public health agencies, general, 5, 6, 365 public health laboratories, 139 public health workers/client relationship, 418 regionalization, 367 shortage of professionals, 235 standards, 372 state public health agencies, 144, 146, 371-372, 373, 374, 419 surveillance, 372 Public education, 32, 99, 124, 417, 421 see also Mass media; School-based interventions business investment in, 292-293 community-level collaboration, 191, 192, 194, 197, 449, 458 competency of health care workers, 431-432 information technology, 242, 243 obesity, 82 outreach workers, 192 population-level studies and interventions, 72, 75 telecommunications infrastructure, 135 Public goods, 22-23 Public health agencies, 2, 3, 29, 46, 96-170 see also Department of Health and Human Services; Local public health agencies; State public health agencies academic cooperation, 5, 6, 155-158, 250-251, 360, 365, 375, 381 accountability, 413 accreditation, 9, 155, 156, 157-158 assessment, 141-143, 156-157 bioterrorism response, 96, 100, 137-138, 139, 140, 141-147 business linkages, 13 community coordination with, 11, 181, 182, 185, 187-188, 191-192 delivery system collaborations, 12, 244-251 DHHS agencies, cooperation with, 9-10 funding, 96, 98-99, 100, 112, 145-154 (passim), 160 genetic testing, 140 health care delivery system and, 212, 213, 244-251 historical perspectives, 26, 97-98 information/communication systems, 134, 139, 143, 144, 154, 244-245 Internet access, 421 leadership, 5-6, 375 managed care organizations and, 111, 153 mass media, relations with, 14, 15, 317, 318-319, 327 performance standards, 150, 155-158 personal health care, 25, 246 political influences, 96, 121, 417-418 professional education and, 5, 6, 365

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The Future of the Public’s Health in the 21st Century public education, 421 rural areas, 108, 159, 161 safety-net services, 246, 247 Public Health Foundation (PHF), 148, 150, 155, 156, 332 Public Health Improvement Act, 144, 149 Public health laboratories, 7-8, 136-140 assessment, 8, 140 Association of Public Health Laboratories, 130, 137, 138 bioterrorism response, 96, 137-138, 139, 140, 143, 146 CDC role, 137, 138, 140 chemical terrorism response, 138, 139, 141, 146 competencies of health care workers, 433 DHHS role, 7, 8, 140 diagnostic tests, 136, 137, 138, 139, 140 epidemiology, 136, 140 funding, 8, 136-138, 139, 140, 146, 154 health officials, 137 health workers, 138-139 information/communications infrastructure, 139 local government, 139 National Laboratory System, 139 professional education, 139 regulations for laboratories, 136-137 reporting requirements, 248 safety-net services, 136 state government, 7-8, 137, 139, 140, 146 surveillance, 136, 138, 140, 247, 248 technological innovation, 139, 140 Public health law Public health law, 101-111, 113 AIDS Federal Policy Act, 310 Clinical Laboratory Improvement Amendments, 137 Emergency Medical Treatment and Labor Act, 238 employer-provided health insurance, 127, 248, 273 enforcement, 32, 102 Federal Emergency Response Act, 124 Indian Self-Determination and Education Assistance Act, 103 infectious diseases, state law, 104(n.3), 105, 106 media advocacy, 339-340 model public health law, 4, 5, 106-107 Model State Emergency Health Powers Act, 4-5, 106, 107 Occupational Safety and Health Act, 283, 284 Pollution Prevention Act, 284 Prevention Research Centers, 383-385 professional education funding, selected laws, 369-370 Public Health Improvement Act, 144, 149 Public Health Preparedness and Response Act, 144 Public Health Service Act, 149 Public Health Threats and Emergency Act, 144-145 public health worker training, 117 reform of national, 26 reform of state, 4-5, 26, 98, 104-107, 108, 414, 422 Ryan White CARE Act, 151, 310 seat belts, 73-74 Toxic Substances Control Act, 284 Turning Point Model State Public Health Act, 4-5 Public Health Law Collaborative, 106-107 Public Health Leadership Institute, 391 Public Health Practice Program Office, 99 Public Health Preparedness and Response Act, 144 Public Health Service, see U.S. Public Health Service Public Health Service Act, 149, 166 Public Health Threats and Emergency Act, 144-145 Public Health Training Centers, 374 The Public Health Workforce: An Agenda for the 21st Century, 117 Public relations, 326 professional training, 367 Public service announcements (PSAs), 15, 319-324 defined, 320 Federal Communication Commission, regulation of, 15, 319-320, 322-323 Q Quality of care see also Outcome assessment; Performance standards chronic conditions, 232-234 educational attainment, 231

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The Future of the Public’s Health in the 21st Century employment-based health insurance, 268, 271, 272, 273 environmental factors, 231 managed care, 233 minority groups, 27, 63, 222-223, 231-232, 233 National Committee for Quality Assurance, 157, 271 socioeconomic status, 231, 232, 233 state public health agency regulation, 213-214, 231, 244, 257 uninsured persons, general, 231, 232, 458 R Race/ethnicity, 21, 25, 35, 36 see also Cultural factors; Immigrants; Language factors; specific groups academia, 358, 362, 372, 419 access to care, 63, 233 advertising of tobacco and alcohol, 76 community-level collaborations, 184, 190, 201 determinants-of-health model, 57, 61-63 diagnostic services, 197-198, 232 digital divide, 331-332 discrimination, 61-62 health insurance, 12, 62-63 health workers, 36, 233, 235-236 immigrants, 38, 62, 111, 457-460 infant mortality, 20 physicians, minority representation, 233, 235-236 preventive interventions, insurance coverage, 222-223 professional training of public health workers, 362 quality of care, general, 27, 63, 222-223, 231-232, 233 seat belt use, 73 socioeconomic status and, 58, 61, 63 tribal governments, 102-103, 421 Radio, 15, 322, 323 RAND Health Insurance Experiment, 218 Rapid Response and Advanced Technology Laboratory, 143 Rapid Syndrome Validation Project, 131 Reasoned action theory Regionalization community collaborations, 410 DHHS, 162, 168 professional education, 367 public health funding, 97 Religious influences community-level collaboration, 190, 191, 454 faith community, 179, 181, 190, 191, 194, 355, 454 Regulatory issues, 9, 23, 101-102, 257 see also Accreditation of institutions; Credentialing; Standards DHHS agencies, regulatory authorities, 9-10, 113-114, 164-165, 169 diet and nutrition, 292 enforcement, 32, 99, 102 environmental, 289-290 essential public health services, 99 federal, general, 111, 114 federal agency cooperation, 164 food labeling, 82 health care delivery system, 213, 257 health insurance, 213 local level, 10, 102 monitoring, 422 occupational safety and health, 283-286 (passim) pharmaceuticals, 164 population-level studies and interventions, 72 private and nonprofit organizations, 23 public health laboratories, 136-137 public service announcements, 15, 319-320, 322-323 smoking prevention, 76 state-level, 10, 101-102, 104-107 Reporting requirements federal law, 114, 149 federal/state relations, 169 National Notifiable Disease Reporting System, 248 National Public Health Program Reporting System, 149, 150 public health agency/delivery system collaboration, 247-250 public health laboratories, 248 public health worker training, 127 state, 106, 149-150, 414 Research methodology, 367 see also Assessment academic research, 16-17, 364, 374-387 applied, 359, 378, 386, 419 basic, 347-348, 358, 359, 378, 386, 419

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The Future of the Public’s Health in the 21st Century biostatistics, 105, 116, 316, 360, 372, 419 committee study at hand, xiii-xiv, xvii, 441-460 competency of public health workers, research , 423-424 descriptive, 378 formative, 334-335, 346, 378, 379 mass media, 334-335, 346-348 occupational safety and health, 286 participatory, 201, 346, 359, 377-378, 380-381, 393, 427 practice-based, 372 process, 378, 379 summative, 378, 379 Research recommendations, xiii, 9, 16, 32 academic research, 16-17, 364, 385, 387 community-based research, 387 essential public health services, 99 interagency cooperation, 164 investigator-initiated research, 385 preventive interventions, 16-17, 387, 422 public health worker training, 117 state law reform, 106 Risk factors, 47 see also Behavioral risk factors; Environmental factors; Preventive interventions and health promotion; specific risk factors community-level collaborations, 186, 193-198 health insurance holders, 216 models for reduction of, 48-49 population perspectives, 