DRAFT PUBLIC HEALTH 101 Third Module

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DRAFTPUBLIC HEALTH 101Third Module

• Legal Basis, Financing, and Organization
• Northwest Center for Public Health Practice
• Jack Thompson

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PUBLIC HEALTH LAW - FEDERAL LEVEL

• The federal government is a government of limited
  power whose acts must be authorized in the
  Constitution.
• Chief powers of the federal government for public
  health purposes are the power to tax, to spend,
  and to regulate interstate commerce.
• The federal government draws its expansive
  authority to act in the field of public health
  from specific, enumerated powers
• power to raise revenues for public health
  services
• power to regulate, both directly and indirectly,
  private activities that endanger human health
• Principles of new federalism question the extent
  to which federal powers may lawfully extend into
  areas of traditional state concern ( such as
  public health).

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PUBLIC HEALTH LAW - STATE LEVEL

• The tenth amendment of the constitution reserves
  to the states all those powers not otherwise
  given to the federal government nor prohibited to
  the states by the Constitution.
• State police powers (the inherent authority of
  the state to protect, preserve, and promote the
  health, safety, morals, and general welfare)
  represent the residual authority to act for
  public health.
• Examples of state police powers
• laws authorizing vaccination, isolation, and
  quarantine
• inspection of commercial and residential
  premises
• abatement of unsanitary conditions or other
  health nuisances
• regulation of air and surface water contaminants
  as well as restriction on the publics access to
  polluted areas and
• licensure of physicians and other health care
  professionals.

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PUBLIC HEALTH LAW - LOCAL LEVEL

• Local governments, including counties,
  municipalities, and special districts, share
  public health authority through delegations of
  state police power, or home rule.
• Exercises of local authority in the interests of
  public health cannot extend beyond limited
  jurisdictional boundaries or conflict with or
  impair federal or state law.
• As a result, the role of local governments in
  public health law is largely limited by federal
  and state laws and regulations to which local
  governments must adhere in setting or
  implementing public health policies.

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TRENDS IN FINANCING PUBLIC HEALTH

• Historically, financing of public health has
  primarily been at the local level (in 1978, 77
  of all resources spent on local public health in
  Washington State from local sources by 1999,
  still over 50)
• Prior to early 1980s, states were primarily
  receivers and redistributors of local and federal
  funds and not direct funders of public health
  services (prior to 1986, no state funds for
  public health in Washington State)
• Historically, the federal government provided the
  major funding for health departments for specific
  categorical programs with little local discretion
  (this changed with the Maternal and Child Health
  Block Grant in 1981)
• In 1992, an estimated 34 per person was spent on
  public health functions in this country in
  contrast to 3000 per person for medical care
  services
• At present, an estimated 8.4 billion is spent
  nationally on public health functions - less than
  1 of total health expenditures

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CHARACTERISTICS OF HEALTH DEPARTMENTS(FROM THE
NACCHO NATIONAL PROFILE OF LOCAL PUBLIC HEALTH
DEPARTMENTS - 1992/93 and the 1997 UPDATE)

• 2888 local health departments in the US in 1993
  2834 in 1997
• of the departments that responded to the 1992-93
  survey
• 65 served populations/jurisdictions less than
  50,000 (same in 1997)
• 4 served populations/jurisdictions over 500,000
  (same in 1997)
• 80 county or multi-county agencies others serve
  cities, townships, or districts
• 13 had budgets less than 100,000
• 34 had budgets over 1,000,000
• 42 had less than 10 FTEs
• 9 had 100 or more FTEs
• in the 1997 survey, the median number of staff
  was 16 the mean was 72

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INVOLVEMENT IN CORE PUBLIC HEALTH FUNCTIONS

• (FROM THE 1992-93 AND 1997 NACCHO PROFILES OF
  LOCAL PUBLIC HEALTH DEPARTMENTS)
• ASSESSMENT
• 87 active in reportable disease data collection
  and analysis
• 92 active in communicable disease epidemiology
• POLICY DEVELOPMENT
• 52 active in public health priority setting
• 57 active in health planning
• 59 active in health code development and
  enforcement
• ASSURANCE
• 72 active in environmental health inspection
  activity
• 74 active in health education
• 59 provide prenatal care
• 60 provide family planning
• 69 provide WIC
• 84 provide child health
• 92 provide immunizations

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States are primary authorities responsible for
health protection, under powers granted by the
United States Constitution.

• Two-thirds of the states have free-standing
  health agencies reporting to the governor or a
  board of health
• One-third have health components in superagencies

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Responsibilities of state health authorities vary.

• 16 are lead for environmental health services
• 18 for mental health
• 16 for Medicaid
• 31 for drug/alcohol
• 86 for services to children with special health
  care needs

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Local public health jurisdictions have many
different organizational structures.

• Of the 2888 local public health authorities in
  the United States
• 56 are county departments
• 13 are city/county
• 11 are townships
• 7 are city departments

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Most local public health jurisdictions serve
small populations.

• Two-thirds serve populations less than 50,000,
  and 44 under 25,000
• Less than 20 serve populations over 100,000 and
  only 4 over 500,000

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Most local public health jurisdictions operate on
small budgets.

• Half of local public health jurisdictions have
  budgets less than 500,000, with 13 expending
  less than 100,000
• Only one-third have budgets over 1,000,000
• Nearly 3/4 of funding comes from local and state
  sources state funding makes up 40 of the
  funding
• Medicare/Medicaid makes up about 10 of the
  budget

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Most local public health jurisdictions have small
staffs.

• Nearly half of local public health jurisdictions
  have fewer than 10 FTE staff
• Only one-third have 25 or more staff, and only 9
  more than 100
• The staff size is related to the size of the
  jurisdiction
• of agencies serving less than 50,000, only 25
  have 10 or more staff
• 90 of the agencies serving 500,000 have 100
  employees or more

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Many local public health jurisdictions provide
personal health care services.

• 96 provide immunizations
• 86 TB treatment
• 79 well-child services
• 68 family planning
• 66 STD treatment
• 64 prenatal care
• 50 home health services

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Most local public health jurisdictions take
responsibility for traditional sanitation
functions.

• 80 provide restaurant inspections
• 75 provide sewage disposal services
• 74 private water supply safety
• 68 swimming pool inspection
• 55 recreational facility inspection
• 52 public water supply safety

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Far fewer local public health jurisdictions deal
with some of the newer environmental threats to
health.

• 58 groundwater pollution control
• 57 environmental emergency response
• 42 hazardous waste management
• 37 indoor air quality
• 24 occupational safety and health

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Virtually all local public health jurisdictions
provide

• Community education (86)
• High blood pressure screening (85)
• Risk reduction advice (84)

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However

• 50 have no activity in cancer, cardiovascular
  disease, or diabetes education and prevention
• Only 45 address tobacco control

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And assessment functions vary greatly among
jurisdictions

• 82 offer communicable disease surveillance
• 42 chronic disease surveillance
• 20 behavioral risk factor surveillance
• 19 injury surveillance