Overview of the Public Health System: Implications for UH ...



Overview of the Public Health System: Implications for UH Planning

Phyllis Gingiss, Dr.P.H.

I. Terminology

Health care, both public and private, can be thought of as direct treatment services provided to individuals, while public health is population-based services that are geared toward protecting the health of the public as a whole (TDH, 2002).

II. Public Health – National Perspectives

Vision: Healthy People in Healthy Communities

Mission: Promote physical and mental health and prevent disease, injury and disability

Overarching Goals: 1) Increase quality and years of healthy life and 2) Eliminate health disparities

Healthy People 2010 includes national health promotion and disease prevention goals. The two goals are supported by 467 objectives in 23 focus areas (see attachment). Each objective contains background information and measures.

Healthy People 2010 also identifies a smaller set of health priorities that reflect 10 major public health concerns in the U.S. These 10 topics highlight individual behaviors as well as related organizational, economic, policy and environmental factors that greatly affect the health of individuals and communities (see attachment).

Healthy Communities, based on Healthy People 2010, is focused on improving quality of life of people in the community.

“A healthy community is one that embraces the belief that health is more than merely an absence of disease: a healthy community includes those elements that enable people to maintain a high quality of life and productivity. For example, a healthy community:

• Offers access to health services that focus on both treatment and prevention for all members of the community

• Is safe

• Has an infrastructure (e.g. roads, schools, playgrounds, and other services) to meet the needs of people in that community.

• Has a healthy and safe environment

II. Public Health: State Perspectives

A. U.S./Texas Essential Public Health Services

In 1999 Texas became the first state to codify into law ten essential public health services to provide a working definition for local public health systems. This listing was originally created by a U.S. Centers for Disease Control and Prevention steering committee, working with representatives of U.S. Public Health Service agencies and other major national public health organizations.

• Monitor the health status of the community.

• Investigate and diagnose health problems and hazards.

• Inform and educate people regarding health issues.

• Mobilize partnerships to solve community problems.

• Support policies and plans to achieve health goals.

• Enforce laws and regulations to protect health and safety.

• Link people to needed personal health services.

• Ensure a skilled, competent public and personal health care workforce.

• Evaluate effectiveness, accessibility and quality of health services.

• Research and apply innovative solutions to health problems.

B. Leading causes of premature death and disease in Texas

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C. Texas Tobacco Prevention and Control Initiative: A model of how national, state and local researchers and community contractors work together. Lessons learned for application to obesity prevention and control and other health focuses.

III. Factors influencing changes in the PHS – Implications for the Future

Emerging trends which influence health professionals involved with the public health system and institutional private and non-for-profit settings, as well as academic institutions preparing professionals, include: 1) a rapid growth of managed care, 2) system integration and mergers – including increasing emphasis on regionalization, 3) a shift from inpatient to outpatient care, 4) constrained resources, 5) workforce modifications such as downsizing and multi-skilling, 6) outcomes and accountability driven, 7) a focus on primary and preventive care, 8) a focus on the patient and family, and 9) increases in "community" responsibility for the health of residents (Pew Commission, 1995). These factors influence both the scope and nature of the health care delivery system and the competencies which are required to address them.

A. Limitations exist in health professions’ capacities to respond to these changes. Multiple factors influencing these limitations include:

• An expanding aging population which will require increasingly intensive resources

• Dramatic shortages in skilled workforces in the next 15-20 years.

• Technical skills gaps

• Diversity disparities, both in health consumers and providers

• Competence of providers is often inadequate, with only 20% of the public health professionals projected to have sufficient education and training to do their jobs effectively

• Collaborative efforts across professional disciplines are increasingly required due to workforce shortages in the health care system and fiscal constraints

B. Major national and state policy papers and manpower studies indicate:

• Enormous projected shortages of skilled health professionals. For example, a recent AMA survey of 3,000 hospitals in the American Hospital Association found that 90% had a shortage of allied health professionals. Problems span a wide range of health professions and occupations.

• Skills for practice have been identified that are needed in the 21st Century*. These skills cross professions.

|Care for the community's health |Practice prevention |

|Expand access to effective care |Involve patients and family in decision-making |

|Provide contemporary clinical care | |

|Emphasize primary care |Promote healthy lifestyles |

|Participate in coordinated care |Use technology appropriately |

|Ensure cost-effective care |Improve the health care system |

|Manage information |Continue to learn |

|Understand the role of the physical environment |Accommodate expanded accountability |

| |Participate in racially and culturally-diverse society |

|Provide counseling on ethical issues |*Pew Commission Competencies for the 21st Century |

• Over half of 2 million deaths in the US annually are estimated to be preventable through increased preparation of health professionals who are able to bring these skills to their roles as administrators, patient educators, health promotion specialists, researchers and health care providers – greatly impacting cost to US, state and local economies as well as individuals and their families.

• Health professionals prepared to conduct and disseminate research are increasingly essential to ensure that evidence-based, effective programs and practices are developed and tested, cost-effective, fully implemented, and adequately evaluated.

• In Texas, numerous areas exist of inadequate or nonexistent health care, even while health services has been identified as one of Texas’ fastest growing industries

• Individuals with doctoral degrees will be increasingly needed across health professions to provide leadership for the education, training and research needed to prepare the health workforce for skills needed for practice.

IV. Planning models

A. Research

• Community-centered.

• Community-based

• High risk populations

• Behavioral, physical, social, and environmental factors

• Specific health problems

• Surveillance and monitoring systems

• Health policy

• Health systems issues

• Others

B. Education and Training

• Foster sufficient future health manpower availability at all levels of the public health system across professions through education and training programs

• Provide training for current practitioners to upgrade skills needed for practice in present and future environments

• Examine alternatives for integrating educational experiences across academic programs to ensure all future health professionals have competencies needed for practice in the 21st century.

• Ensure that the public health workforce of the 21st century reflects the demographics of our community

• Provide students broad-based experiences in both treatment and community-based settings serving diverse populations

C. Service

See attachment for models for linking research, education and practice

Healthy People 2010

What is Healthy People 2010?

Healthy People 2010 is a comprehensive set of disease prevention and health promotion objectives for the Nation to achieve over the first decade of the new century. Created by scientists both inside and outside of Government, it identifies a wide range of public health priorities and specific measurable objectives.

Overarching Goals: 1. Increase quality and years of health life

2. Eliminate health disparities

| | |

|Focus Areas | |

|Access to quality health services |Injury and violence prevention |

|Arthritis, Osteoporosis, and chronic back conditions |Maternal, infant and child health |

|Cancer |Medical product safety |

|Chronic Kidney Disease |Mental health and mental disorders |

|Diabetes |Nutrition and overweight |

|Disability and secondary conditions |Occupational safety and health |

|Educational and community-based programs |Oral health |

|Environmental health |Physical activity and fitness |

|Family planning |Public Health infrastructure |

|Food safety |Respiratory diseases |

|Health communication |Sexually transmitted diseases |

|Heart Disease and Stroke |Substance Abuse |

|HIV |Tobacco use |

|Immunization and infectious diseases |Vision and hearing |

What Are the Leading Health Indicators (LHIs)?

| |

|The Leading Health Indicators are the 10 major health issues for the nation. The LHIs are: |

|Physical activity |Mental health |

|Overweight and obesity |Injury and violence |

|Tobacco use |Environmental quality |

|Substance abuse |Immunization |

|Responsible sexual behavior |Access to health care |

Public Health System Functions

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Public Health Functions:

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