{"id":88,"date":"2017-12-18T18:35:14","date_gmt":"2017-12-18T18:35:14","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/atd-clinton-hsm111\/?post_type=chapter&p=88"},"modified":"2017-12-18T18:35:14","modified_gmt":"2017-12-18T18:35:14","slug":"defining-public-health","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/atd-clinton-hsm111\/chapter\/defining-public-health\/","title":{"raw":"Defining Public Health","rendered":"Defining Public Health"},"content":{"raw":"

\"\"<\/p>\r\nPublic Health<\/b>\u00a0- \u201cimproving health, prolonging life and improving the quality of life among whole populations through health promotion, disease prevention and other forms of health intervention.\u201d (World Health Organization<\/b>, 1998)\r\n

\"\"<\/p>\r\nAccording to the\u00a0Institute of Medicine\u00a0<\/b>(IOM, 1998), public health is\u00a0\u00a0 \u201cthe science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort for sanitation of the environment, the control of communicable diseases, the education of the individual in personal hygiene.\u201d\r\n\r\nPublic health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.\r\n\r\nOverall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world.\r\n

\"\"<\/p>\r\nPublic health professionals try to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services and conducting research \u2013 in contrast to clinical professionals like doctors and nurses, who focus primarily on treating individuals after they become sick or injured. Public health also works to limit health disparities. A large part of public health is promoting healthcare equity, quality and accessibility.<\/b><\/i><\/u>\r\n\r\nComparing public health to community medicine, public health is an agency-based rather than clinic-based field. It is focused upon the health of the population, such as a county, state, or the world. Primary goals of public health agencies are focused upon prevention, education, and monitoring.\r\n\r\nCommunity medicine is illness or injury focused. Traditionally, community medicine is focused on the health of the individual. Community medicine consists of clinicians and other health care providers.\r\n

