MZC1© 2005 by Lippincott Williams & Wilkins Unit I: Foundations of Community Health Chapter 6 Structure and Function of CHN Services

MZC2© 2005 by Lippincott Williams & Wilkins Objectives: Upon mastery of this chapter, you should be able to: Trace historic events and philosophical developments leading to today’s health services delivery systems. Outline the current organizational structure of the public health care system. Examine the three core functions of public health as they apply to health services delivery.

MZC3© 2005 by Lippincott Williams & Wilkins Objectives: Differentiate between the functions of public versus private sector health care agencies. Explain the influence of selected legislative acts in the United States on shaping current health services policy and practice. Examine the public health services provided by selected international health organizations. Explore how the structure and functions of community health services affect community health nursing practice.

MZC4© 2005 by Lippincott Williams & Wilkins Historic Events 1500 BC Hebrew hygienic code: personal and community sanitation 1000 to 400 BC Athenians added personal hygiene, diet, and exercise Romans added environmental sanitation laws, aqueducts, & sub-surface drainage Quarantine established in Middle Ages British laws laid foundation for American sanitary ordinances

MZC5© 2005 by Lippincott Williams & Wilkins Philosophical Developments Middle Ages: Body was thought evil leading to neglect of sanitation & development of epidemics 1800s: Development of view of public health responsibility at community level Understanding of the relationship between living conditions and health (Table 6-1 p. 109) Need for systems to address community issues (Table 6-2 p. 110)

MZC6© 2005 by Lippincott Williams & Wilkins Reports & Developments Influencing Health Policy 1842: Chadwick (Sanitation) 1855: Snow (Cholera) 1850: Shattuck (Boards of Health) Official Agencies Voluntary Agencies Health Related Professional Associations

MZC7© 2005 by Lippincott Williams & Wilkins Organizational Structure of Public Health Care Public Sector Health Services (Figure 6-3 p. 116) FederalFederal HHS: Public Health Service CDC, FDA, NIH, SAMHSA, HRSA, ATSDRCDCFDANIHSAMHSAHRSAATSDR State: Varies from State to State Local: See Figure 6-2 p. 114 for example

MZC8© 2005 by Lippincott Williams & Wilkins Three Core Functions and Health Care Delivery Assessment: measuring and monitoring the health status and needs of a designated community or population Policy Development: formation of a guide for action that determines present and future decisions affecting the public’s health Assurance: the process of translating established policies into services

MZC9© 2005 by Lippincott Williams & Wilkins Public vs. Private Sector Health Services Delivery Public: Government Focus on Core Public Health Functions Supported by tax revenues & mandated by laws Require community- wide action Record keeping Research, coordination, collaboration with other agencies Private Non-governmental and Voluntary Agencies Non-profit or Proprietary Private Professional Healthcare Practice Address special group needs Philanthropically supported

MZC10© 2005 by Lippincott Williams & Wilkins Functions of Private-sector Health Agencies Detecting unserved needs or exploring better methods for meeting needs already addressed Piloting or subsidizing demonstration projects Promoting public knowledge Assisting official agencies with innovative programs not otherwise possible

MZC11© 2005 by Lippincott Williams & Wilkins Functions of Private-sector Health Agencies Evaluating official programs and assuming a public advocacy role Promoting health legislation Planning and coordinating to promote collaboration among voluntary services and between voluntary and official agencies Developing well-balanced community health programs that seek to make services relevant and comprehensive

MZC12© 2005 by Lippincott Williams & Wilkins Selected Legislative Acts Shaping Health Policy The Shepard-Towner Act of 1921 The Social Security Act of 1935 The Hill-Burton Act (Hospital Survey and Construction Act) of 1946 The Maternal and Child Health and Mental Retardation Planning Amendments of 1963 The Heart Disease, Cancer, and Stroke Amendments of 1965 (Pub L No. 89–239)

MZC13© 2005 by Lippincott Williams & Wilkins Selected Legislative Acts Shaping Health Policy The Social Security Act Amendments of 1965 (Pub L No. 89–97) The Comprehensive Health Planning and Public Health Service Amendments Act (Partnership for Health Act) of 1966 (Pub L No. 89–749) The Health Manpower Act of 1968 (Pub L No. 90–490) The Occupational Safety and Health Act of 1970 (Pub L No. 91–956)

MZC14© 2005 by Lippincott Williams & Wilkins Selected Legislative Acts Shaping Health Policy The Professional Standards Review Organization Amendment to the Social Security Act of 1972 (Pub L No. 92–603) The Health Maintenance Organization Act of 1973 (Pub L No. 93–222) The National Health Planning and Resource Development Act of 1974 (Pub L No. 93– 641) The National Center for Health Statistics (Pub L No. 93–353)

MZC15© 2005 by Lippincott Williams & Wilkins Selected Legislative Acts Shaping Health Policy The Omnibus Budget Reconciliation Act of 1981 (Pub L No. 97–35) The Social Security Amendments of 1983 (Pub L No. 98–21) The Consolidated Omnibus Budget Reconciliation Act of 1985 Omnibus Budget Reconciliation Act Expansion of 1986 The Medicare Catastrophic Coverage Act of 1988 (Pub L No. 100–360)

MZC16© 2005 by Lippincott Williams & Wilkins Selected Legislative Acts Shaping Health Policy The Family Support Act of 1988 The Health Objectives Planning Act of 1990 (Pub L No. 101–582) Preventive Health Amendments of 1992 Personal Responsibility and Work Opportunity Reconciliation Act of 1996 Nurse Reinvestment Act of 2002

MZC17© 2005 by Lippincott Williams & Wilkins Services of International Health Organizations World Health Organization World Health Organization (WHO) Pan American Health Organization Pan American Health Organization (PAHO) United Nations International Children’s Emergency Fund United Nations International Children’s Emergency Fund (UNICEF) United States Agency for International Development United States Agency for International Development (USAID) Other Agencies (p. 121)

MZC18© 2005 by Lippincott Williams & Wilkins How CHS Structure and Functions Affect CHN Practice Public: Three Core Functions Assessment Assess the health needs of aggregates Collect data on health and safety hazards in the community Determine unmet community health needs Identify available health resources

MZC19© 2005 by Lippincott Williams & Wilkins How CHS Structure and Functions Affect CHN Practice Public: Three Core Functions Policy Development Incorporate community values and input in agency policy formation Formulate plans and policies that address community health needs Advocate for the health of the public and promote interprofessional collaboration

MZC20© 2005 by Lippincott Williams & Wilkins How CHS Structure and Functions Affect CHN Practice Public: Three Core Functions Assurance Translate intent of agency policies into needed services Assure access to services by community members Implement and provide services through programs Participate in Joint Efforts of Public and Private Agencies Participate in International Efforts

MZC21© 2005 by Lippincott Williams & Wilkins Additional Internet Resources American Nurses Association: power power CARE: National Center for Health Statistics: Population Reference Bureau: