PHealth-SLID_CH03 -3

Chapter 3: Powers and Responsibilities of Government

Introduction to Public Health

• Overview of powers and responsibilities of government related to public health.

• Emphasis on health not being explicitly mentioned in the U.S. Constitution.

Federal Versus State

• Fundamental Purpose: The U.S. Constitution aims "to promote the general welfare."

• Reserve Clause: 10th Amendment implies public health responsibilities lie with states due to lack of mention in the Constitution.

• Interstate Commerce Provision: Justifies FDA activities.

• Federal Funding: Federal government controls public health policy through the power to tax and spend; contributes 50%-80% of Medicaid funding.

• New Federalism: Limits Congress's powers, returning authority to states.

Branches of Government: Federal, State, and Local

• Legislative: Passes statutes related to public health.

• Executive: Public health agencies implement laws and may issue regulations.

• Judicial: Laws and regulations can be challenged in court.

Local Public Health Agencies

• Responsibilities:

  • Conduct day-to-day public health tasks.

  • Perform core public health functions.

  • Provide medical care for the poor.

• Funding Sources:

  • Variable funding from city or county legislatures; may not always recognize the importance of core functions.

  • Mandates can be funded from state or federal governments.

State Health Departments

• Roles:

  • Coordinate activities of local health agencies and provide funding.

  • Collect and analyze data from local agencies.

  • Provide laboratory services and manage Medicaid.

  • License and certify medical personnel and health facilities.

  • Address issues related to environment, mental health, social services, and aging, potentially through separate agencies.

  • Fund hospitals to reimburse care for uninsured patients.

Federal Agencies

• Main Agencies:

  • Department of Health and Human Services (HHS): www.hhs.gov

  • Centers for Disease Control and Prevention (CDC): www.cdc.gov - Main epidemiologic agency; publishes MMWR; collects health data.

  • National Institutes of Health (NIH): www.nih.gov - Major biomedical research complex; involved in various health topics; includes National Library of Medicine.

  • Food and Drug Administration (FDA): www.fda.gov

  • Centers for Medicare & Medicaid Services (CMS): www.cms.gov

  • Agency for Healthcare Research and Quality (AHRQ): www.ahrq.gov

  • Indian Health Service: www.ihs.gov

  • Environmental Protection Agency (EPA): www.epa.gov

Additional Federal Agencies

• Occupational Safety and Health Administration (OSHA): www.osha.gov

• Department of Agriculture (USDA): www.usda.gov

• Department of Transportation: www.transportation.gov

• Department of Labor: www.dol.gov

• Department of Veterans Affairs: www.va.gov

• Department of Defense: www.defense.gov

• Department of Homeland Security: www.dhs.gov

Centers for Disease Control and Prevention (CDC)

• CDC focuses on epidemiology and public health assessment.

• Key publication: Morbidity and Mortality Weekly Report (MMWR).

• Data Collection: National Center for Health Statistics collects comprehensive U.S. health data.

• Addresses infectious diseases, chronic diseases, and injury prevention.

National Institutes of Health (NIH)

• The largest biomedical research organization globally.

• Various institutes target specific health topics (cancer, heart disease, aging, etc.).

• Houses National Library of Medicine and provides grant funding.

• Conducts medical research at the clinical center in Bethesda, MD.

• Supported strongly by Congress.

Nongovernmental Public Health Organizations

• Specific Disease Organizations:

  • American Cancer Society

  • American Heart Association

  • American Diabetes Association

  • Alzheimer's Disease and Related Disorders Association

• Professional Membership Organizations:

  • American Medical Association

  • American Nurses Association

  • American Public Health Association

• Future Public Health Organizations:

  • National Association of City and County Health Officers

  • Association of State and Territorial Health Officers

  • Association of Schools of Public Health

Philanthropic Foundations

• Key organizations include:

  • Rockefeller Foundation

  • Robert Wood Johnson Foundation

  • Pew Charitable Trusts

  • Kaiser Family Foundation

  • Commonwealth Fund

  • Bill and Melinda Gates Foundation

Discussion Questions

• Discuss the division of responsibilities among federal, state, and local government for a specific health issue.

• Identify a federal public health agency and current issues it is addressing, alongside any controversies.

• Importance of involvement of nongovernmental organizations in public health activities.

• Explore activities of a philanthropic foundation from the previous slide.