History of the U.S. Public Health Service<\/h3>\r\nProtecting and advancing the health of our nation's people and contributing to the delivery of health care world-wide is very important work and the main task of the\u00a0Public Health Service\u00a0<\/b>(PHS). The PHS is a principal part of the\u00a0Department of Health and Human Services\u00a0<\/b>(HHS) and the major health agency of the Federal Government. The PHS has about 5,700 Commissioned Corps officers and 51,000 Civil Service employees. Its budget in 1993 was approximately 17 billion dollars.\r\n\r\nIn order to fulfill its very broad mission of promoting health in our nation and the world, the PHS has designed programs and created agencies which help control and prevent diseases; conduct and fund biomedical research that will eventually lead to better treatment and prevention of diseases; protect us against unsafe food, drugs, and medical devices; improve mental health and deal with drug and alcohol abuse; expand health resources; and, provide health care to people in medically underserved areas and to those with special needs.\r\n\r\nThe eight major agencies that make up the PHS and that do this work are the\u00a0Centers for Disease Control and Prevention (CDC),\u00a0<\/b>the\u00a0Agency for Toxic Substances and Disease Registry (ATSDR),\u00a0<\/b>the\u00a0National Institutes of Health (NIH), the Food and Drug Administration (FDA),\u00a0<\/b>the\u00a0Substance Abuse and Mental Health Services Administration (SAMHSA),\u00a0<\/b>the\u00a0Health Resources and Services Administration (URSA),\u00a0<\/b>the\u00a0Agency for Health Care Policy and Research (AUCPR),\u00a0<\/b>and the\u00a0Indian Health Service (IHS).<\/b>\r\n\r\nThe\u00a0Assistant Secretary for Health<\/b>, with the assistance of the\u00a0Surgeon General<\/b>, heads the PHS, advises the HHS Secretary on health and health-related matters, and directs the activities of the major PHS agencies. Located in the\u00a0Office of the Assistant Secretary for Health (OASH)<\/b>\u00a0are other important programs such as the\u00a0National AIDS Program Office,<\/b>\u00a0the\u00a0Office of International Health,\u00a0<\/b>and the\u00a0President's Council on Physical Fitness and Sports<\/b>.\r\n\r\nThis\u00a0is the history of the\u00a0Marine Hospital Service\u00a0<\/b>(1798-1902), the\u00a0Public Health and Marine Hospital Service<\/b>\u00a0(1902-1912), and the\u00a0Public Health Service\u00a0<\/b>(1912-present).\r\n\r\nThe\u00a0PHS<\/b>\u00a0grew out of a need for healthy seamen in our infant republic, which relied so much on the sea for trade and security. These seamen traveled widely, often became sick at sea, and then, away from their homes and families, could not find adequate health care in the port cities they visited or would overburden the meager public hospitals then in existence. Since they came from all the new states and former colonies, and could get sick anywhere, their health care became a national or Federal problem. A loose network of marine hospitals, mainly in port cities, was established by Congress in 1798 to care for these sick and disabled seamen, and was called the Marine Hospital Service (MHS).\r\n\r\nThe Federal Government had only three executive departments then to administer all Federal programs -- State, Treasury, and War. The MHS was placed under the Revenue Marine Division of the Treasury Department. Funds to pay physicians and build marine hospitals were appropriated by taxing American seamen 20 cents a month. This was one of the first direct taxes enacted by the new republic and the first medical insurance program in the United States. The monies were collected from ship masters by the customs collectors in different U.S. ports.\r\n\r\nThe President was granted the authority to appoint the directors of these hospitals, but later allowed the customs collectors to do it. The appointments thus became influenced by local politics and practices. Often times hospitals were built to meet political rather than medical needs. Each hospital was managed independently and the Treasury Department had no supervisory mechanism to centralize or coordinate their activity. For example, the report of a Congressional commission formed to investigate the MHS stated in 1851 that the \"hospital at Mobile is as distinct and different from that at Norfolk or New Orleans as if it were a hotel and the other a hospital...\"\r\n\r\nLack of money, in addition to the lack of any supervisory authority, was another major problem for the MHS. The demand for medical services far exceeded the funds available. For that reason sailors with chronic or incurable conditions were excluded from the hospitals and a four-month limit was placed on hospital care for the rest. Additional funds had to be appropriated constantly from Congress in order to maintain the Service and to build the hospitals. Because of these problems Congress was forced to act and in 1870 reorganized the MUS from a loose network of locally-controlled hospitals to a centrally-controlled national agency with its own administrative staff, administration and headquarters in Washington, D.C.\r\n\r\nThrough this reorganization, the MHS became a separate bureau of the Treasury Department under the supervision of the Supervising Surgeon, who was appointed by the Secretary of the Treasury. The title of the central administrator was changed to Supervising Surgeon General in 1875 and to Surgeon General in 1902. Additional money to fund the reorganized Service was appropriated by raising the hospital tax on seamen from twenty to forty cents per month. The money collected was deposited in a separate MHS fund.\r\n\r\nTaxing seamen to fund the MHS was abolished in 1884. From 1884 to 1906 the cost of maintaining the marine hospitals was paid from the proceeds of a tonnage tax on vessels entering the United States, and from 1906 to 1981, when the Public Health Service hospitals were closed, by direct appropriations from Congress.\r\n\r\nThe 1870 reorganization also changed the general character of the Service. It became national in scope and military in outlook and organization. Medical officers, called surgeons, were required to pass entrance examinations and wear uniforms. In 1889, when the Commissioned Corps was formally recognized by legislative action, the medical officers were given titles and pay corresponding to Army and Navy grades. Physicians who passed the examinations were appointed to the general service, rather than to a particular hospital, and were assigned wherever needed. The goal was to create a professional, mobile, health corps, free as possible from political favoritism and patronage, and able to deal with the new health needs of a rapidly growing and industrializing nation.\r\n\r\nEpidemics of contagious diseases, such as small pox, yellow fever, and cholera, had devastating effects throughout the 19th century. They killed many people, spread panic and fear, disrupted government, and caused Congress to enact laws to stop their importation and spread. As a result of these new laws, the functions of the MHS were expanded greatly beyond the medical relief of the sick seamen to include the supervision of national quarantine (ship inspection and disinfection), the medical inspection of immigrants, the prevention of interstate spread of disease, and general investigations in the field of public health, such as that of yellow fever epidemics.\r\n\r\nTo help diagnose infectious diseases among passengers of incoming ships, the MUS established in 1887 a small bacteriology laboratory, called the Hygienic Laboratory, at the marine hospital on Staten Island, New York. That laboratory later moved to Washington, D.C., and became the National Institutes of Health, the largest biomedical research organization in the world.\r\n\r\nTo better consolidate these increased functions of the MHS, including medical research, and give them legal powers, Congress passed an act in 1902 which expanded the scientific research work at the Hygienic Laboratory and gave it a definite budget. The bill also required the Surgeon General to organize annual conferences of local and national health officials in order to coordinate better state and national public health activities, and changed the name of the MHS to the\u00a0Public Health and Marine Hospital Services (PHMHS<\/b>) to reflect its broader scope.\r\n\r\nThe PHMHS was not the only government agency engaged in health-related work. The enforcement of the pure food and drugs law, passed in 1906, was placed in the hands of the\u00a0Bureau of Chemistry\u00a0<\/b>of the\u00a0Department of Agriculture<\/b>. The Federal inspection of meats entering interstate commerce, also mandated by law in 1906, was done by the\u00a0Bureau of Animal Industry\u00a0<\/b>of the\u00a0Department of Agriculture.\u00a0<\/b>The\u00a0Bureau of the Census<\/b>\u00a0was authorized in 1902 to collect vital statistics -- data relating to health and disease from around the country.\r\n\r\nEfforts were made during the early decades of the 20th century by both political parties and by people inside and outside of government concerned with the nation's health to combine public health-related work being done by various Federal agencies, but they were unsuccessful in Congress. The act of\u00a0August 14, 1912\u00a0<\/b>changed the name of the PHMHS to the\u00a0Public Health Service<\/b>\u00a0and further broadened its powers by authorizing investigations into human diseases (such as, tuberculosis, hookworm, malaria, and leprosy), sanitation, water supplies and sewage disposal, but went no further.\r\n\r\nReal consolidation began in June 1939, when the PHS was transferred by President Franklin D. Roosevelt to the newly created\u00a0Federal Security Agency (FSA<\/b>), which combined a number of New Deal government agencies and services related to health, education, and welfare. Over 140 years of association between the PHS and the Treasury Department came to an end. All of the laws affecting the functions of the services were also consolidated for the first time in the Public Health Services Act of 1944.\r\n\r\nThe FSA was a noncabinet-level agency whose programs grew to such size and scope that, in 1953, President Eisenhower submitted a reorganization plan to Congress which called for the dissolution of the FSA and the transfer of all its responsibilities to a newly created\u00a0Department of Health, Education, and Welfare (HEW<\/b>). A major objective of this reorganization was to ensure that the important areas of health, education, and social security be represented in the President's cabinet. In 1979, HEW's educational tasks were transferred to the new\u00a0Department of Education<\/b>\u00a0and the remaining divisions of HEW were reorganized as the\u00a0Department of Health and Human Services (HHS).<\/b>\r\n\r\nThroughout all of these reorganizations which have shaped, defined, and established the PHS in its present place in the Federal Government, and which have spanned nearly two centuries, the PHS has never lost sight of its primary goal -- providing health care for those with special needs. From the care of sick and disabled sailors the PHS has extended its activities to other groups with special needs (such as, the American Indians, the Alaska Natives, migrant workers, Federal prisoners, and refugees), and to the nation as a whole.\r\n\r\nThe duties and functions of the PHS have expanded to include disease control and prevention, biomedical research, regulation of food and drugs, mental health and drug abuse, health care delivery, and international health. These six themes provide the organizational structure for the images of the PHS that follow.\r\n

