Henry G' Taylor MD MPH

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Public Health Practice 101
Module III The Structure of Public Health
Henry G. Taylor MD MPH Public Health Education
Program htaylor_at_hepc.wvnet.edu
Rachel T. Abraham MD MPH WVU Office of Public
Health Practice rabraham_at_hsc.wvu.edu
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Course Objectives

• By the end of these modules, the learner will
• Be familiar with the basic concepts of public
  health practice
• Understand 4 ways to describe and define public
  health
• Describe the Public Health System at multiple
  levels
• Recite the 3 Core Functions of Public Health
• Recognize the 10 Essential Services
• Be aware of the 13 Core Competencies of Public
  Health
• Recognize the variety of public health careers
• See themselves as a continuation of the grand
  tradition of public health

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Module III Objectives

• By the end of this module, the learner will
• Understand Public Health as a System of Health
  Care

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Public Health as a System

• Public health is not a single product or service
  provided by one type of professional
• It is a web of relationships between many
  different people and organizations about a wide
  variety of topics
• This web of relationships serves to assure
  conditions that result in a healthy public

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1987 IOM Report

• Public Health is in disarray.
• More linkages between theory and practice,
  between academia and field work.
• Public Healths mission is to create the
  conditions within which people can be healthy
  (paraphrase).
• BPH Shape the environments within which
  people and communities can be safe and
  healthy.

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The Public Health System
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Public Health Structure

• Four governmental levels
• Local Health Departments
• State Health Agency
• Bureau for Public Health, Health Care Authority
• Federal Government
• CDC, HRSA, EPA, ?
• International Health Agencies
• WHO, UNICEF, etc

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Responsibilities

• Public Health is fundamentally local
• Local Health Departments are where the rubber
  meets the road
• A Governmental Presence at the Local Level
• States with home rule delegate particular
  authority to counties and municipalities

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Boards of Healthin the USA

• Forty states report having local boards of
  health.
• 3,186 local boards were identified by the CDC.
• 45.7 boards of health serve counties,
• 24.6 serve a town/city, and
• 29.7 serve other jurisdiction.
• 58 serve populations less than 25,000.

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WV Local Health System

• Responsibility is designated by State Code
• Local boards of health are autonomous units
• Local boards of health members are appointed by
  county commissions
• Not organizationally part of the state system
• Local Health Departments provide just under one
  million encounters (patient services) statewide

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Local Health Employees

• Local boards of health hire staff to carry out
  their responsibility to protect and promote the
  health of the public
• Local Health Officer is selected by the Board of
  Health, and confirmed by State Health Officer
• Local Health Department staff are employees of
  the county which the health department serves
• Local Health Departments participate in the state
  personnel and insurance systems

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Selected County Health Departments
Population based on 1990 Census data, FTE (Full
Time Equivalents) based on 1997-98 Program Plan
and Budget Document, Funding based on
1996-97financial reports.
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Public Health as a part of the Health Care
Delivery System
? Public Health ?
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State Health Agency

• The unit of government housing the State Health
  Officer
• US Constitution makes states responsible for the
  health and safety of their citizens
• The commerce clause allows the federal
  government to regulate interstate business
• Federal funding often controls state activity

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State and Local Public Health Agencies in WV
Governor andDHHR Secretary
Local Boardsof Health
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BPH is a complex organization

• Almost 800 staff, highly professional, dedicated,
  and enthusiastic!
• Over 160 million budget for FY 2002.
• 110 Programs, the equivalent of brand names a
  cluster of services easily recognizable to those
  we serve.

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Commissioners Plan

• All state programs under one roof
• New State Hygenic Lab
• Complete the extension of autonomy to full time
  local health departments as rapidly as they are
  prepared to accept the responsibility

• Full time local health services for the entire
  population of the state
• State/Local pay raises
• Equitable formula for state aid distribution
• Realign state programs
• State merit system
• Eliminating line-items

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The Complex Regulation of Air and Water in WV

• Air pollution is regulated by the Department of
  Environmental Protection (DEP)
• Indoor Air Quality is regulated by County Boards
  of Health

• Water pollution is by DEP
• Fish and wildlife are regulated by the Division
  of Natural Resources
• Drinking water is regulated by the State Bureau
  for Public Health with funds from EPA
• County Health Departments enforce State sewage
  laws

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Federal Health Agencies
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Bio-terrorisms impact

• The FBI investigates acts of terrorism
• Federal funding goes through the State
• Criminal issues are handled by state police,
  county sheriffs, and municipalities
• County Boards of Health and the State Public
  Health Commissioner have certain police powers
  to restrict civil liberties

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Global Health

• World Health Assembly
• World Health Organization
• United Nations Childrens Fund (UNICEF)
• Agreements for standard travel documents
  regarding vaccination
• Sharing of information about epidemics
• Refugees from disasters