Public Health System: Structure and Function

25 Public Health System

Structure and Function

The U.S. Institute of Medicine (IOM) describes the challenges inherent in organizing the public health system for the 21st century as follows1:

The U.S. public health system was designed at a time when most threats to health were infectious, before computer information systems, and when local autonomy prevailed. This chapter describes the structure of the U.S. health system and discusses how it must respond to contemporary challenges. Public health systems in other countries are likely structured very differently but still need to adapt to the same challenges.

I Administration of U.s. Public Health

A Responsibilities of the Federal Government

The public health responsibility of the U.S. Federal Government is based on two clauses from Article 1, Section 8, of the U.S. Constitution. First, the Interstate Commerce Clause gives the federal government the right “to regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.” Second, the General Welfare Clause states that “the Congress shall have Power to lay and collect Taxes. .. for the common Defense and general Welfare of the United States.” Federal responsibility also is inferred from statements that Congress has the authority to create and support a military and the authority to negotiate with Indian tribes and other special groups.

5 Coordination of Federal Agencies

In the United States the federal department most concerned with health is the Department of Health and Human Services (DHHS), which has four major operating units, described next2 (Fig. 25-1).

Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) is responsible for administering two major programs of the Social Security Act. Medicare is covered under Title 18 of the Social Security Act and pays for medical care for the elderly population. Medicaid is covered under Title 19 and pays for medical and nursing home care in cooperation with the states (see Chapter 29). CMS duties include setting standards for programs and institutions that provide medical care, developing payment policies, contracting for third-party payers to cover the bills, and monitoring the quality of care provided. CMS also supports graduate medical education, residency, and fellowship programs that provide care for individuals covered by Medicare or Medicaid.

Public Health Service

The U.S. Public Health Service (PHS) comprises the following eight constituent agencies:

1. The Agency for Healthcare Research and Quality (AHRQ) is the main federal agency for research and policy development in the areas of medical care organization, financing, and quality assessment. Since 2000, the agency has placed increasing emphasis on medical care quality.

2. The Agency for Toxic Substances and Disease Registry (ATSDR) provides leadership and direction to programs designed to protect workers and the public from exposure to and adverse health effects of hazardous substances that are kept in storage sites or are released by fire, explosion, or accident.

3. The Centers for Disease Control and Prevention (CDC) has the responsibility for “protecting the public health of the [United States] by providing leadership and direction in the prevention and control of diseases and other preventable conditions and responding to public health emergencies.” The CDC directs and enforces federal quarantine activities; works with states on disease surveillance and control activities; develops programs for prevention and immunization; is involved in research and training; makes recommendations on how to promote occupational health and safety through the National Institute on Occupational Safety and Health (NIOSH); provides consultation to other nations in the control of preventable diseases; and participates with international agencies in the eradication and control of diseases around the world. The CDC has a complex organizational structure (Fig. 25-2).

4. The Food and Drug Administration (FDA) is the primary agency for regulating the safety and effectiveness of drugs for use in humans and animals; vaccines and other biologic products; diagnostic tests; and medical devices, including ionizing and nonionizing radiation–emitting electronic products. The FDA is also responsible for the safety, quality, and labeling of cosmetics, foods, and food additives and colorings.

5. The Health Resources and Services Administration (HRSA) is responsible for developing human resources and methods to improve health care access, equity, and quality, with an emphasis on promoting primary care. HRSA also supports training grants and training programs in preventive medicine and public health.

6. The Indian Health Service promotes the health of and provides medical care for Native Americans and Alaska Natives.

7. The National Institutes of Health (NIH) consists of 27 institutes, which perform intramural (in-house) research on their particular diseases, organ systems, or topics (e.g., National Cancer Institute; National Heart, Lung, and Blood Institute; National Human Genome Research Institute; National Center for Advancing Translational Science). The institutes also review and sponsor extramural research at universities and research organizations through competitive grant programs. Some of the institutes also undertake disease control programs and public and professional education in their area (e.g., National Library of Medicine, National Institute for Neurological Disorders and Stroke).

8. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides national leadership in preventing and treating addiction and other mental disorders, based on up-to-date science and practices, and has four major operating divisions: Center for Mental Health Services, Center for Substance Abuse Prevention, Center for Substance Abuse Treatment, and Center for Behavioral Health Statistics and Quality.

The PHS is not the only important agency in public health. The other major federal organization is the Office of Public Health and Science (OPHS), which leads the Healthy People initiative through its Office of Disease Prevention and Promotion (see Chapter 26) and oversees the U.S. Surgeon General’s office, President’s Council on Bioethics, U.S. Public Health Service Commissioned Corps, and Office of Minority Health (Fig. 25-3).

B Responsibilities of States

In the United States the fundamental responsibility for the health of the public lies with the states. This authority derives from the 10th Amendment to the Constitution: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

In 1988 the IOM stated that “the mission of public health is to ensure conditions in which people can be healthy”, and that the three “core functions of public health agencies at all levels of government are assessment, policy development, and assurance.”3

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Aug 27, 2016 | Posted by in PUBLIC HEALTH AND EPIDEMIOLOGY | Comments Off on Public Health System: Structure and Function

Full access? Get Clinical Tree

Get Clinical Tree app for offline access