Question 1Drugs that are non-prescription that can be purcha.docx

Question 1
Drugs that are non-prescription that can be purchased in retail
stores such as pharmacies, grocery stores are called over the
counter drugs.
True
False
10 points
Question 2
The Hazard Communication Standard ensures that all non-
hazardous chemicals are properly labeled and that companies
are informed of these risks.
True
False
10 points
Question 3
Established in 1965, the Administration on Aging is one of the
largest providers of home and community based care for older
persons. Their mission is to develop a cost effective and
efficient system of long term care that helps the elderly to
maintain dignity in their homes and communities.
True
False
10 points
Question 4

The Office of the Surgeon General oversees the operations of
the commissioned U. S. Public Health Service Commissioned
Corps who provide support to the Surgeon General.
True
False
10 points
Question 5
The Surgeon General is the U.S. chief health educator who
provides information on how to improve U.S. health.
True
False
10 points
Question 6
The U.S. Constitution gives the federal government the primary
role in health care for their citizens. They also license health
professionals such as physicians, dentists, chiropractors, nurses,
pharmacists, optometrists and veterinarians who practice within
their jurisdiction.
True
False
10 points
Question 7
Local health departments are the governmental organization that
provides most direct services to the population

True
False
10 points
Question 8
The Food and Drug Administration is responsible for advancing
the public health by helping to speed innovations that make
medicines and foods more effective, safer, and more affordable.
True
False
10 points
Question 9
The mission of the Administration on Aging is to help protect
the rights of the family members who are responsible for caring
for elderly individuals.
True
False
10 points
Question 10
Social regulation focuses on:
Organization’s actions such as those in the health care industry
that impact individual’s safety. These regulations focus on
protecting individuals as employees and consumers.
The economic status of healthcare organizations to ensure they
help consumers.
The social relationship that exists between the consumer and the

physician.
None of the above are suitable answers.
10 points
Question 11
The National Institute of Health is a federal agency that is
responsible for:
Research towards preventing and curing disease.
Improving access to health care services for people who are
medically vulnerable.
Improving the quality, safety, efficiency of healthcare.
Improving access to quality substance abuse and mental health
services.
10 points
Question 12
Which agency was established in 1970 to govern the workplace
environment to ensure that employees have a safe and healthy
environment?
Hazard Communication Agency
Occupational Safety and Health Act
Occupational Safety and Health Administration

U.S. Public Health Service Corps
10 points
Question 13
Which federal agency was established in 2002 and why?
The Federal Emergency Management Agency to monitor U.S.
natural disasters.
The Council of State and Territorial Epidemiologists to assess
terrorist attacks.
The Department of Homeland Security to oversee any major
catastrophic events such as terrorism, natural disasters and
severe weather.
National Response Framework to provide national policy for
emergency management.
10 points
Question 14
Which of these statements are true?
There are 25 accrediting organizations that target certain
healthcare sectors
The U.S. Surgeon General is the chief health educator in the
U.S.
There are approximately 3000 local health departments in the
U.S.
All are correct statements
10 points

Question 15
Created in 1982, ____________________ is the primary federal
agency for improving access to healthcare services for people in
every state who are uninsured, isolated or medically vulnerable.
Coalition for Health Services Research
Centers for Disease Control and Prevention
Agency for Toxic Substance and Disease Registry
Health Resources and Services Administration
Question 1
The determinants of health are external factors within the
immediate environment of an individual that influences the
person’s health.
True
False
10 points
Question 2
The determinant of health that includes pollutants, hazardous
exposure at work, water contamination is called the
psychomotor environment.
True
False
10 points
Question 3

An individual’s lifestyle or behavior includes diet, exercise,
sexual activity, stressful job, which are types of determinants of
health.
True
False
10 points
Question 4
This program, the Turning Point, funded by the Robert Wood
Johnson Foundation allocated funds to 21 states for six years to
assess the public health system.
True
False
10 points
Question 5
Public health marketing involves using governmental funds to
prepare advertising campaigns for local health clubs such as LA
Fitness and Crunch Gym.
True
False
10 points
Question 6
Public health emergency preparedness is a term used for
planning protocols that are in place to manage a large scale
event such as a natural disaster such as a hurricane or massive
flooding or man-made disaster such as a terrorist attack like

