use healthcare delivery in the united states.

1) On the most part the Federal authority to carry out public health initiatives comes from the Department of Health and Human Services (DHHS). DHHS essentially has two major divisions, health activities and human service activities. As such, DHHS is compromised of sub-agencies that do not interact well and have different constituencies. DHHS activities include (among others) sponsoring research, formulating policies and objectives and documenting health status (refer to handout link for leading causes of death).

The major portion of Federal activities, however, are through grants and contracts to states, local municipalities, and private organizations. States carry out public health protection through what Kovner describes as ‘police powers’….meaning power to enact and enforce laws to protect the public. State health departments are more tightly organized than the Feds. State activities include the collection and processing of statistics, education regarding matters of health importance to the public i.e. smoking cessation, and licensure, etc.

Local municipalities are responsible for vital statistics, communicable disease control, and environmental sanitation, etc. As Kovner points out, the biggest problem is that responsibility for directly carrying out public health activities are the ones that have the least ability to generate financial resources to do so. In other words, the Feds establish the national policies whereas the responsibilities to carry out those policies are often left to the state or worse yet the locals. And as we know, both state and local governments are perennially in the funding hole.

The Preliminary Data for 2010 report provides the reader with a good overview of mortality in the US. On page 6, the report contains numbers of death for 2010 and percentages by ethnicity. Note that black males and females show a decrease (similar to 2009 stats). Page 8-9 lists the 15 leading causes of death with heart disease still ranking number 1. Note the standing of diabetes as the seventh leading cause of death. On page 10, the report looks at infant mortality. The rate is currently 6.14 (down slightly from 2009). Note that black infant mortality is 11.61 deaths per 1000. Despite the decrease from the previous year the rate is still very high compared to white infants at 5.19 deaths per 1000 (down slightly from previous year). At the end of the report, there are a number of tables and charts providing the reader with quick overview.

The RWJ document, Beyond Health Care: New Directions to a Healthier America, provide the reader with a critical look at the health status of Americans. It contends that the US is losing ground despite the huge amounts of money we spend on health care. Even unlikely countries such as Korea, Czech, and Hungry are beating us when it comes to infant mortality (US ranked 18th). The report observes that social factors and not direct health care services have a profound effect on who is healthy and who is not.

The Health Affairs article, Americans Conflicting Views about the Public Health System analyzes the paradoxical opinions of Americans when it comes to our public health system. In some ways, Americans want to see increased funding but are reluctant to increase the funding on a Federal level. In the political arena, the differences of how public health should be funded runs along party lines.

The Institute of Medicine (IOM) report, For the Public’s Health: The Role of Measurement in Action and Accountability offers the reader suggestions on how health status should be quantified to provide a roadmap to healthier individuals and communities. The report recommends a standardized core measurement for outcome indicators that provide accurate comparisons on a national, state, and local level. It also recommends a broad measurement tool to look at health similar to GDP that is widely recognized when measuring our economy.

The question that I would like you to explore, is our current public health system effective in improving the health status of Americans?

2) Whether it is H1N1, an anthrax scare or a natural disaster such as an earthquake, all are frequent examples of what could potentially be harmful to the public. The RWJ report, Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism and the article, Emergency Preparedness examines the preparedness of our public health system. Such occurrences can no longer be considered something only witnessed in a science fiction movie, yet the report observes that funding for such scenarios are facing major cuts. Deficits in trained personnel, research and development, capacity to respond, and surveillance may be cause for concern.

In your opinion, could we effectively respond to a pandemic, terrorism or natural disaster?