Participants in Public Health Kristine M. Gebbie, DrPH, RN Columbia University School of Nursing Center for Health Policy 630 West 168 th Street, Mail Box 6 New York, NY (212)

Developed as part of an Enhanced AHEC Community Partnership for Health Professions Workforce and Educational Reform project funded by the Health Resource and Service Administration (HRSA)

OBJECTIVES l List key infrastructure components

Official and Voluntary Public Health Sectors l Official agencies assigned specific responsibilities for a geo-political unit or programmatic area l Private not-for-profit voluntary agencies with commitment to a particular issue or population l Public and private providers of personal care

Federal Public Health Agencies l The US has no Cabinet Secretary of Health, unlike most other countries l Almost every federal agency has some responsibility that impacts the health of the public

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Federal Agencies Continued l Environmental Protection Agency l US Department of Agriculture l Department of Labor - Occupational Safety and Health Administration l Department of Veterans Affairs l Department of Transportation

Federal Agencies Continued l Department of Defense l Housing and Urban Development l White House s Office of Management & Budget s Office of Drug Control Policy s Office of AIDS Policy

State Public Health Agencies l State public health agency (dept of health, dept of public health) l Umbrella human services agency l Agency on aging (often includes long term care planning/licensing) l Medicaid l Mental health agency

State Agencies Continued l Substance abuse agency l Environment (water, air, soil quality; waste disposal) l Agriculture (food, dairy, pesticides) l State-OSHA l Health planning agency l Health professions licensing bodies

Did you know that... l South Carolina’s first public health employee was Dr. Fred Williams, in 1908? l The Department of Health and Environmental Control was created in 1973?

Local and Community Public Health l County, city or district health departments l County, city or district mental health, substance abuse or environmental agency l Special taxing districts for public hospitals, home health, environmental control or public health l Local zoning authority

Did you know that... l Orangeburg and Greenwood counties established the first county health departments in the state, in 1915, to combat hookworm? l Every county had a health department by 1936? l County health staff were transferred to the state payroll in 1981?

Voluntary Associations l Disease- or issue-specific organizations l Advocacy groups l Professional and industrial organizations l Coalitions with health as only or major topic

Hospitals and Other Care Systems l Access to care is an essential public health service l Health-department-operated hospital, personal care program, or strong relationship with the local provider systems

Other Care Systems Continued l The structure of public health services varies over time and place depending on size and composition of uninsured population and economics and attitudes of care systems l Care systems may join population- focused activities for a variety of reasons

Discussion Time l Identify the components of the public health system serving your community l Be sure to include non-governmental participants

Summary l US public health services may be comprised of federal, state and local governmental agencies, not-for-profit organizations, hospitals and other health care providers, and voluntary associations l The exact structure of the system varies by issue and over time