47-48 uninsured persons, 217 World Trade Center attack, response, 287 Robert Wood Johnson Foundation, 106, 121, 317, 328 see also Turning Point initiative Ron Brown Award for Corporate Leadership, 299 Rural areas, 54 academia, 250, 376 hospital nursing shortages, 236 public health agencies, 108, 159, 161 school funding, tax increases for, 253 small and remote communities, 98, 108, 134, 160, 161, 188, 250, 415 Ryan White CARE Act, 151, 310 S Safety, see Accidents and injuries Safety-net services, 111, 153-154, 216, 219-221, 245 see also Health insurance academia, 219 alcohol/drug abuse treatment, 228 community health centers, 153-154, 215, 219 community services, 153-154, 215, 219, 446 defined, 219 federal government, direct provision of, 219, 221, 245 health officials’ role, 216, 220 hospitals, 219, 220 local government, 153, 219-220 mental health care, 228 private sector, 153 public health agencies, general, 246, 247 state government, 153, 219-220 Sanitation, 20, 22, 48, 51, 54, 60, 362 School-based interventions, 194, 386, 445-446, 450, 451-452 obesity, 79, 80, 82, 197 physical education, 79, 188, 194 smoking, 74-75 Schools of public health, 358, 360, 419-420 see also Academia; Professional education accreditation, 360-361, 368 Association of Schools of Public Health, xi(n.1), 122, 360-361, 394 communication/information systems, 132, 333 continuing education, 419 credentialing, 122 curricular content, 419, 422(n.9) international programs, 362, 419 Internet use, 333 leadership training, 122 mass media partnering, 324 minority groups, 362, 419 policy development, 419 recruitment efforts, 420 research agenda, 5-6, 360, 419 state/local public health agency linkages, 419 Screening, see Diagnosis and screening Seat belts, xv, 73-74, 240

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The Future of the Public’s Health in the 21st Century Sentinel for Health Award for Daytime Drama, 327-328 Sentinel surveillance, 131, 247, 250-251 Sex-based differences, see Gender factors Sexual behavior, 222, 334 see also Gays and lesbians contraception, 232, 325-326 television, 325, 328-329 urban areas, 54 Sexually transmitted diseases, 222, 325, 328 see also HIV/AIDS community-level collaborations, 183-184, 444, 449, 458 competencies of health care workers, 440 employee screening, 274 SHINE Awards, 328 Smoking, xv, 53, 60, 70, 223 advertising, 76 community-level collaborations, 188, 196 employees, 274, 275, 276 mass media interventions, population-level studies and interventions, 72, 74-76 school-based interventions, 74-75 taxation, 75, 76, 323, 324 Social Climate Survey, 75 Social comparison theory, 342 Social convergence theory, 342 Social factors, general, xv, 21, 22-24, 29, 56-71 see also Cultural factors; Mass media; Political influences; Race/ethnicity academic research, 374 business involvement in community, 293-294, 298-299 community-level collaborations, 184, 188, 204, 451 connectedness, 63-66, 70-71, 180 determinants of health, xv, 36, 56-71, 188, 338, 346, 456 health determinant models, 57, 403-405 media advocacy, 338-339 obesity, 76 oral diseases, 229 peer influences, 74-75, 241, 329-330, 342 professional training, 362 public health defined, 28 public service announcements, 323 telecommunications infrastructure, 135 Social influence theory, 342 Social learning theory, 343-344 Social marketing, 14, 117, 125, 201, 282, 299, 319, 326, 333-338 Socioeconomic status, xv, 21, 23, 25, 68, 69, 70-71 see also Educational attainment; Income; Poverty access to care, general, 233, 239 determinants-of-health model, 57-61 environmental factors, 54 gender and, 58 Healthy People 2010, 19 international perspectives, 68-70 media advocacy, 338 obesity, 79 occupational status, 57, 58 population-level studies and interventions, 71 preventive measures, 25-26 primary care, 240 quality of care, general, 231, 232, 233 race/ethnicity and, 58, 61, 63 social marketing, 336 Stages-of-change theory, 344 Standards see also Accreditation of institutions; Competencies of health workers; Ethical issues; Performance standards; Regulatory issues computer medical records, 242-243 cultural/linguistic competence, 195 dietary guidelines, 79, 80, 292 federal agency cooperation, 164 health care workers, 34 information/communication, 39, 130, 132, 139, 144, 242-243 international movements of goods, 39 national health data set, 127, 417 obesity, clinical guidelines, 81 occupational safety and health, 284 practice scholarship, 394 professional education, 372 public health function, general, 98, 107, 155-158, 415 public health laboratories, 137 public health workforce taxonomy, 117 reporting systems, 130, 150 toxic substance exposure levels, 55 treatment and prevention measures, 272 World Health Organization, 165 State Children’s Health Insurance Program (SCHIP), 215

