Chapter 2: Organizations That Help Shape Community Health

Main challenges for achieving 2015 Millennium Development Goals

1. strengthenning health systems 2. ensuring health is recognized as a priority within development and economic policies 3. developing appropriate strategies to address the diverse needs of the countries 4. mobilizing more resources for health in the poor countries 5. improving the quality of health-related data to track progress toward goals

The WHO and smallpox

1967-smallpox active in 31 countries, 1979-World Health Assembly declared global eradication of smallpox, more than 40 million lives have been saved since

Department of Health and Human Services' formation

1980 under President Jimmy Carter; Department of Health, Education, and Welfare divided into HHS and the Department of Education; largest department in the federal government; has a reserve fund from new revenue and savings proposals for funding health care reform

Typical state health department divisions

Administration, Communicable Disease Prevention and Control, Chronic Disease Prevention and Control, Vital and Health Statistics, Environmental Health, Health Education or Promotion, Health Services, Maternal and Child Health, Mental Health, Occupational and Industrial Health, Dental Health, Laboratory Services, Public Health Nursing, Veterinary Public Health, Public Health Preparedness dealing with bioterrorism

National Academy of Sciences

Advises the government on questions of science and technology

Three largest voluntary agencies in the US

American Cancer Society, the American Heart Association, and the American Lung Association

Philanthropic foundation

An endowed institution that donates money for the good of humankind; for community health-funds programs and research on prevention, control, and treatment of many diseases; foundation directors sometimes with a review committee decide what gets funded; geographical scope can be national, state, or local; money to give away so don't have to worry about fundraising, can afford to fund long-term/innovative research projects (likely too risky for voluntary, or even government-funded); ex: Bill and Melinda Gates Foundation, the Commonwealth Fund, Ford Foundation, Robert Wood Johnson Foundation, Henry J. Kaiser Family Foundation, W. K. Kellogg Foundation, Milbank Memorial Fund

World Health Day

April 7

Core functions of public health

Assessment of information on community's health, comprehensive public health policy development, and assurance of public health services being provided to the community

How is the WHO financed?

By its member nations, each assessed according to ability to pay such that the wealthiest countries pay the most of the total budget

Professional health organizations

Composed of health professionals who have completed specialized education and training programs and have met the standards of registration, certification, or licensure for their respective fields; purpose: promote high standards of professional practice for their profession to subsequently improve the health of society by improving the people in the profession, primarily funded via membership dues, ex: American Medical Association, American Nursing Association, etc.; continuing education programs for professional renewal, conventions to share information, publication of journals and other reports (Journal of the American Medical Association, American Journal of Public Health, and the American Journal of Health Education); advocate on issues important to their membership

Department of Homeland Security

Deals with all aspects of terrorism in the U.S.

Religious organizations

Effective venue for health program promotion due to a history of volunteerism and preexisting reinforcement contingencies for volunteerism, influence over entire families, and accessible meeting-room facilities; solicitation of donations, donation of space for voluntary health programs, food bank/shelter sponsorship, sharing the doctrine of good personal behavior, allowing community health professionals to deliver their programs through the congregations

State health department

Establish and promulgate health regulations with the force and effect of law throughout the state, act as a link between federal and local public health agencies, conduits for federal funds aimed at local health problems (receive funding as block grants-->those for a specific project are distributed accordingly to the local health departments), sometimes links local needs with federal expertise; local health departments may use state health resources

Agency for Toxic Substances and Disease Registry

Evaluates information on hazardous substances released into the environment in order to assess the impact on public health; conducts and sponsors studies and other research related to hazardous substances and adverse human health effects; establishes and maintains registries of human exposure for long-term follow-up and complete listings of areas closed to the public/otherwise restricted due to contamination, summarizes and provides access to this data, provides consultations/training to ensure adequate response to public health emergencies

Food and Drug Administration

Focused on speeding up innovations to increase food/medicine effectiveness and safety; providing the public with reliable, science-based information needed to effectively use medicines and foods to improve health; regulating the production, marketing, and distribution of tobacco to the public and reducing minors' tobacco use; address the nation's counterterrorism capability and ensuring the security of food/medical products supply; Federal Food, Drug, and Cosmetic Act

