"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government—federal, state, and local—at which these functions would best be handled.
- The Future of Public Health
- Copyright
- Preface
- Acknowledgements
- Contents
- Summary and Recommendations
- WHY STUDY PUBLIC HEALTH
- THE APPROACH
- THE STATE OF U.S. PUBLIC HEALTH
- The Public Health Mission
- Professional Expertise and the Political Process
- Public Health and the Medical Profession
- The Knowledge Base and its Application
- THE FUTURE OF PUBLIC HEALTH: RECOMMENDATIONS
- THE PUBLIC HEALTH MISSION, GOVERNMENTAL ROLE, AND LEVELS OF RESPONSIBILITY
- Mission
- The Governmental Role in Public Health
- Assessment
- Policy Development
- Assurance
- Levels of Responsibility
- FULFILLING THE GOVERNMENT ROLE: IMPLEMENTING RECOMMENDATIONS
- Statutes
- Organizational Structure
- Special Linkages
- Environmental Health
- Mental Health
- Social Services
- Care of the Indigent
- Strategies for Capacity Building
- Technical
- Political
- Managerial
- Programmatic
- Fiscal
- Education for Public Health
- CONCLUDING REMARKS
- 1 The Disarray of Public Health: A Threat to the Health of the Public
- IMMEDIATE CRISES
- AIDS (Acquired Immune Deficiency Syndrome)
- Access to Health Care for the Indigent
- ENDURING PUBLIC HEALTH PROBLEMS
- Injuries
- Teen Pregnancy
- Control of High Blood Pressure
- Smoking and Substance Abuse
- GROWING CHALLENGES AND IMPENDING CRISES
- Toxic Substances
- Alzheimer's Disease or Dementia of the Alzheimer Type
- Revitalization of Public Health Capacities
- REFERENCES
- 2 A Vision of Public Health in America: An Attainable Ideal
- A DEFINITION OF PUBLIC HEALTH
- The Mission of Public Health
- The Substance of Public Health
- The Organizational Framework of Public Health
- The Role of Government in Public Health
- The Functions of Government in Public Health
- Assessment
- Policy Development
- Assurance
- State, Local, and Federal Roles in Public Health
- State Governments
- Federal Government
- Local Governments
- The Public and Private Sectors in Public Health
- THE BASIC SERVICES OF PUBLIC HEALTH
- REFERENCES
- 3 A History of the Public Health System
- HISTORY
- Before the Eighteenth Century
- The Eighteenth Century
- The Nineteenth Century: The Great Sanitary Awakening
- The Development of Public Activities in Health
- Late Nineteenth Century: Enter Bacteriology
- The Development of State and Local Health Department Laboratories
- The Successes of Bacteriology
- Early Twentieth Century: The Move Toward Personal Care
- Further Development of State and Local Health Agencies
- The Growth of Federal Activities in Health
- Mid-Twentieth Century: Further Expansion of the Governmental Role in Personal Health
- Federal Activities
- State and Local Activities
- The Late Twentieth Century: A Crisis in Care and Financing
- CONCLUSION
- REFERENCES
- 4 An Assessment of the Current Public Health System: A Shattered Vision
- VIEWING THE SYSTEM
- THE PUBLIC HEALTH SYSTEM
- Summary of the National Public Health System
- State
- Local
- Federal
- Resources
- Other Actors
- The Public Health System as Observed by the Committee
- Organization of Health Agencies
- Leadership
- Range of Activities
- Assessment
- Policy Development
- Assurance of Health Services
- Intergovernmental and Interorganizational Relationships
- Resources
- CONCLUSION
- REFERENCES
- 5 Public Health as a Problem-Solving Activity: Barriers to Effective Action
- THE LACK OF CONSENSUS ON MISSION AND CONTENT OF PUBLIC HEALTH
- Public Health Responsibility for Indigent Care
- Relationship of Public Health to Environmental Health
- Relationship of Public Health to Mental Health
- The Public Health Role in Encouraging Healthful Behaviors Through Education and Through Modification in Social Environment
- IMPEDIMENTS TO THE ESSENTIAL WORK OF PUBLIC HEALTH
- Assessment and Surveillance
- Policy Development
- Assurance of Access to the Benefits of Public Health
- LEADERSHIP FOR PUBLIC HEALTH
- The Interaction of Technical Expertise and Political Accountability
- Continuity of Leadership
- National Leadership for Public Health
- Poor Relationships with the Medical Profession
- Community Organization for Public Health Action
- STRUCTURE AND ORGANIZATION OF PUBLIC HEALTH
- Organizational Separation of Environmental Health Programs, Mental Health Programs, and Indigent Care Programs
- Creation of Health and Human Services Superagencies
- Lack of a Clear Delineation of Responsibilities Between Levels of Government
- DEFICITS IN THE CAPACITY TO CONDUCT PROGRAMS
- Knowledge and its Application
- The Need for Well-Trained Public Health Personnel
- Distribution of Technical Expertise
- Building Constituencies for Public Health
- Managerial Capacity
- The Lack of Fiscal Support
- HOW THE PUBLIC HEALTH SYSTEM WORKS—AIDS AS AN EXAMPLE
- Statutory Base
- Assessment
- Policy Development
- Assurance
- THE STATE OF PUBLIC HEALTH
- REFERENCES
- 6 Conclusions and Recommendations
- THE PUBLIC HEALTH MISSION, GOVERNMENTAL ROLE, AND LEVELS OF RESPONSIBILITY
- Mission
- The Governmental Role in Public Health
- Assessment
- Policy Development
- Assurance
- Federal, State, and Local Responsibilities
- States
- The Federal Government
- Localities
- FULFILLING THE GOVERNMENT ROLE: RECOMMENDATIONS
- Statutory Base
- Structural/Organizational Steps
- Special Linkages
- Environmental Health
- Mental Health
- Social Services
- Care of the Medically Indigent
- Strategies for Capacity Building
- Technical
- Political
- Managerial
- Programmatic
- Fiscal
- Education for Public Health
- CONCLUDING REMARKS
- REFERENCES
- Supplementary Statements
- HARVEY I. SLOANE
- ROBERT J. RUBIN
- Appendixes
- Appendix A Summary of the Public Health System in the United States
- Public Health Agencies
- Federal
- Leadership
- Organization
- Activities
- Resources
- State
- Leadership
- Organization
- Activities
- Resources
- Local
- Leadership
- Organization
- Activities
- Resources
- Other Participants in the Public Health System
- National
- Governmental
- Nongovernmental
- State
- Governmental
- Nongovernmental
- Local
- Governmental
- Nongovernmental
- Conclusion
- References
- Appendix B Biographies of Committee Members
- Appendix C Model Standards
- Program Areas
- Promoting Health/Preventing Disease: Objectives for the Nation—1990
- Appendix D Site Visits: Site Selection and Methodology
- Objectives for the Site Visits
- Site Selection
- Methodology
- References
- Index
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