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PAPERBACK list:$29.95 Web:$26.95 add to cart PDF BOOK your price: $23.00 add to cart Rights & Permissions Free Resources PDF EXECUTIVE SUMMARY Display this book on your site! Related Titles The Future of the Public's Health in the 21st Century Ensuring an Infectious Disease Workforce: Education and Training Needs for the 21st Century - Workshop Summary Other Related Titles The Future of Public Health (1988) Institute of Medicine (IOM) Web Search Builder Use this book's key terms to search within this book, across our collection, or across the Web. Skim This Chapter Skim this chapter and use this chapter's key terms to search within this book. Reference Finder Paste in your own text to find books that relate to your topic. Page 217   E-mail  Facebook  Digg  Stumble  Twitter More Page 217 Front Matter (R1-R14) Summary and Recommendations (1-18) 1. The Disarray of Public Health: A Threat to the Health of the Public (19-34) 2. A Vision of Public Health in America: An Attainable Ideal (35-55) 3. A History of the Public Health System (56-72) 4. An Assessment of the Current Public Health System: A Shattered Vision (73-106) 5. Public Health As A Problem-Solving Activity: Barriers to Effective Action (107-137) 6. Conclusions and Recommendations (138-159) Supplementary Statements (160-162) Appendix A: A Summary of the Public Health System in the United States (163-202) Appendix B: Biographies of Committee Members (203-210) Appendix C: Model Standards (211-212) Appendix D: Site Visits: Site Selection and Methodology (213-216) Index (217-225)

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Index A Access to health care, see Assurance of service Accidents, see Injuries Accountability, 47 see also Levels of responsibility Addiction, see Smoking; Substance abuse Administrators and administration, 5 local, 84, 185, 189-190 state, 181 of super agencies, 124 see also Management; State health officers Adolescents, 95 pregnancy, 24-25 Agency for Toxic Substances and Disease Registry, 166 Aging and aged persons, 30-31 see also Medicare AIDS, 20-21, 52 American Medical Association stance, s federal role, 123 fiscal implications, 70 intravenous drug use and, 29 mandatory testing, 119 public health response, 132-135 research response, 126-127 state agency educational actions, 95, 97 217 Alcohol, Drug Abuse, and Mental Health Administration, 167, 191 Alcoholism, 28-29, 95 Alzheimer's disease, 30-31 American Medical Association stance on AIDS, 5 Assessment, 118 of AIDS problem, 133 epidemiology and surveillance, 113-114 government role, 7, 44, 80, 140-141, 143, 145 by state and local government, 49, 82, 87-91, 143, 176-177, 181 Assurance of service, 8, 45-47, 80, 94-98, 152 AIDS patients, 134-135 government role, 140, 142, 144, 145 indigents, care of, 13, 21-23, 46, 91, 95-96, 97-98, 109-110 as local agency responsibility, 78, 144 and public health as problem-solving, 117-119 state agency role, 179, 181 Automobiles, 23 B Bacteriology, 63-65 Basic services, 37, 53-54, 143