American Red Cross

Founded in 1881 by Clara Barton, quasi-governmental (official federal government designated responsibilities with voluntary contribution funding); provides natural disaster relief, acts as a liaison between members of the active armed forces and their families during emergencies; engages in nongovernmental services such as blood drives, safety services, nursing and health services, youth services,community volunteer services, and international services; granted a Congress charter in 1900, president of the US is the honorary chairman, US attorney general=honorary counselor, secretary of the treasury=honorary treasurer

Nongovernmental health agencies

Funded by private donations or membership dues, generally operate free from governmental interference provided that they meet International Revenue Service guidelines regarding specific tax status; types=voluntary, professional, philanthropic, service, social, religious, corporate

Service and social organizations

Group members enjoy social interactions with people of similar interests in addition to fulfilling the groups' purpose (service to others in their communities), some raise money to fund health-related programs

World Health Organization

HQ in Geneva, Switzerland; most widely recognized international governmental health organization, six regional offices around the world

Secretary of Health and Human Services

Head of the Department of Health and Human Services, appointed by the president, member of the cabinet

Organization of local health departments

Headed by a health officer/commissioner/administrator (if not a physician, one is hired on a consulting basis for advice) who is appointed by a board of health, if can't afford full-time physician-administrator trained in public health is hired by the board of health and health officer's recommendation, board of health consists of appointed (by city/county government officials) members, health officer and admin assistants recommend the programs for the LHDs to provide but the board of health must approve this

What hinders today's communities to respond effectively to one's own problems?

Highly developed and centralized resources in our national institutions and organizations; continuing concentration of wealth and population in the largest metropolitan areas; rapid movement of information, resources, and people made possible by advanced communication and transportation technologies that eliminate the need for local offices where resources were once housed; the globalization of health; limited horizontal relationships between/among organizations; top-down funding system for many community programs

Department of Labor

Houses the Occupational Safety and Health Administration, which deals with workplace safety

Department of Commerce

Includes the Bureau of the Census, which deals with a lot of national data driving our nation's health programs

Department of Agriculture

Inspects meat and dairy products and coordinates the Women, Infants, and Children food assistance program

International Committee for the Relief to the Wounded

Led by Henry Dunant, five Swiss men concerned about treatment for wounded during wartime, organized the Geneva Convention for the Amelioration of the Condition of the Wounded Armies in the Field (first Geneva Convention, 1864) where they signed the Geneva Treaty and eventually established the International Committee of the Red Cross (visits prisoners of war today to make sure they are being treated properly, works during disaster and international conflict)

Superfund legislation

Legislation enacted by the Comprehensive Environmental Response, Compensation and Liability Act (1980) to deal with the cleanup of hazardous substances in the environment, created the Agency for Toxic Substances and Disease Registry

State level of voluntary health agencies

Link national headquarters with local offices, coordinating local efforts and making sure that policies created at the national headquarters are carried out; training services for employees and volunteers of local-level offices

Local health department

Local-level governmental health organizations, city/county government's responsibility, community health needs best served by a city health department in large metropolitan areas while smaller regions generally come under the jurisdiction of a country health department; sometimes have jurisdiction over city and county, provide health services to the community (many of which are mandated by state laws), can enact ordinances that are stricter than the state's but cannot enact ones that fall below state standards, local sources=main source of revenue, followed by state funds and federal pass-through funds, some are fee-for-service (very small source of revenue)

Agency for Healthcare Research and Quality

Main US federal agency focused on evidence-based information on health care outcomes, quality, cost, use, and access research

Substance Abuse and Mental Health Services Administration

Main federal agency responsible for making that up-to-date information and state-of-the-art practice are effectively used to prevent/treat addictive and mental disorders, contains three centers: Center for Substance Abuse Treatment, Center for Substance Abuse Prevention, and the Center for Mental Health Services; one office=Office of Applied Studies (collects, analyzes, and releases behavioral health data)

Health Resources and Services Administration

Main primary health care service agency of the federal government that provides essential health care services access to patients who are low-income, uninsured, or living in areas with few health care resources; maintains the National Health Service Corps; training and education; Ryan White CARE Act HIV/AIDS programs; oversees organ transplant system in the US

