Public Health 1

1

• Chapter 11

2
Public Health (1)

• Began with Hebrews, Greeks, Romans
• Early infirmaries for sick, poor first public
  hospitals

3
Public Health (2)

• Health problems of people living in groups
  communicable diseases, sanitation, safe food,
  water care for destitute, disabled
• Reflects current knowledge of diseases, control
  measures, social beliefs

4
Middle Ages and Renaissance

• Middle ages return to superstition, anarchy,
  demonic theories of disease over-populated,
  walled towns were unsanitary, disease-ridden
• Renaissance 16th-18th centuries learning
  revival, medical services, concept of
  government care

5
Public Health in England

• Poverty, illness, disability common support for
  medical care in private homes, public infirmaries
• 17th century first collection, analysis of
  national data on industrial production,
  demographics epidemiologic tools, social factors
  in health

6
Elizabethan Poor Law (EPL)

• EPL Amendment of 1834 Aid to able bodied only in
  regulated workhouses.
• Industrialization, decrepit housing spawned and
  spread diseases
• Poor Law Commission linked conditions to benefit
  of economy

7
Englands Public Health Leadership

• Sanitary reform movement
• 1848 General Board of Health est.
• Model for public health in America epidemics
  stimulated sanitary reforms, early cities
  responsible for collective citizen health towns
  employed MD till 1930s.

8
Sanitary Commission Report, 1850

• First ignored, now most influential document in
  evolution of U.S. public health.
• 1850 MA statistician conducted U.S. sanitary
  surveys of morbidity, mortality rates related to
  environmental conditions advocated city, state
  responsibility

9
U.S. Chronology (1)

• Late 1700s Marine hospitals
• 1870 Marine Hospital Service reorganized as
  national hospital system medical officer
  entitled Surgeon General commercial interest
  put Marine Hospital in Treasury Department

10
U.S. Chronology (2)

• 1889 Congress est. Public Health Service Corps
  a mobile physician force to assist in disease
  control and health protection
• 1912 Marine Hospital Service became U.S. Public
  Health Service
• 1935 SS Act, Title V jurisdictions to create
  public health agencies, services ended makeshift
  services

11
U.S. Chronology (3)

• 1946 Hill-Burton Act
• 1953 Public Health Service joined new Dept. of
  Health, Education and Welfare (HEW)
• 1970s National Institutes of Health created for
  several diseases public safety issues Dept. of
  HEW renamed Dept. of Health and Human Services

12
Dept. of Health and Human Services

• 11 operating divisions budget 2nd only to Dept.
  of Defense
• NIH, FDA, CDC, Agency for Toxic Substances and
  Disease Registry, IHS, HRSA, SAMSA, AHRQ, CMS,
  ACF, AoA

13
Public Health Service Decline (1)

• Funding competed for more highly valued demands
• 1960s criticized ineffective grants to state,
  local agencies
• New, important programs given to non-public
  health agencies

14
Public Health Service Decline (2)

• 1970s ended Creative Federalism Nixon opposed
  federal, state, local public health system
  federal responsibilities moved to states
• 1980s Reagan continued more extreme measures
  block granted Federal funds

15
Public Health Sector Decline

• Institute of Medicine Report (1988) cited
• Public health disorganized with weak leadership
• Declining professional competence
• Inadequate support
• Poor links between public and private sectors
• Outdated public health statutes

16
Resource Priorities Favor Curative Medicine (1)

• U.S. fascination with dramatic, hi-tech medicine
• Less than 1 of resources allocated to public
  health prevention
• 1981-93 AIDS emerged TB, measles re-emerged
  substance abuse, teen pregnancy escalated

17
Resource Priorities Favor Curative Medicine (2)

• U.S. health care expenditures increased by 210
• Public health funding, as a proportion of total
  health care budget declined 25

18
Voluntary Agencies Public Health Services

• Supplement and/or fill gaps in government or
  other private services.
• Not-for-profit hospitals, nursing homes, hospice,
  home care, medical and vocational rehabilitation
  center serve needs of special populations.

19
The Federal Role

• Monitors health needs, sets policies and
  standards, supports research supports state and
  local initiatives
• Finances through Medicare, Medicaid, Veterans
  and Community Health Centers, etc.

20
The State Role

• Supports Medicaid, medical education, state
  local health care initiatives, e.g. SCHIP
• Enforces codes, licensing coordinates health
  with social service, aging and other services
  mental health services and facilities

21
Conclusion

• Nation ignored public health benefits, withdrew
  support and moved toward privatization.
• New epidemics and bio-terrorism threats spawning
  resurgence in public healths importance.
• Gaining new support for Public Health requires
  new recognition of importance.