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218 assurance of, 45 Births, teen pregnancy, 24 see also Prenatal care Block grants, 68-69, 70, 80, 169, 171, 189 Boards of health, see State boards of health C Canada, national health care, 2, 110 Cancer and carcinogens, 29-30 Capacity building, 13-15, 31-33, 153 Categorical grants, 169, 171 Centers for Disease Control, 129, 166 Chadwick, Edwin, 59-60, 71 Chapin, Charles, 64-65 Chemicals, see Toxic substances Children, 67 see also Adolescents Chronic diseases, 31 see also specific diseases Cigarettes, see Smoking Cities, see Local governments; Local health agencies; Urbanization; and ·r. . . specific cities Citizen participation, 14, 154, 155, 194-195 Commerce clause, 50 Commissioned Corps (U. S. Public Health Service), 120 Communicable diseases bacteriology and, 63-65 federal responsibility in control of, 9 legislation on, 10 see also Epidemics; and specific dis- eases Community-based action, 11, 13, 53, 111, 114 leadership and, 122 Model Standards: A Guide for Commu- nity Preventive Health Services, 11, 13, 53, 114, 115, 118, 149 Community Mental Health Centers, 111 Congressional committees, 191-192 Constitutional law, 48, 49-50, 51, 77, 172 Cost containment, 70 Cost of health care, see Spending for health care INDEX Counties, see Local governments; Local health agencies Court proceedings, McCulloch vs. Mary- land, 49 Crises in public health AIDS, 20-21, 52 financial problems, 69-70, 131-132 governmental response to, 45 indigents, care of, 13, 21-23, 46, 91, 95-96, 97-98, 109-110, 123-123 pollution, 29-30 D Decision-making, 4-5, 107 see also Policy development Definitional issues, 36, 37-42, 66, 73-74 Dementia, see Alzheimer's disease Demography of study states, 75, 101 see also Epidemiology Department of Agriculture, 192, 193 Department of Defense, 193 Department of Education, 192 Department of Health and Human Ser- vices budget, 170 structure and function, 166-172, 193 Department of the Interior, 193 Departments of health, state-level, 147 directors of, 148 Diagnostic tests, 64 AIDS, 119 Disease early conceptualization of, 57, 59 see also Chronic diseases; Communica- ble diseases; Epidemics; Epidemiol- ogy; and specific diseases Dix, Dorothea, 62 Doctors, see Physicians Dropouts, and teen pregnancy, 24 Drug abuse, see Alcoholism; Substance abuse E Economics of health care, see Fiscal is- sues; Funding; Spending for health care Education

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INDEX see Dropouts; Health education; Infor- mation dissemination; Professional education Elderly, see Aging and aged persons Environmental health, 8, 9, 12, 51, 192 Agency for Toxic Substances and Dis- ease Registry, 166 local spending, 189 organizational issues, 123-124, 150-151 state-level organization, 82, 95, 110-111, 175, 196, 197 state spending, 181 water pollution and purification, 29, 58, 63, 65 see also Sanitation; Toxic substances Environmental Protection Agency, 192 Epidemics, 51, 57, 61-62, 98 urbanization and, 58-59 see also AIDS; Plague Epidemiology agency responsibilities, 7, 173 AIDS, 20-21, 29 Centers for Disease Control, 129, 166 in definition of public health, 41 high blood pressure, 25 mental illness, 111-112 Europe, early public health measures, 57 Evaluation, see Assessment Expertise distribution across health jurisdictions, 129-130 knowledge base and public health ac- tion, 126-127 political process and, 4-5, 119 see also Technical assistance F Family planning, 95 and teen pregnancy, 25 Federal government block grants, 68-69, 70, 80, 169, 171, 189 categorical grants, 169, 171 early activities, 66-67 funding of local programs, 69, 101, 102, 188, 189 funding of state programs, 15, 48-50, 156, 169, 179, 180-181 219 intergovernmental and interorganiza tional relationships, 98-100, 107, 125-126, 169 leadership role, 120-121, 166 Marine Hospital Service, 62, 67 Model Standards: A Guide for Commu nity Preventive Health Services, 11, 13, 53, 114, 115, 118, 149 national public health system, role in, 79, 165-172 1990 Health Objectives for the Nation, The, 107 1990 Objectives for the Nation, The, 53, 93, 114, 115, 120 organizational structure, 12, 150, 166-168 research role, 143, 169 resources and spending, 79-80, 170-172, 192-193 role of, 9, 47, 49-50, 67-68, 143-144, 165-172, 191-194 standards for health care, 11, 13, 53, 93-94 task forces, federal, 12, 150 see also specific federal agencies and de partments Fiscal issues, 15, 108, 156 crises during twentieth century, 69-70, 131-132 indigents, care of, 13, 21-23, 46, 87, 91, 95-96, 97-98, 109-110, 152-153, 123-124, 197-198 resources available to state and local agencies, 100-105, 178-183, 188-190 see also Cost containment; Funding; Spending for health care Food and Drug Administration, 166 Funding, 9 access to care issues and, 118 block grants from federal government, 68-69, 70, 80, 169, 171, 189 categorical grants from federal govern- ment, 169, 171 cuts, effects on state and local pro- grams, 104, 180-181, 190 distribution problems, 131-132 federal support of local programs, 69, 101, 102, 188-189 federal support of state programs, 15, 48-50, 80, 101, 156, 179-181 local agency sources, 15, 156, 189-190