Local level of voluntary health agencies

Managed by a paid staff hired by the state-level office or a local board of directors; local volunteers work under each agency's manager; professional (trained in a medical profession) and lay (no training) volunteers

World Health Assembly's work with tobacco

May 21, 2003-World Health Assembly adopted the first global public health treaty to reduce tobacco-related deaths and diseases throughout the world

Ten essential public health services

Monitor health status to ID community health problems; diagnose and investigate health problems and health hazards in the community; inform, educate, and empower people about health issues; mobilize community partnerships to identify and solve health problems; develop policies and plans that support individual and community health efforts; enforce laws and regulations that protect health and ensure safety; link people to needed personal health services and assure the provision of health care when otherwise unavailable; ensure a competent public health and personal health care workforce; evaluate effectiveness, accessibility, and quality of personal- and population-based services; research for new insights and innovative solutions to health problems

Voluntary health agencies

Nonprofit organizations created by concerned citizens to deal with a health need not met by governmental health agencies, exist at three levels (national, state, local)

Membership in the World Health Organization

Open to any nation that's ratified the WHO constitution and receives a majority vote of the World Health Assembly

Quasi-governmental health organizations

Organizations that have some responsibilities assigned by the government but operate more like voluntary agencies; carry out some governmental tasks and get some funding legitimacy from the government-operate independently of government supervisionex: American Red Cross, National Science Foundation, National Academy of Sciences

Centers for Medicare and Medicaid Services

Originally the Health Care Financing Administration; oversees Medicare and the federal portion of Medicaid along with the related quality assurance activities; CHIP also their responsibility

Administration for Children and Families

Part of the HHS, direction and leadership for all federal programs for needy children and families, ex: Head Start

Administration on Aging

Principal agency of the HHS to carry out the Older Americans Act of 1965; tracks older people's needs, circumstances, etc.; develops policies, etc. to promote their welfare; offers adminster-granted programs to benefit older Americans and administers training, research, demonstration programs, and protective services for older Americans, ex; Meals on Wheels

Millennium Declaration

Principles and values to govern international relations in the 21st century in peace, security, and disarmament; development and poverty eradication; protecting our common environment; human rights democracy, and good governance; protecting the vulnerable; meeting special needs of Africa; and strengthening the United Nations

Indian Health Service

Provides federal health services to American Indians and Alaska Natives as a provider and advocate of health care for them

Indian Health Care Improvement Act

Reauthorized in Obama's 2010 healthcare reform, modernized and improved health care services to Alaska Natives and American Indians

The Futures Initiative

Strategic planning process for the CDC, main health protectional goals are preparedness; health promotion and prevention of disease, injury, and disability; and healthy places; Reorganized CDC to include an Offie of the Director, the National Institute for Occupational Safety and Health, six coordinating centers/offices (Centers, Institutes, and Offices-->improve response to public health concerns)

What documents guide the current work of the WHO?

The 11th General Programme of Work and the UN Millennium Declaration (adopted at the Millennium Summit in 2003)

Department of Health and Human Services

The primary national health agency in the US

Sliding scale

The scale used to determine the fee for services based on ability to pay, used by LHDs

Hiring of the head of the state health department

Typically a medical doctor appointed by the governor carrying the title of director, commissioner, or secretary

Hiring middle/lower-level employees for the state health department

Usually through a merit system and likely they will lack influence on health department policy; usually trained as microbiologists, nurses, epidemiologists, etc.

