Module Components

• Overview

Topics

• Definitions
• Case Study
• Structure and Financing
• U.S. Public Health System

Nurs 467 - Public Health Nursing

Module 5: Healthcare Delivery

U.S. Public Health System

Basics

The US public health system coordinates the three core functions of public health (assessment, assurance and policy development) in order to protect, promote and ensure the good health of the entire US population. It is headed by the Department of Health and Human Services (DHHS) in the federal government, and also includes state and local level agencies.

National Level

The Department of Health and Human Services is led by the Secretary of Health. Our current acting Secretary of Health is Xavier Becerra. The department houses over 80,000 employees and receives 1 out of every 4 federal dollars. You will find numerous agencies within DHHS, including:

• Agency for Healthcare Research and Quality (AHRQ)
• Agency for Toxic Substances and Disease Registry
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare and Medicaid Services (CMS)
• Federal Drug Administration (FDA)
• Health Resources and Services Administration
• Indian Health Service
• National Institutes of Health (NIH)
• Substance Abuse and Mental Health Services Administration

DHHS is also responsible for our Healthy People national prevention initiative. The most recent iteration is called Healthy People 2020, which is the 4th version. The initiative lays out national goals related to 12 “leading health indicators” that cover 42 topic areas. Review the goals and indicators for Healthy People 2030.

Other agencies besides DHHS contribute to public health at the national level. For example, the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) play major roles in public health by using federal dollars to do things like regulate environmental hazards and inspect worksites for safety.

For example, employees of Solvay USA Inc. in Curtis Bay, who work with potentially dangerous chemicals and substances every day, are protected from many harms by OSHA regulations.

Watch a short video on the History of OSHA.

The DHHS and other federal agencies work to fulfill the three core functions in many ways, including:

• Assessment – Vital Statistics data, Census data, CDC houses lots of epidemiological data
• Assurance – ensuring quality health care (AHRQ); regulating healthcare (FDA, OSHA, CMS); improving access to care (Federally Qualified Health Centers, Veteran’s Administration); providing resources to healthcare personnel (training grants, National Health Service Corps)
• Policy Development – ACA (2010); Social Security Act (1935); Asthma Legislation and Policy

State Level

The State Health Department is the principal agency for public health services in each state. The range of authority over health issues varies from state to state. State health departments often manage and administer programs such as Women, Infants and Children (WIC) and the state Children’s Health Insurance Program (CHIP).

Local Level

County and city health departments take on more of the day-to-day operations related to public health. These agencies have direct responsibilities to the citizens in that community or jurisdiction. Available services depend on the health codes of the state or county, the needs of the community and the availability of funding/resources from state or federal governments.

View Baltimore City Health Department services available in Curtis Bay. Choose different services on the pull down list to see what specifically is available. Hint – there is only ONE service in Curtis Bay, can you figure out what it is?

Now view an interactive map of Baltimore City that shows information on health insurance coverage as well as locations of hospitals and Federally Qualified Health Centers (FQHC). Zoom in on Curtis Bay. We just saw that Curtis Bay has no clinics operated by the Baltimore City Health Department, but note that there are two FQHCs nearby.

FQHCs are community-based clinics (not operated by a local or state health department) that meet specific requirements in order to receive special reimbursement from Medicare and Medicaid. Some of the requirements are: operate in underserved community, offer comprehensive services and offer sliding fee scale.

Community/public health nurses provide direct services most often at the local level.

Please view the video depicting a public health nurse, Marguerite, providing care at the local level. Marguerite works for the Baltimore City Health Department conducting home visits to families of children with asthma. Marguerite is visiting Constance, who lives in Curtis Bay with her grandson Andrew. Andrew has asthma and Constance struggles to keep up with the care needed to keep him healthy. Marguerite has visited this family before and knows some of the challenges that they face. She is about to learn more.