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220 state agency sources, 180 state support of local programs, 15, 156, 189-190 Future of Public Health, Committee for the Study of the methodology of study, 1-2, 74-77 recommendations of, 6-18, 31-33, 139-159 state study findings summarized, 77-105 G General Report on the Sanitary Conditions of the Labouring Population of Great Britain, 59-60 Government intergovernmental and interorganiza- tional relationships, 98-100, 107, 125-126 role in public health, 7-8, 36-37, 42-48, 140-142 see also Federal government; Local governments; Local health agencies; State governments; State health agencies Griscom, John, 61 H Hazardous substances, see Toxic sub- stances Health Care Financing Administration 167, 168-169, 170 Health departments state-level departments, early develop- ment, 61 state medical associations and, 5 variety of roles, 3-5 Health education on AIDS, 21, 95, 97 efficacy, 113 public information dissemination, 7, 13 safety, 23 state agencies and, 82, 95 Health officers, see Local health officers; State health officers Health promotion, 112- 113 in definition of public health, 40 by federal authorities, 66-67 by local and state authorities, 66, 91 INDEX Health Resources and Services Adminis- tration, 166-167 High blood pressure, 25-26 stroke deaths, 27 Hill, Herbert, 65 History of public health, 3, 35, 40, 51, 53, 56-71 early, 57 eighteenth century, 57-58 nineteenth century, 58-65 twentieth century, 65-70 Hospitals first voluntary, 57-58 indigent and uninsured, care of, 22-23, 95-96 for mentally ill, 58, 62 House of Representatives, committees, 191-192 Hypertension, see High blood pressure Indigents, care of committee recommendations, 13, 152-153 Poor Law, 57-58, 59, 62 state and agency provisions, 87, 91, 95-96, 97-98, 109-110, 123-124, 197-198 status, 21-23, 46 Individual rights versus public health, 42-43, 71, 96-97, 130 Infectious diseases, see Bacteriology; Communicable diseases; Epidemics; and specific diseases Information dissemination, 7, 13 Injuries, 23-24 Institute of Medicine, 1-2 Insurance, care of uninsured, 13, 22-23. 153, 160 Intravenous drug use and AIDS, 29, 92, 95 Issues in public health current status of, 1-6, 19, 73-74, 77-105, 135, 165-200 definition of, 36, 37-42, 66, 73-74 history, 3, 35, 40, 51, 53, 56-71 impediments, 113-119 problem-solving, 107-135 recommendations of committee, 31-33, 139-159