September 11, 2001.
True
False
10 points
Question 7
Primary prevention activities focus on:
Early detection and treatment of diseases.
Stopping the progression of disease.
The rehabilitation of individuals from disease progression.
Reducing disease development.
10 points
Question 8
The three core public health functions are:
Assurance, policy development and detection of disease.
Policy development, prevention of disease and assurance.
Assessment, detection of disease and policy development.
Assessment, policy development and assurance.
10 points
Question 9
Epidemiologists identify three major risk factors for disease
which are called

Bermuda triangle of the disease, bacteria, and environment.
Public health triangle of the agent, host and environment.
Epidemiology triangle of the host, the agent and the
environment.
None of the above.
10 points
Question 10
Epidemiologic surveillance consists of:
Monitoring individuals to determine their behaviors that cause
disease.
Monitoring disease outbreaks to develop public health
intervention strategies to combat disease.
Monitoring individuals to reduce their risky behavior of
spreading disease.
All of the above are examples of surveillance.
10 points
Question 11
Examples of primary prevention activities are:
Smoking cession programs
Immunization programs
Educational program for pregnancy

All are examples
© 2010 Jones and Bartlett Publishers, LLC
Basic Concepts of the U.S. Health Care Delivery System:
Student Activity Workbook
Chapter 4
Public Health Role
Nancy J. Niles
Introduction: Two Definitions
Charles Winslow (1920) defined public health as the science
and art of preventing disease, prolonging life, and promoting
physical health and efficiency through organized community
efforts for the sanitation of the environment, control of
community infections, education of individuals regarding
hygiene to ensure a standard of living for health maintenance.
The Institute of Medicine in its’ 1988 Future of Public Health
report defined public health as an organized community effort
to address public health by applying scientific and technical
knowledge to promote health .
Introduction
Public health specialists view health from a collectivistic and
preventive care viewpoint—to protect as many citizens as
possible from health issues and to provide strategies to prevent
health issues from occurring.
Public health concepts were in stark contrast to traditional

medicine which focused on the sole relationship between a
provider and patient.
Private practitioners held an individualistic viewpoint—citizens
more often would be paying for their services from their health
insurance or from their own pockets.
Physicians would be providing their patients guidance on how
to cure their diseases, not preventing disease.
What Is Health?
The World Health Organization defines “health” as the state of
complete physical, mental and social well-being and not merely
the absence of disease or infirmity .
The Institute of Medicine defines “health” as a state of well
being and the capability to function in the face of changing
circumstances. It is a positive concept emphasizing social and
personal resources as well as physical capabilities.
According to the Society for Emergency Medicine (SAEM),
health is a state of physical and mental well-being that
facilitates the achievement of individual and societal goals.
How would you define the concept of health?
Determinants of Health
Health has several determinants or influences that impact the
status of an individual’s health.
The physical environment would include pollutants, hazardous
exposure at work, water contamination, etc.
The social environment would include socioeconomic status
which relates directly to quality of health
An individual’s lifestyle or behavior includes diet, exercise,
sexual activity, stressful job, which all have an impact on
health.
Also, genetic factors or a person’s biology predispose
individuals to certain diseases.

Primary, Secondary And Tertiary Prevention Of Public Health
Primary prevention activities focus on reducing disease
development. Smoking cessation programs and immunization
programs are examples.
Secondary prevention activities refer to early detection and
treatment of diseases. The goal of secondary prevention is to
stop the progression of disease such as blood pressure
screenings, colonoscopies, and mammograms.
Primary, Secondary And Tertiary Prevention Of Public Health
Tertiary prevention activities focus on activities to
rehabilitation and monitoring of individuals from disease
progression. Activities may also include patient behavior
education to limit disease impact and further progression.
Although public health professionals may participate in each
area of prevention activities, they focus primarily on primary
and secondary prevention.
Origins Of Public Health
During the 1700s-1800s, the concept of public health was born.
Edwin Chadwick, Dr. John Snow, and Lemuel Shattuck in their
reports demonstrated a relationship between the environment
and disease which established the foundation of public health.
In 1842, Edwin Chadwick published the General Report on the
Sanitary Condition of the Labouring Population of Great
Britain. His report highlighted the relationship between
unsanitary condition and disease.
Origins of Public Health
Dr. John Snow, a famed British anesthesiologist, is more

