Public Health Notes
What was public health like in pre-industrial societies ?
Hebrews: Spiritual cleanliness and community responsibilities Greeks: Personal hygiene to achieve mind-body balance Romans: Water systems, sewage disposal, & swamp drainage; infirmaries for sick, poor were first "public hospitals" Medieval Period: Overpopulated, filthy walled towns spawned epidemics; superstitious, demonic, and theological theories of disease displaced earlier attention to personal hygiene and sanitary environment. Renaissance Period: Rebirth of art, literature, and science; production and world trade demanded healthy laborers and soldiers; centralized government public health measures (in book pg. 429 and top of pg. 430)
What was the Poor Law Commission ?
Poor Law Commission of 1834 under the leadership of Edwin Chadwick that developed the means to address public health problems. Motivated by the belief that it would be good economy to prevent disease, Chadwick advocated the use of carefully collected data to link population characteristics, environmental conditions, and the incidence of diseases. (in book mid of pg. 431)
Public Health vs. Traditional Medicine
Public Health Focus = population Data from surveillance or descriptive studies Generate hypothesis Analytical studies Community intervention Healthcare Focus = one person Data from medical history Make differential diagnosis Diagnostic studies Medical treatment
What were the Elizabethan Poor Laws?
Elizabethan Poor Laws of 1601: Government provisions for the "lame, impotent, old, blind, and such other among them being poor and unable to work" (in book pg. 430-431)
County's Role in Public Health
Support and deliver general and specialty healthcare services through their health departments and over 1,000 hospitals and health systems that together comprise the infrastructure of many of America's metropolitan health systems. Provide services that are financially unattractive to other community hospitals, such as burn care, psychiatric medicine, trauma care, and crisis response units for both natural and human-made disasters. ( in book 438)
Why is Surgeon General called such?
The medical officer in charge, known at first as the supervising surgeon, was later given the title of "surgeon general". The title of surgeon general continues to this day for the chief medical officer of the US. In light of the commercial motivation for its creation, The Marine Hospital Service was established as a component of the Treasury Department. (in book pg. 433)
What was the impact of 1935 Social Security Act on Public Health?
Title VI of the landmark Social Security Act of 1935 was instrumental in the expansion of the Public Health Service. It delegated to the Public Health Service the authority to assist states, counties, health districts, and other political subdivisions to establish and maintain public health services. Title VI provided impetus for all political jurisdictions to create public health agencies and services. (in book pg. 434)
What is the Marine Hospital Service?
US Public Health service was established in 1798 as the Marine Hospital Service when President John Adams signed into law an act providing for the care and relief of seamen who were sick or disabled....... First marine hospital was set up in Boston Harbor. In 1870, the Marine Hospital Service was reorganized as a national hospital system with central headquarters in Washington DC (aka Chocolate City).
Explain the structure and size of DHHS
National Institutes of Health (NIH): 18 health institutes, National Library of Medicine, National Center for Complementary & Alternative Medicine; 30,000 research projects Food and Drug Administration (FDA): Food, cosmetic, drug, & biological product safety Centers for Disease Control and Prevention (CDC): Monitors disease trends, disease, injury investigations, and control measures Indian Health Service (IHS): Operates hospitals, health centers, health stations serving 1.5 million members of 500+ tribes Health Resources and Services Administration (HRSA): Multiple programs serving needy; FQHCs; health professional training for underserved areas Substance Abuse and Mental Health Services Administration (SAMHSA): Quality & access to substance abuse prevention, addition treatment, mental health services, HIV/AIDS services Agency for Healthcare Research and Quality (AHRQ): Research to improve quality, reduce costs, improve patient safety; evidence-based research Centers for Medicare & Medicaid Services (CMS): Administers these and Children's Health Insurance Program Administration for Children and Families (ACF): 60+ programs (e.g., Head Start, child support enforcement, TANF, domestic violence, adoption, foster care) Administration on Aging (AoA): Administers federal programs under the Older Americans Act (e.g., Meals on Wheels, community level programs to support older persons and their caregivers) (in book pg. 434-437)
Public Health in Early America
Colonial period-1800s: Strong influences of the British model: NY Poor Law (1788) established almshouses Epidemics stimulated sanitary reforms Almshouses and town-employed physicians dominated till the 1930s 1850: Lemuel Shattuck, statistician, conducted U.S. sanitary surveys of morbidity, mortality rates related to environmental conditions; advocated city, state responsibility Sanitary Commission Report: First ignored, now most influential document in evolution of U.S. public health; emulated Chadwick 1865: NYC Council of Hygiene and Public Health expose created Board of Health, United States' turning point Early U.S. public health initiatives motivated more by economic than humanitarian concern USPHS established in 1798 as Marine Hospital Service to care for ill sailors in seaport cities; 1870: Marine Hospital system reorganized as national system with "Surgeon General" in charge (Dept. of the Treasury) 1889: Congress established Public Health Service Commissioned Corps, a mobile physician corps to assist with disease control & health protection 1891: Staten Island Marine Hospital lab moved to D.C.; forerunner of the NIH 1912: Marine Hospital Service renamed U.S. Public Health Service; became major agency of DHHS 1933: Federal Emergency Relief Act; optional federal aid to states for acute & chronic medical & nursing care, obstetrics, drugs, & supplies 1970s: National Institutes of Health created for disease, occupational health, & safety research 1979: Dept. of HEW renamed Dept. of Health & Human Services; education moved to its own department 2013: DHHS budget $941 billion; responsible for health protection, promotion, provision of health, other human services to vulnerable populations; 300 programs through 10 operating divisions (~65,000 employees) (pg. 432-434)
State's Role in Public Health
Contribute 14% of total national healthcare expenditures Operate or support hospitals, support medical schools, operate mental institutions, health departments that conduct infectious disease monitoring & control, support primary & preventive health services at state and local levels (top of pg. 438)
Public Health Act of 1848 and General Board of Health
The creation of the board of health in 1848 established the British as world leaders in public health philosophy and practice. Public Health in America was heavily influenced by the medical and administrative experience of the British. (in book pg. 431)