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INDEX role of public health, 3-4, 7, 36, 38-40, 108-113, 140-159 system components, 73, 74, 77-105, 165-200 value framework, 36-54 L Law, see Statutes Leadership, 6, 14, 107, 119-122 continuity problems, 119-120 federal role, 120-121, 166 local health officers, 84, 185 local systems, 173, 185 medical professions' relations with leaders, 121-122 state systems, 83-86, 173 see also Management; State health offi- cers Legislation, see Statutes Levels of responsibility, 8-10, 125-126, 142 epidemiology and, 7, 173 federal, 9, 143-144 local, 9-10, 11, 78, 144-145, 149 state, 8-9, 11, 48-49, 54, 143, 146, 172, 175-176 Local governments, 9-10, 11-12 public health councils, 149-lSO role of, 47, 50-51, 143-144, 199 spending, 79 Local health agencies activities of, 9-10, 50-S1, 69, 87, 183-184, 186-188, 199 assessment activities, 82, 87-91 boards and departments, 62-63, 64, 65-66, 185-187, 183-191 federal exclusion of, 121 funding sources, 15, 69, 101, 102, 188-189 intergovernmental and interorganiza- tional relationships, 98-100, 107, 125-126 jurisdictions of, 185-186 laboratories, 63-64 legal empowerment, 184-185 national public health system, role in, 78, 183-191 organizational structure, 11-12, 81-83, 149-150, 185-187 policy development by, 92 221 public health units, functions, 145 resources, 100-105, 188-190 San Diego County (California), indi- gent care, 46 spending, 79, 188-190 staffing, 190 standards for, 91 Local health officers, 84, 185 London (England), public health in, 58, 59-60 M Management, 155-156 personnel, 14-15 salaries of public health managers, 155 tasks of public health managers, 130-131 see also Administrators and administra- tion; Local health officers; State health officers Manpower, 127-129 Health Resources and Services Admin- istration, 166-167 local staffing, 190 nurses as state agency staff, 103 state staffing, 103, 181-183, 184 Marine Hospital Service, 62, 67 Market forces, 46 Massachusetts, nineteenth century, 58-59, 60-61, 63-64, 66 Massachusetts Board of Public Health, 63 McCulloch vs. Maryland, 49 Medicaid, 10, 13, 68, 70, 153 administration of, 167-168 budget, 170 expenditures, 79, 80, 193 refusal of service to recipients, 96, 117 state agencies and, 83, 110, 197-198 and uninsured persons, 22 Medicare, 68, 70 administration of, 167-168 budget, 170 expenditures, 79, 80, 193 Medical associations and societies, 5, 71, 121-122 Medical professionals private practitioners and public health, 5-6, 14, 121-122 see also Physicians Mental health, 111-112

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222 Alcohol, Drug Abuse, and Mental Health Administration, 167, 191 early history, 57-58, 62 federal activities, 68, 167, 191-192 insanity, early conception of, 59, 62 organizational issues, 123-124, 151 services, 4, 12 state activities, 197 and substance abuse, 28 Methodology of study, see Future of Pub- lic Health, Committee for the Study of the Michigan, guaranteed prenatal care, 46, 54 Minimum services, see Basic services Model Standards: A Guide for Commu- nity Preventive Health Services, 11, 13, 53, 114, 115, 118, 121, 149 Morality, in conception of disease and treatment, 60, 62 Motor vehicles, see Automobiles Municipalities, see Local governments; Local health agencies N National Center for Health Services Re search, 168 National Center for Health Statistics, 166 National Institutes of Health, 68, 166 National Mental Health Act, 68, 111 Needs assessment, see Assessment New York Board of Health, 61-62 New York City nineteenth century, 58-59, 61-62, 63-64 public health in, 57, 58-59, 61-62, 63-64 New York City Health Department, 61, 63, 64 1990 Health Objectives for the Nation, 107 1990 Objectives for the Nation, 53, 93, 114, 115, 120 Nonprofit organizations, 22-23, 194 Nurses, as state agency staff, 103 o Opinion, see Public opinion Organizational frameworks and struc- tures, 107, 123-126 INDEX defined, 41-42 of Department of Health and Human Services, 166-172, 193 federal, 12, 150, 166-168, 191-194 intergovernmental and interorganiza- tional relationships, 98-100, 107, 125-126, 150-153, 169 local, 11-12, 81-83, 149-150, 185-187, 199-200 nongovernmental, 194-195 (national), 198-199 (state), 199-200 (local) policy development and, 115-116 recommendations, general, 146 special linkages, 12-13, 150 state-level, 10-11, 81-83, 147-149, 173, 175, 195-199 super agencies, 124-125, 151, 173, 197 p Partnership in Health Act of 1966, 68 Pasteur, Louis, 63 Personal health care federal action, direct, 169 local spending, 189 national expenditures, 79-80, 169 state agency activities, 95, 97-98, 181 Pesticides, 29-30, 111 Physicians, 14, 51, 121-122, 190 as local health directors, 185 as state health officers, 83, 103 Plague, 57, 59 Planning, by state agencies, 91, 92, 175 Poisoning, see Toxic substances Policy development, 7-8, 14, 44-45, 53, 80 AIDS and, 133-134 decision-making, 4-5, 107 government role, 140, 141-142 local agency efforts, 92 problem-solving and, 114-117 schools of public health and, 16, 157 state agency role, 49, 91-94, 178 Political issues, 14, 154-155 expertise and, 4-5, 119, 120 Political philosophy, 46 individual rights versus public health, 42-43, 71, 96-97, 130 Pollution, 29, 58 see also Environmental health; Sanita- tion; Toxic substances