famous for investigating the cholera epidemics in London in the
1800s. He made the connection between contaminated water
and the spread of disease—cholera.
Dr. Snow surveyed local London residents and discovered that
those who were ill had retrieved water from a specific
neighborhood pump on Broad Street.
When the pump handle was removed, the disease ceased.
Origins of Public Health
In the United States, Lemuel Shattuck in his Census of Boston
report discussed high mortality rates among lower income and
unsanitary living conditions.
In 1850, he published a plan for health promotion to combat
unsanitary conditions. He was considered the American
advocate for environmental health.
As a result of their work, public health law was enacted and by
the 1900s’, public health departments were focused on the
environment and its relationship to disease outbreaks.
What Is Public Health?
In 1945, the American Public Health Association issued a set of
guidelines for the basic functions of the local health
department:
Vital statistics – data management of the essential facts births,
deaths, and reportable diseases;
Communicable disease control – management of tuberculosis,
venereal disease, and malaria;
Sanitation- management of the environment including milk,
water and dining;
Laboratory services;
Maternal and child health – management of school aged
children’s health; and
Health education of the general public.

What is Public Health?
These functions remained the cornerstone of public health until
the 1960s when the American Public Health association
(APHA), reacting to cultural and political changes, revised the
definition of the core public health functions. The APHA issued
the following guidelines for the core public health functions:
Health surveillance, planning and program development;
Health promotion of local health activities;
Development and enforcement of sanitation standards; and
Health services provisions.
What is Public Health?
The Institute of Medicine (1988), as a result of an in-depth
study of public health, stated that the three core public health
functions of public health are:
Assessment which includes surveillance, identifying problems,
data collection and analysis;
Policy development which includes developing policies to
address public problems;
Assurance which includes evaluation of policies meeting
program goals .
Public Health Functions
In 1994, the Public Health Steering Committee, as part of the
U.S. Public Health Service, issued a list of essential public
health services that provided specific information on the
implementation of the core public health functions and how they
should be implemented.
The following slides lists essential public health services:
Essential Public Health Services

monitor community health status;
diagnose and investigate community health issues;
educate people;
develop community partnerships;
develop public health policies;
enforce public health laws and regulations;
sustain a competent health care workforce;
evaluate the effectiveness, access and long term sustainability
of community health services;
link people to needed health services.
What is Epidemiology?
Epidemiology is the study of disease distribution and patterns
among populations. Epidemiologists search for the relationship
of those patterns of disease to the causes of the disease.
The epidemiology triangle which consists of the host, which is
the population that has the disease; the agent or organism which
is causing the disease, and the environment, or where the
disease is occurring (see Figure 4-2) is the foundation of
epidemiology.
What is Epidemiology?
Public health workers attempt to assess each factor’s role in
why a disease occurs. Public health workers develop prevention
strategies to alter the interaction between the host, disease and
the environment, so the disease occurrences will be less severe
or will not occur again
Epidemiologic Surveillance
An important component of epidemiology is surveillance which
is the monitoring of patterns of disease and investigating
disease outbreaks to develop public health intervention