Community Living Assistance Services and Supports Act

Voluntary, self-funded long-term-care insurance option

World Health Assembly

a body of delegates of the member nations of the WHO, meets in annual general sessions+special sessions if needed, main jobs=approve the WHO program and budget for the next biennium along with make major policy questions

Top-down funding

a method of funding in which funds are transmitted from federal or state government to the local level

Global Strategy on Diet, Physical Activity, and Health

adopted by the World Health Assembly in 2004

Coordinated school health program

an organized set of policies, procedures, and activities designed to protect, promote, and improve the health and well-being of students and staff to improve the student's ability to learn; includes comprehensive school health ed, school health services, physical education, healthy school environment, school counseling, psychological and social services, school nutrition services, family and community involvement in school health, and school-site health promotion for staff

Administration of the WHO

director-general, deputy director general, and nine assistant directors-general

Millennium Development Goals

eight goals to achieve the Millennium Declaration in the area of development and poverty eradication, focused on reducing poverty and hunger, tackling ill health, gender inequality, lack of education, lack of access to clean water, and environmental degradation; interaction between health and economic development; health-related goals=Eradicate Extreme Poverty and Hunger, Reduce Child Mortality, Improve Maternal Health, Combat HIV/AIDS, Malaria, and other Diseases, Ensure Environmental Sustainability, and Develop a Global Partnership for Development; SLOW progress

The Pan American Health Organization

est. 1902, independent organization but is integrated with WHO in a regional office

International D'Hygiene Publique

est. 1907, absorbed by the WHO

The Health Organization of the League of Nations

est. 1919, dissolved when the WHO was created

The United Nations Relief and Rehabilitation Administration

est. 1943, dissolved in 1946, work done today by the Office of the United Nations High Commissioner for Refugees (UNHCR) (1950)

The United Nations Children's Fund

est. 1946, formerly known as the UN International Children''s Emergency Fund

Centers for Disease Control and Prevention

focused on disease prevention and control, environmental health, and health promotion/education activities to improve the health of Americans, analyzes disease trends, works to control communicable diseases, publishes epidemiological reports on lifestyle, environment, and occupation-caused diseases, supports state and local health departments, cooperates with similar national health agencies from other WHO member nations

Governmental health agencies

health agencies that are part of the governmental structure (federal, state, or local) and that are funded primarily by tax dollars, each has authority over some geographic area-international, national, state, or local

Corporate involvement in community health

health care benefits, health-related programs at and away from the worksite, health promotion policies, state/local law enforcement of prohibitory laws regarding smoking, mandatory laws about safety belts, etc.

Three main components of a coordinated school health program

health education, healthy school environment, and health services

New responsibilities for the HHS from Obama's 2010 healthcare reform

included implementation of new provisions to assist families and business owners in getting information to make the best choices for insurance coverage in a new market; working with states and additional partners to strengthen public programs like CHIP, Medicare, and Medicaid; coordinating efforts with other departments to design and implement a "prevention and health promotion strategy" to promote prevention, wellness, and public health; taking action to strengthen and support the primary care workforce; taking on the new and improved authority to establish a transparent health care system to oversee that every dollar authorized to be spent in the act is done pragmatically; the implementation of new provisions to decrease the costs of medications; taking on authority to establish the Community Living Assistance Services and Supports Act; implementation of the Indian Health Care Improvement Act

coordinated school health program barriers

insufficient local administrative commitment, inadequately prepared teachers, too few school days to teach health in a school year, inadequate funding, the lack of credibility of health education as an academic subject, insufficient community/parental support, concern for the teaching of controversial topics

World Health Organization's history

planning started when UN charter detailing the establishment of a health agency with wide powers adopted at an international meeting in 1945, constitution created and ratified in 1946 at the International Health Conference; constitution in action April 7, 1948

National Science Foundation

quasi-governmental, funding and promotion of scientific research and development of individual scientists; receives and disperses federal funds but operates without governmental supervision

Environmental Protection Agency

regulates hazardous wastes

The primary objective of the WHO

the attainment by all peoples of the highest possible level of health, see p. 36-37 for the 22 core functions to achieve this goal

Four main objectives of voluntary health agencies

to raise money to fund their programs (with most of the money going to fund research), to provide education both to professionals and to the public, to provide service to those individuals and families afflicted with the disease or health problem, to advocate for beneficial policies, laws, and regulations that affect the agency's work and who they are trying to help

National Institutes of Health

"federal focal point for medical research in the US," research done at their labs in Bethesda but also at public and private universities and research institutions elsewhere, funding provided for research through competitive, peer-review grant application process

American Recovery and Reinvestment Act of 2009

$19 billion for health information technology, subsidies for those recently unemployed to maintain health insurance, and continued effectiveness research in health