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INDEX Poor Law (1601), 57-58, 59, 62 Poverty early conceptions of disease and, 59 Poor Law, 57-58, 59, 62 prenatal care and, 3 teen pregnancy and, 24 see also Medicaid Pregnancy teenagers and, 24-25 Prenatal care guaranteed by Michigan, 46, 54 for poor women, 3 for teens, 25 Preventive medicine early efforts, 58 Model Standards: A Guide for Commu- nity Preventive Health Services, 11, 13, 53, 114, 115, 118, 121, 149 Private sector, 5, 51-52 government role in relation to, 46, 69, 115-116, 154 intergovernmental and interorganiza- tional relationships, 98-100 local-level activities, 199-200 market forces, 46 medical associations and societies, 5, 71 national activities, 194-195 state-level activities, 198-199 Problem-solving, public health as, 107-135 Professional education, 76, 103 local health officer requirements, 185 managerial and leadership skills, 14 need for, 127-128 schools of public health, role, 15-17, 128-129, 157-159 Professionals, 4-5, 76 local health officers, 84, 185 medical associations and societies, 5, 71, 121-122 nurses as state agency staff, 103 public health officials, salaries of, 15, 16, 86, 155, 174 see also Management; Manpower; Medical professionals; Physicians; State health officers Public Health Act of 1848, 60 Public Health Foundation, 176 Public Health Service (U.S.), creation, 67 budget, 170 role of Commissioned Corps, 120 223 structure and function, 166-167, 168 Public opinion, 108 of public health activities, 85-86, 129-130 public health system, effect of, 3, 4-5, 41, 42 Q Quality control, 8 local responsibilities, 9 state responsibilities, 11 see also Accountability; Standards Quarantine, 57, 58 urbanization and, 58-59 R Recommendations of the Committee for the Study of the Future of Public Health capacity building, 13-15 education, 15-17 general, 17-18, 31-33 organizational structure, 10-12 special linkages, 12-13 specific, 6-10, 139-159 Report of the Massachusetts Sanitary Commission, 60-61 Research educational institutions and, 15-16, 128, 158 federal role, 143, 169 knowledge base development, 126-127 population-based problems, 14, 154 private supporters, 195 schools of public health, role, 128, 158 state and local activities, 89, 176 state-level investment in, 6 Responsibilities, see Levels of respon- sibility Robert Wood Johnson Foundation, The, 22-23 S Salaries, of public health professionals, 15, 16, 86, 155, 174 San Diego County (California), care for indigents, 46