strategies to combat disease.
A new form of surveillance involves biosurveillance which
focuses on early detection of unusual disease patterns that may
be due to human intervention.
What is Environmental Health?
Since the discovery of John Snow who linked disease with
environmental factors, the field of environmental health is an
integral component of public health.
Environmental health workers often are responsible for
investigating environmental hazards in the community and
monitoring and enforcing environmental regulations.
Both state and local health departments have environmental
health.
Emergency Preparedness
Public health emergency preparedness is a term used for
planning protocols that are in place to manage a large scale
event such as a natural disaster such as a hurricane or massive
flooding or man-made disaster such as a terrorist attack like
September 11, 2001.
During a public health emergency such as Hurricane Katrina in
Louisiana and recent food contamination outbreaks in 2008 with
salmonella cases nationwide, risk communication protocols are
implemented to inform the public regarding the health issue.
Emergency Preparedness
The federal government may intervene in a disease outbreak.
If not, state and local public health departments are responsible
for monitoring the disease threat.
Since the terrorist attacks in 2001, simulating public health
emergencies have been staged across vulnerable areas of the

United States like large urban areas such as New York City and
Las Vegas.
Public health funding for state activities such as these are
largely from Centers for Disease Control and Prevention grants
and budget allocations
Department of Homeland Security
As result September 11, 2001, the federal Department of
Homeland Security (DHS) was created from 23 federal agencies,
programs and offices to coordinate an approach to emergencies
and disasters. Several public health functions were transferred
into the DHS in 2003.
The Emergency Preparedness and Response Directorate
coordinates emergency medical response in the event of a public
health emergency.
National Response Framework
The National Response Framework (NRF), created by the
Department of Homeland Security, presents the guiding
principles that enable all response partners to prepare for and
provide a unified national response to disasters and
emergencies.
The National Response Framework describes how communities,
states, the federal government, private-sectors, and
nongovernmental partners collaborate to coordinate national
response and describes “best practices” for managing incidents.
State And Local Response To Disasters
Incident Command Systems and Public Health
Incident command systems (ICS) are used by police, fire and
emergency management agencies. ICS eliminates many
communication problems, spans of control, organizational

structures and differences in terminology when multiple
agencies respond to emergency events (www.fema.gov).
The ICS is a coordinator for an emergency event. They are in
control of a situation and make decisions about how to manage
an emergency. They coordinate all responders to the event
which increases management effectiveness.
Bioterrorism: A New Public Health Threat
According to the Centers for Disease Control and Prevention,
bioterrorism is an attack on a population by deliberately
releasing viruses, bacteria or other germs or agents that will
contribute to illness or death in people.
Homeland Security, American Red Cross, the American Medical
Association and the Environmental Protection Agency have
developed educational campaigns regarding the U.S. response to
bioterrorism.
Bioterrorism
More than 20 federal departments and agencies have roles in
preparing for a bioterrorist attack. In 2002, the Public Health
Security and Bioterrorism Preparedness and Response Act
provided grants to hospitals and public health organizations to
prepare for bioterrorism as a result of September 11, 2001.
The Food and Drug Administration also has additional
responsibilities in the detection of food as a threat to
community health.
Public Health Functions And Administration
Accreditation of Public Health Departments
The 2003 IOM Report discussed earlier recommends a national
accreditation system for public health agencies because there is
no national accrediting body to institute standards.
In 2004, the Centers for Disease Control and Prevention and the

Robert Wood Johnson Foundation funded a study, the Exploring
Accreditation Project, to assess accreditation of public health
agencies.
Public Health Functions And Administration
Mobilizing for Action through Planning and Partnership
(MAPP)
This cooperative agreement, between the CDC and the
NACCHO, is a strategic plan for community health
Based on the needs assessment of the community, a long range
plan is developed that establishes goals and a set of actions to
accomplish these goals.
The Influence of the Institute of Medicine Reports on Public
Health Functions
Published in 1988, the Institute of Medicine published a report,
the Future of Public Health, which indicated that although the
health of the American people has been accomplished through
public health measures such as consumer food regulations,
water safety standards; epidemic control of disease, the public
has come to take public health measures for granted.
There was poor collaboration between public health and private
medicine, no strong mission statement and weak leadership, and
politicized decision making. Three core public health functions
were identified: assessment, policy development and assurance.
Three Core Public Health Functions
Assessment was recommended because it focused on systematic
continuous data collection of health issues which would ensure
that public health agencies were vigilant in protecting the
public.