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The Future of the Public’s Health in the 21st Century State government, 7, 412 see also Medicaid; Medicare; State public health agencies block grants, 150-152, 228-229, 245, 444 community-level efforts, 203 epidemiology, 144, 146 essential public health services, 110, 168, 413 federal government relations, 10-11, 26, 103-104, 115, 145-146, 148, 150, 151-152, 165, 166-170, 418 health insurance regulation, 213 legislative reform, 4-5, 26, 98, 104-107, 414, 422 local public health agencies, cooperation with, 108-109, 142, 143, 410, 412, 415 managed care organizations, 111, 153 national health data set, 127, 417 organizational factors, 101 professional education and training, 5, 372 public health function, general, 97, 98, 99, 101-102, 104-107, 147-149, 412-413, 414 public health laboratories, 7-8, 137, 139, 140, 146 regulatory role, 10, 101-102, 104-107 reporting requirements, 106, 149-150, 414 safety-net services, 153, 219-220 surveillance, 106, 128, 129, 130-131, 132, 146 toxic substances in food, 55 State Health Leadership Initiative, 121 State-level trends elderly persons, 35 employer-provided health insurance, 272 income effects on mortality, 69, 70 national health data set, 127, 417 obesity, 77 occupational safety and health, 285 safety-net services, 219 State public health agencies, 107-108, 142, 145-149, 414, 454, 455 academic qualifications of workers, 360 accreditation, 9, 155, 157-158 costs of infrastructure, 144 environmental factors, 416 epidemiology, 144, 146 Graduate Certificate Program, 371-372 health care delivery system and, 213 performance standards, 150, 155-158 professional education, 144, 146, 371-372, 373, 374, 419 quality of care regulation, 213-214, 231, 244, 257 schools of public health, linkages, 419 Stress, xvi environmental, 60, 66 management, 278, 282, 283 psychosocial, 47, 62, 65, 66, 275, 278, 282 workplace, 275, 278, 279, 282, 283 Substance abuse, 228-229 see also Alcohol abuse attitudes, 228 community-level efforts, 203, 445 costs to society, 228, 229, 276, 278 employees, 275, 276-277, 278 entertainment television, 328-329 insurance coverage for treatment, 12, 27, 73, 218, 225, 228-231 National Institute on Drug Abuse, 328 social influence interventions, 74-75 Substance Abuse and Mental Health Services Administration, 112 Suicide, 70, 275 Surgeon General, 74, 167, 225, 328 C. Everett Koop National Health Award, 299 dental care, 230 Surveillance, 127-136 Agency for Toxic Substances and Disease Registry, 112, 117, 118, 132, 163 CDC, 128, 129, 131-133, 140, 248, 249-250 chronic diseases, 128, 130 DHHS, 113, 128 diagnostic procedures and, 248-250 food-borne pathogens, 129-130 funding, 127-128, 146 health officials’ role, 248 information technology, 131, 243, 248, 249 international efforts, 40 local government efforts, 128, 129, 130-131, 132 National Center for Health Statistics, 114, 368 National Electronic Disease Surveillance Network, 99

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The Future of the Public’s Health in the 21st Century National Notifiable Disease Reporting System, 248 obesity, 82 partnerships, 131, 132 privacy and confidentiality, 13, 248 private sector, 127-128 professional education, 372 public health agency/delivery system collaboration, 244, 247-250 public health laboratories, 136, 138, 140, 247, 248 sentinel, 131, 247, 250-251 state government, 106, 128, 129, 130-131, 132, 146 syndrome, 130-131 uninsured/underinsured persons, 218 Sustainability bioterrorism response, 139, 145 change, 202, 254 funding, 7-8, 10, 98-99, 136, 148, 149, 150, 154, 157, 160, 161, 169, 170, 189, 457 technical assistance, 7, 150 Syndrome surveillance, 130-131 T Taxation, 