| Remember me Forgot Login? |
 |
 |
 |
|
 |
|
 |
|
 |
|
 |
Public Health Infrastructure and its Relationship to Healthcare Delivery
Donald Zeigler, PhD
The public health infrastructure is made up of state and local public health organizations and staff that deliver the essential public health services to every community and the information and communication systems used to collect and disseminate population data. While approximately 3,000 federal, state and local governmental agencies have a role in the public health system, no single organization or governmental agency has complete responsibility for public health goals in this country(1). Increasingly, public health addresses determinants of health, the behavioral and environmental forces that cause 70% of avoidable mortality. Public health focuses on population health, behavioral risk factors, and the establishment of a publicly-funded medical safety net. Public health overlaps and complements the health care delivery systems that pursue biological mechanisms of disease, pharmacology, diagnostics, and therapeutic procedures for individual patients (2,3).
Trends:
- The major public health issues of the next decade are emerging infectious diseases (e.g., influenza, monkeypox, Dengue, drug resistant staph and TB, West Nile and food-borne illnesses); chronic diseases; emergency preparedness; climate change; injury mitigation; public health research; public health infrastructure; and health reform (including evidence-based quality care for all persons and involving moving from a sickness to a wellness system(4)).
- Public health is on the front lines of the country’s defenses to prevent or contain major disease outbreaks, including those caused by an act of bioterrorism, or to provide wide-scale treatment to the survivors of major disasters(1).
- The bond between medicine and public health has weakened in the late 20th century(5).
- Extreme weather and climate events are projected to affect agriculture, forestry and ecosystems, water resources, industry, settlement, and every mode of transportation. Extreme weather and rising sea levels would have adverse effects on infrastructure, including destruction of hospitals, primary health centers and homes. Every mode of transportation in the United States would be affected.
- State-level public health preparedness is inadequate. Not all states have adequate plans to distribute emergency vaccines, antidotes and medical supplies. Not all states have statutes that allow for adequate liability protection for health care volunteers during emergencies. Some states lack compatibility in their disease surveillance system with that of the CDC. Some states have not purchased antivirals to use during a pandemic flu and lack sufficient capabilities to test for biological threats (6).
- Despite the extreme health challenges, the complex web of public health practices and organizations is in disarray (1).
- In addition to fragmented responsibilities, there is a lack of clear roles among state, local and federal health agencies. There are no minimum standards, guidelines or recommendations for levels of capacity or service required of state and local health agencies.
- Most public health agencies are seriously understaffed and have serious needs to upgrade the skills of their employees. Worker qualifications have been eroding over time.
- Bioterrorism and disaster preparedness, the growing burden of chronic diseases, health disparities, patient safety, and healthcare access for the uninsured are urgent matters requiring effective collaboration between medicine and public health(7).
- Medicine and public health are both under financial siege.
1 US Department of Health and Human Services. Understanding and improving health. In: Healthy People 2010. 2nd ed. Washington, DC: US Dept of Health and Human Services; 2000.
2McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993
3McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff. 2002
4Benjamin G (Feb 29, 2008). Leading US Health Challenges: The coming decade. Coalition for Health Funding Hill Briefing, Washington, DC. Available at: www.aamc.org/advocacy/healthfunding/obesityamerica.htm
5Davis R. Marriage counseling for medicine and public health: strengthening the bond between these two health sectors. Am J Prev Med. 2005
Committee on Climate Change and US Transportation, National Research Council (2008). Potential Impacts of Climate Change on US Transportation: Special Report 290.
6Washington, DC: Transportation Research Board; 2008
7Ready or not?: protecting the public’s health from diseases, disasters, and bioterrorism. Trust for America’s Health
8Beitsch LM, Brooks RG, Glasser JH, Coble YD. The medicine and public health initiative: ten years later. Am J Prve Med 2005
Medical societies and their executives should: Collaborate with the public health community on issues of population health and emergencies, e.g., cooperate with other governmental agencies and other associations to help physicians to acquire training and to be able to identify and mobilize health professionals before and during an emergency. Provide training and resources for physicians to be able to diagnose and treat illnesses caused by exposure to biological, chemical or radiologic agents. Facilitate training of physicians on:
Provide training and resources so that physicians are able to integrate effective clinical preventive services (screening, counseling, preventive medication) and community services (group education and community resources, policy change, environmental change), e.g., tobacco and obesity, to address fully the opportunities for prevention(1). Medicine and public health officials need to work together to ensure adequate funding for care of patients and whole populations(2). Advocate for support of the public health infrastructure and prevention activities through public initiatives including:
• Encourage public health and preventive medicine physicians to have a greater role in medical associations(2). State and county medical societies should establish public health committees if they do not already have them and expand their involvement and their members’ involvement in public health activities(2). Medicine and public health officials should work together to bolster funding of each sector(2). 1.Ockene JK, Edgerton EA, Teutsch SM, et al. Integrating evidence-based clinical and community strategies to improve health. Am J Prev Med. 200 |