Policy development was also mentioned but the recommendation
was to ensure that any policies were based on valid data to
avoid any political decision making.
Assurance focuses on evaluating any processes that have been
put in place to assure that the programs are being implemented
appropriately
Healthy People Reports
The Healthy People series is a federal public health planning
tool that assesses the most significant health threats and sets
objectives to challenge these threats.
The first major report, published in 1979, Healthy People: The
Surgeon General’s Report on Health Promotion and Disease
Prevention discussed 5 goals of public health: reduce mortality
rates among children, adolescents, young adults and adults, and
increase independence among older adults.
Objectives were set for 1990 to accomplish these goals.
The Healthy People 2000 report, the National Health Promotion
and Disease Prevention Objectives, released in 1990, was
created to implement a new national prevention strategy with 3
major goals: increase life expectancy, reduce health disparities,
and increase access to preventive services.
An evaluation report in 2002 indicated that only 21% of their
objectives was met with an additional 41% indicating progress.
Unfortunately, in the critical areas of mental health, there were
significant reversals in any progress.
There was also minor progress in the areas chronic diseases and
diabetes
The Healthy People 2010 report, Understanding and Improving

Health, based on the previous Healthy People reports and their
progress, was released in 2000.
The report contained a health promotion and disease prevention
focus to identify preventable threats to public health and to set
goals to reduce the threats.
Like Healthy People 2000, its major goals were to increase
quality and life expectancy and to reduce health disparities. The
goals for these reports are consistent with both Winslow’s and
the IOM’s report’s definition of public health.
Federal Government
The major federal agency responsible for public health
activities is the Department of Health and Human Services.
They are responsible for the following activities:
data gathering and analysis, and surveillance and control;
conducting and funding research;
providing assistance to state and local government programs;
formulating health policy;
ensuring food and drug safety;
ensuring access to health services for the poor and elderly; and
providing direct services to special populations
State Government
The major key feature of state agencies is their relationship
with their local public health agencies which are responsible for
implementing state policy and regulations.
Most states have public health activities distributed across many
agencies which include environmental protection, human
services, labor, insurance, transportation, housing and
agriculture.
Local Government
Local government agencies are directly responsible for

performing the majority of community public health services.
On November 1, 2005, NACCHO released the operational
definition of a local health department which is defined as the
“public health government entity at a local level including a
locally governed health department, state-created district,
department serving a multi-county area or any other
arrangement with governmental authority and responsibilities
for public health at the local level”.
Nongovernmental Public Health Activities
Community hospitals have been important to public health. The
Hill-Burton Act of 1943 which financed hospital construction
projects required them to provide charitable services which
established a tradition of charitable services among community
hospitals.
Hospitals may operate primary care clinics, sponsoring health
education programs, and health screening fairs. The Joint
Commission requires hospitals to participate in community
health assessment activities
Ambulatory or outpatient care providers such as physician
practices also contribute to community public health.
Physicians may serve on local public health organizations or
provide services to the uninsured for reduced fees.
Health insurers and managed care providers also make
important public health contributions. All types of health care
providers cooperate with state and local health departments by
providing immunizations and offering patient education.
Nonprofit agencies such as the American Cancer Society,

American Heath Association and American Lung Association
have active health promotion and health screening programs at
the national, state, and local levels.
United Way is a civic organization that is active in identifying
health risks and implementing community public health
programs to target these risks.
Rotary International, is responsible for efforts to eradicate polio
through vaccine programs throughout the world.
Robert Wood Johnson Foundation (RWJ) have provided
funding for public health activities such as community
education and intervention programs.
Public Health Education And Health Promotion
Public health educational strategies are a crucial component to
public health interventions.
Health education focuses on changing health behavior through
educational interventions such as multi-media education and
classes.
Health promotion is a broader intervention term in public health
that encompasses not only educational objectives and activities
but also organizational, environmental and economic
interventions to support activities conducive to healthy behavior
Public Health Education Campaign
There are several steps to planning and developing a successful
public health educational campaign.
The first step in implementing a public health education
campaign is to perform a community assessment.
The second step is collaborating with the community for their
input on prioritizing their target health issues.
The third step is performing surveillance activities for specific
data.