https:\/\/www.nlm.nih.gov\/exhibition\/phs_history\/intro.html<\/a><\/p>\r\n\r\n

Historical Timeline of Public Health 1776 - 1900<\/h3>\r\n
\r\n
\r\n
Disease Control and Prevention<\/h5>\r\n1776 - Pension Act<\/b>\r\n\r\ngave (first disabilities act) gave benefits to Revolutionary War soldiers and veterans\r\n
Health Care for Seamen<\/h5>\r\nTo show the new nation's concern that a healthy merchant marine was necessary for economic prosperity and a strong national defense, President John Adams signed into law in 1798 an act which furnished medical relief to merchant seamen.\r\n\r\nA monthly deduction from the seamen's wage was used by the Federal Government to provide medical services for the seamen in existing hospitals or to build new hospitals.\r\n\r\nThe first marine hospitals were established in the port cities along the East Coast. As trade expanded along the inland waterways and the Great Lakes, the marine hospitals followed. One was erected even in Hawaii. The major function of the Marine Hospital Service until the 1870s remained the care of sick seamen. But after 1878 its functions were expanded greatly.\r\n\r\n
\r\n\r\nCastle Island in Boston Harbor was chosen as the temporary site for the first marine hospital. Dr. Thomas Welsh, a Harvard College graduate (1772) and participant in the Revolutionary War battles of both Lexington and Bunker Hill, was appointed as the physician in charge in 1799.\r\n

c. 1800<\/h4>\r\nA more permanent home for the Boston Marine Hospital was found in 1804 in the Charlestown section of Boston. The rules and orders for this establishment were printed in April, 1808 and signed by Dr. Benjamin Waterhouse, who was the physician in charge from 1807-1809.\r\n

1808<\/h4>\r\nDr. Benjamin Waterhouse (1754-1846) introduced into the United States in 1800 the technique of smallpox vaccination discovered in England by Dr. Edward Jenner. Smallpox was one of the most dreaded epidemic diseases in America during the 17th and 18th centuries.\r\n

c. 1800<\/h4>\r\nThe first marine hospital owned by the Federal Government was purchased from the State of Virginia in 1801 and was located at Washington Point in Norfolk County. The hospital had been erected by the state of Virginia for use by merchant seamen. Following the Civil War, this facility was no longer used as a hospital. The building was demolished in 1933. Other early marine hospitals were established in the port cities of Boston, Massachusetts; Newport Rhode Island; and Charleston, South Carolina.\r\n

c. 1860<\/h4>\r\nThe Marine Hospital Fund was reorganized into the Marine Hospital Service, the precursor to the Public Health Service Commissioned Corps\r\n

1871<\/h4>\r\nThe first\u00a0supervising surgeon general was named.\r\n

1873<\/h4>\r\nNational Quarantine Act passed, regulated by Marine Hospital Service.\r\n

1878<\/h4>\r\nMedical examination of immigrants was mandated\u00a0by the Immigration Act: the law excluded \"all idiots, insane persons, paupers or persons likely to become public charges, persons suffering from a loathsome or dangerous contagious disease\u201c (and also criminals).\r\n

1891<\/h4>\r\nThe first US school of public health and preventive medicine was established.\r\n

1893<\/h4>\r\n

Historical Timeline of Public Health - Twentieth Century<\/h3>\r\n
\r\n\r\n1910<\/b>\u00a0- Tuberculosis epidemic leads the\u00a0PHS into the arena of workplace health and safety.\r\n\r\n1916\u00a0<\/b>- Rockefeller Foundation grants opening of\u00a0Johns Hopkins University School of Public Health\r\n\r\n1920<\/b>\u00a0= Ambulances and other vehicles parked by the San Francisco Public Health Service Hospital. The first marine hospital in San Francisco was completed in 1853 with special funds appropriated by Congress. The tax on seamen was not enough to finance all of the activities of the Marine Hospital Service and supplemental funds had to be appropriated constantly from Congress. The 1870 reorganization act that centralized the control of the Service increased the hospital tax on seamen from 20 cents to 40 cents per month. The tax on seamen was abolished in 1884 and from 1884 to 1906 the cost of maintaining the marine hospitals was paid out of a tonnage tax. After 1906 and until all of the Public Health Service hospitals were closed in 1981 medical care for merchant seamen and other beneficiaries was supported by direct appropriations from Congress.\r\n
<\/h5>\r\n1921<\/b>\u00a0- Ambulatory patients in a cafeteria food line at Galveston's Public Health Service Hospital. This hospital in Galveston, Texas, was completed in 1931 as part of a major Public Health Service hospital building program begun in the late 1920s and completed about 1940.\r\n\r\n1932<\/b>\u00a0- The Bureau of Indian Affairs Health Division was established.\r\n\r\n1935<\/b>\u00a0- Dental clinic at the New Orleans Public Health Service Hospital. When the Marine Hospital Service became the Public Health Service in 1912 the names of the marine hospitals were changed to Public Health Service hospitals. The hospital housing this clinic was built in 1931. But the presence of a United States marine hospital in New Orleans, Louisiana, dates back to the early years of the 19th century. Congress authorized such a hospital in 1802 while the port was still under foreign rule. Starting in 1919 dental officers were added to Public Health Service hospitals and dispensaries filling a long recognized need.\r\n
<\/h5>\r\n