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224 Sanitary Condition of the Labouring Pop- ulation of New York, The, 61 Sanitary Conditions of the Labouring Population of Great Britain, General Report on the, 59-60 Sanitation, 58-65 bacteriology and, 63-65 "great sanitary awakening," 58-63 urbanization and, 58-59, 64-65 Schools of public health, role, 15-17, 128-129, 157-159 Sedgwick, W. T., 63-64 Senate committees, 191-192 Shattuck, Lemuel, 60-61 Sheppard-Towner Act of 1922, 67 Small pox, 57, 58 Smoking, 26-29 state-level prevention activities, 91 Social issues, related to public health, 40, 59, 62, 70-71, 112-113 Social Security Act, 68, 191 Social Security Administration, 170, 191 Social services and public health, 4, 13, 151, 197 Department of Health and Human Ser- vices, structure and function, 166-172, 183 Sources and Modes of Infection, 64 Special interests, 116 Spending for health care cost containment, 70 federal, 170-172, 191-193 government intervention into health, impact on, 69-70 national, 79-80, 171 state and local, 101-102, 178-179, 181-182, 188-190 Staffing, see Manpower Standards on access to services, 96-97 federal standards, 11, 13, 53, 93-94, 107, 114, 115, 118, 121, 149 state-level development and use of, 91, 94, 149, 176-177 see also Accountability; Quality control State boards of health, 172, 173 State governments health councils, 147-148 role of, 47, 48-49, 143, 172-183, 195-198 State health agencies INDEX activities of, 69, 87, 88, 175 AIDS, 95 (education), 127 (research) assessment activities, 49, 82, 87-91, 176-177 boards and departments of health, 62-63, 63-64, 65-66, 185-187, 183-191 federal exclusion of, 121 first, 61-62, 63 funding of and by, 15, 48-50, 156, 179-181, 188-189 indigents, care of, 87, 91, 95-96, 97-98, 110, 197-198, 123-124 leadership within, 83-86, 173 Massachusetts, nineteenth century, 60-61 Michigan prenatal care, 46, 54 national public health system, role in, 77-78, 172-183 organizational structure, 10-11, 81-83, 147-149, 173-175 planning, by state agencies, 91, 92, 175 policy development, 91-94, 176, 178 research role, 154 resources, 100-105, 178-183 responsibilities, 8-9, 10-11, 48-49, 54 role of, 3-4, 143, 196-198 spending, 178-182 staffing, 103, 181-183, 184 standards development, 91, 94, 149, 176-177 statistical activities, 87-91 survey of six states, 74-77 (methodol ogy), 81-105 (results) see also specific state agencies State health officers, 173 appointment procedures and qualifica- tions, 174 physicians as, 83, 103 tenure, 4, 119-120 salaries, 16, 86, 119-120, 155, 174 Statistical programs and activities agency responsibilities, 7 national health status data set, 13, 153-154 state and local activities, 87-91 state responsibilities, 8, 175-176 see also Demography; Epidemiology Statutes, 10, 45 AIDS, response to, 132-133

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INDEX Constitutional law, 48, 49-50, 51, 77, 172 local agency empowerment, 184-185 National Mental Health Act, 68, 111 Partnership in Health Act of 1966, 68 Poor Law (1601), 57-58, 59 Public Health Act (1848), 60 Sheppard-Towner Act of 1922, 67 Social Security Act, 68, 191 state responsibilities, 8, 143, 146, 172 on toxic substances, 30 Stroke, 27 Structure and organization of public health, see Organizational framework and structures Substance abuse, 28-29 intravenous drug use and AIDS, 29, 92, 95 see also Alcoholism Superagencies, for health and human ser- vices, 151, 173, 197 creation, 124-125 T Task forces, federal, 12, 150 Technical assistance, 153-154 federal and state, 14-15 see also Expertise Teenagers, see Adolescents 225 Tobacco, see Smoking Toxic substances, 29-30, 70, 111 Toxic Substances and Disease Registry, Agency for, 166 Tuberculosis, 59 Typhus, 58 1 J Uninsured, care of, 13, 22-23, 153, 160 see also Indigents United Kingdom, 59-60 Urbanization, effects on public health, 58-59, 60, 64-65 V Veteran's Administration, 193 Virginia, public health law, 172 W Water pollution, 29 Thames (London, England), 58 Water purification, 63, 65 Welfare services, 4, 193 superagencies, 124-125 Winslow, C. E. A., public health defined, 39, 66 World Health Organization, health de- fined, 39

Representative terms from entire chapter:

local health