Public Health Education Campaign
The fourth step is to develop a pilot study to assess the
effectiveness of the proposed campaign.
The fifth step is to revise the campaign based on the pilot study.
The sixth step is to implement the chosen campaign for a period
of time.
The seventh step is to perform an evaluation of the impact of
the campaign and revise, if needed
Health Promotion
Health promotion focuses on a comprehensive coordinated
approach to long term health behavior changes by influencing
the community through educational activities.
Examples of health promotion include nutritional, genetic or
family counseling which would include health education
activities
Public Health Marketing
According to the CDC, health marketing is an innovative
approach to public health practice. Public health marketing
draws from the business discipline of marketing theory and adds
science-based health strategies of promotion and prevention.
It involves creating, communicating and delivering health
information and interventions using customer-oriented and
science-based strategies to protect and promote health in
diverse populations
Summary of Chapter 4
Public health is challenged by its very success because
consumers now take public health measures for granted.
When some major event occurs like anthrax or SARS, people
immediately think that public health will automatically control
these problems. The public may not realize how much effort and

dedication and research takes place to protect the public.
It is important to recognize as a health care consumer, the role
public health plays in our health care. Public health surrounds
consumers with educational opportunities to change a health
condition or behavior.
You can visit the federal organization Centers for Disease
Control’s website that is discussed in several chapters, which
provides information about different diseases and health
conditions. You can also visit your local health department.
© 2010 Jones and Bartlett Publishers, LLC
Chapter Basic Concepts of the U.S. Health Care Delivery
System: Student Activity Workbook
Chapter 3
The Role of Government in Health Care
Nancy J. Niles
Introduction
As discussed in chapter one, during the Depression and World
War II, the U.S. had no funds to start a universal health care
program—an issue that had been discussed for years.
As a result, a private sector system was developed which did
not provide health care services to all citizens.

The passage of the Social Security Act of 1935 and the
establishment of Medicaid and Medicare programs in 1965
mandated government’s increased role in providing health care
coverage.
Introduction
Also, the State Children’s Health Insurance Program (SCHIP),
established in 1997, which continues to be reauthorized expands
government’s role in children’s health care
In both instances, the government increased accessibility to
health care
This chapter will focus on the different roles the federal, state
and local government play in the U.S. health care system.
Noted Federal Government Agencies
Many federal agencies are responsible for a sector of
healthcare.
The United States Department of Health and Human Services
(HHS) is the most important federal agency. HHS collaborates
with state and local governments because many of the services
are provided at those levels.
Noted Federal Government Agencies
There are 11 Public Health Service operating divisions of the
HHS:
the Centers for Disease Control and Prevention (CDC),
National Institutes of Health (NIH),
Agency for Toxic Substances and Disease Registry (ATSDR),
Indian Health Service (IHS),
The Health Resources and Services Administration (HRSA),
The Agency for Health care Research and Quality (AHRQ), the
Substance Abuse and Mental Health Services Administration

(SAMHSA);
and the Food and Drug Administration (FDA).
Centers for Disease Control and Prevention
Established in 1946, and headquartered in Atlanta, GA, the
CDC’s mission is to protect health and promote quality of life
through the prevention and control of disease, injury, and
disability.
The CDC has created four health goals that focus on:
healthy people in healthy places,
preparing people for emerging health threats,
positive international health and
healthy people at all stages of their life.
Agency for Toxic Substances
and Disease Registry (ATSDR)
1985: Atlanta, GA headquarters Administered with CDC.
Is responsible for finding and cleaning up the most dangerous
hazardous waste sites in the country.
ATSDR’s mission is to protect the public against harmful
exposures to toxic substances.
ATSDR is the lead federal public health agency responsible for
determining human health effects associated with toxic
exposures and mitigating associated human health risks.
National Institute of Health (NIH)
1930: headquartered in Bethesda, MD, is the primary federal
agency for research towards preventing and curing disease.
They have 27 institutes and centers that focus on different