\"Image<\/a><\/p>\r\n\u00a01935 - 40<\/b>\u00a0 - Social Security Act and the Federal Food, Drug and Cosmetic Act.\r\n

1946<\/b>\u00a0- Communicable Disease Center established for the control of malaria, use of DDT as pesticide. It was the former Malaria\u00a0Control in War Areas (MCWA) agency and began to monitor diseases and maintain\u00a0health statistics for\u00a0prevention and control.<\/h5>\r\n

1953<\/b>\u00a0- The Department of Health, Education and Welfare was created.<\/h4>\r\n

1955<\/b>\u00a0 - The polio vaccine was invented.<\/h4>\r\n

1961<\/b>\u00a0- Migrant Health Act was enacted.<\/h4>\r\n

1964<\/b>\u00a0- Surgeon General's Report on Smoking was released.<\/h4>\r\n

1965<\/b>\u00a0- Medicare and Medicaid signed into law by President Johnson.<\/h4>\r\n

1968<\/b>\u00a0- The Older Americans Act was enacted.<\/h4>\r\n

1970<\/b>\u00a0- The National Health Service Corps was created.<\/h4>\r\n

1977<\/b>\u00a0- Smallpox was eradicated worldwide.<\/h4>\r\n

1981\u00a0<\/b>- AIDS was identified.<\/h4>\r\n

1984 -<\/b>\u00a0HIV isolated as cause of AIDS<\/h4>\r\n

1985<\/b>\u00a0- HIV blood test available<\/h4>\r\n

1980s = National Organ Transplantation Act<\/h4>\r\n
    \r\n \t
  • McKinney Act to provide health care for the homeless<\/li>\r\n \t
  • Agency for Health Care Policy and Research created<\/li>\r\n<\/ul>\r\n

    1990s -<\/h4>\r\n
      \r\n \t
    • \r\n
      Human Genome Project<\/div><\/li>\r\n \t
    • Nutrition Labeling and Education Act<\/li>\r\n \t
    • Health Insurance Portability and Accountability Act (HIPAA)<\/li>\r\n \t
    • State Children's Health Insurance Program (SCHIP)<\/li>\r\n<\/ul>\r\n

      2000 - 2010<\/h4>\r\n
        \r\n \t
      • American Recovery and Reinvestment Act (ARRA) of 2009 includes the HITECH stimulus opportunity.<\/li>\r\n<\/ul>\r\n
          \r\n \t
        • \u2022Human genome sequencing published<\/li>\r\n \t
        • HHS responds to anthrax bioterrorism attack<\/li>\r\n \t
        • creation of Office of Public Health Emergency Preparedness<\/li>\r\n \t
        • Medicare Prescription Drug Improvement and Modernization Act of 2003 expands Medicare<\/li>\r\n<\/ul>\r\n

          2010<\/b>\u00a0- President Barack Obama signs into law the Portability and Access to Care Act (ACA)<\/h4>\r\n

          Resources and References<\/h3>\r\n

          View video<\/h5>\r\n
          \r\n
          \r\n