104 community, 182, 253 credits, 104, 136, 274 hospital/community collaboration, 253 tobacco, 75, 76, 323, 324 Technical assistance, 5, 7 community-level collaborations, 11, 184, 202, 203 federal support for states/localities, 367, 413, 417 information/communications systems, 139, 242-244, 307 sustainability, 7, 150 Technological innovations, 35, 37-38, 387 see also Computer applications; Internet; Technical assistance academic health centers, 251 cost factors, general, 37-38, 39, 131-133 diffusion of, 39, 342-343, 367 health care delivery system, 213 information/communication systems, general, 35, 37-38, 39, 131-133, 134, 136 international perspectives, 38 managed care, 242 personal health care, 37 preventive measures, 35 public health agency/delivery system collaboration, 244, 251 public health laboratories, 139, 140 public health worker understanding of, 116, 117 Telecommunications Act, 134 Television, 31 see also Mass media community-level collaboration, 255 entertainment programming, 324-329 Hispanics, 320-321 public service announcements, 15, 319-324 (passim) sexual behavior, 325, 328-329 violence, 311, 328-329 Terrorism, 3 see also Bioterrorism chemical agents, 138, 139, 141 hospital emergency response, 237 Model State Emergency Health Powers Act, 106 state law reform, 106 World Trade Center, 286-288 Theory of reasoned action, 343 Tobacco use, see Smoking Toxic substances, 3, 60 community-level efforts, 312-313, 390 epidemiology, 55-56 in food, 55-56 gender factors, 55 industrial pollution, 289-290, 291 lead, 55 methylmercury, 55-56 monitoring systems, 100 rural areas, 54 urban areas, 54 workplace, 284 Toxic Substances Control Act, 284 Training, see Professional education Transportation, 36 hospital emergency response, 238 Tribal governments, 102-103, 421-422 TRICARE, 215 Turning Point initiative, xiii, xiv(n.3), 4(n.1), 106, 107, 121, 182-183, 184, 185, 203, 337, 442, 443, 451, 452, 454

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The Future of the Public’s Health in the 21st Century U Unequal Treatment, 231-232 Uninsured persons, 1, 11-12, 22, 25, 62-63, 153, 154, 215, 216-219, 221, 416 see also Medicaid; Safety-net services; State Children's Health Insurance Program children, 216, 217, 218, 220 community health centers, 153-154, 215, 219 emergency care, 217-218 employed persons, 215, 217, 271, 273, 274 hospital emergency treatment, 238-239 Medicaid managed care, 220, 221, 225, 241, 246-247 oral health care, 229 physicians, visits to, 217 primary care, 239 quality of care, general, 231, 232, 458 racial/ethnic factors, 62-63, 222-223 State Children’s Health Insurance Program, 215 Universities and colleges, see Academia; Schools of public health Urban areas, 36, 54 AIDS, 310 bioterrorism, 7 community-level collaborations, 187, 374, 444-460 housing, 36, 54, 60, 252, 255, 445 local government role, 108 Native Americans, 103 service learning, 376 sexual behavior, 54 U.S. Conference of Mayors, 168 U.S. Epidemiologic Catchment Area, 67 U.S. Preventive Services Task Force, 222, 231, 273 U.S. Public Health Service, 112, 113, 149, 162, 167, 222, 245 V Vaccines, 20, 100, 110, 111, 146, 221, 222, 274 adolescents, 223 childhood, 111, 223, 274, 336-337, 362, 386 federal government, 111 professional training, 362 Veterans Health Administration, 215 Veterinarians, 111, 144, 360 competencies required, 440 Violence, see Crime and violence Viruses, 27 HIV/AIDS, 40 oral diseases, 230 Vision for Health Consortium, 444-449 Visual perception, 274, 458 Vital Interest in Global Health, 166 Voluntary Hospital Association of America, 254 Voluntary organizations, 23, 30, 417 regulation, health care delivery system, 213 Volunteer workers, 116, 361 W Walsh-Healey Public Contracts Act, 284 Washington Business Group on Health, 271, 297 Water quality, 60, 114 community-level efforts, 180, 190, 193 sanitation, 20, 22, 48, 51, 54, 60, 362 Who Will Keep the Public Healthy?, 365, 366, 424 Women, Infants and Children program, 82 Working Group on Bioterrorism Preparedness, 139 Workplace, see Occupational safety and health World Health Organization (WHO), 22, 39, 165 community health services, 178 World Trade Center, 286-288 World Wide Web, see Internet

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