diseases and conditions including cancer, eye, heart and lung
and blood, genes, aging, alcoholism and drug abuse, infectious
diseases, chronic diseases, children’s diseases and mental
health.
Although they have sponsored external research, they also have
a large internal research program .
The Health Resources and Services Administration (HRSA)
1982: headquartered in Rockville, MD, the HRSA is the primary
federal agency for improving access to health care services for
people who are uninsured, isolated or medically vulnerable in
every state.
They have six bureaus: primary health care, health professions,
health care systems, maternal and child, the HIV/AIDs bureau
and the bureau of clinician recruitment and service
HRSA trains health professionals and improves systems of care
in rural communities.
They oversee 650 community and migrant health centers plus
150 primary care programs for the homeless and residents of
public housing. Service is provided to individuals with AIDS.
They also oversee organ, bone marrow and cord blood donation
and support programs against bioterrorism.
1989: headquartered in Rockville, MD, the agency’s mission is
to improve the quality, safety, efficiency, and effectiveness of
health care for all U.S. citizens.
AHRQ's cutting edge research helps people make more informed
decisions and improve the quality of health care services

The Agency for Health care Research and Quality (AHRQ)
There is a Coalition for Health Services Research that is a
voluntary organization that is an advocacy group for the AHRQ.
It is comprised of more than 250 non-profit organizations that
support the AHRQ.
They send letters to Congress encouraging more funds for
research.
Indian Health Services (IHS)
1921: headquartered in Rockville, MD, their mission is to raise
the physical, mental, social, and spiritual health of American
Indians and Alaska Natives to the highest level.
They are also responsible to promote their communities, and
cultures and to honor and protect the inherent sovereign rights
of these people
The Substance Abuse and Mental Health Services
Administration (SAMHSA)
1992: the main federal agency for improving access to quality
substance abuse and mental health services in the U.S by
working with state, communities and private organizations.
SAMSHA is the umbrella agency for mental health and
substance abuse services which includes the Center for Mental
Health Services (CMHS), The Center for Substance Abuse
Prevention (CSAP), and the Center for Substance Abuse
Treatment (CSAT).
The Substance Abuse and Mental Health Services
Administration (SAMHSA)
The Office of Applied Studies (OAS) is their focal point for

data collection, analysis, and dissemination of critical health
data to assist policymakers in developing mental health issues.
Food and Drug Administration (FDA)
1906: the FDA is responsible for ensuring that the following
products are safe: food, human and veterinary products,
biological products, medical devices, cosmetics and electronic
products.
The agency monitors approximately $1 trillion worth of goods
on an annual basis.
Administration on Aging (AOA)
1965: as part of the Older Americans Act (OAA), the AOA is
one of the largest providers of home and community based care
for older persons.
The AOA is a partnership of federal, state and local networks
called the National Network on Aging which services seven
million elderly and their caregivers in the U.S.
The Administration for Children and Families (ACF)
The Administration for Children and Families, which has 10
regional offices, is responsible for federal programs that
promote the economic and social well-being of families,
children, individuals and communities.
Their mission is to empower people to increase their own
economic well-being, support communities that have a positive
impact on the quality of life.
Center for Medicare and Medicaid Services (CMS)
The Center for Medicare and Medicaid Services was established
when the Medicare and Medicare programs were signed into law

in 1965 by President Lyndon B.Johnson, as a result of the
Social Security Act.
Medicaid was established for low income children, elderly, the
blind and the disabled and linked with the Supplemental
Security Income program (SSI).
In 1972, Medicare was extended to cover people under 65 with
permanent disabilities.
Occupational Safety and Health Administration (OSHA)
1970: the Occupational Safety and Health Administration
(OSHA) was established to govern the workplace environment
to ensure that employees have a safe and healthy environment.
The Hazard Communication Standard (HCS) ensures that all
hazardous chemicals are properly labeled and that companies
are informed of these risks.
Occupational Safety and Health Administration (OSHA)
The Medical Waste Tracking Act requires medical waste
disposal procedures to ensure there is no risk to employees and
the environment.
The Occupational Exposure to Blood borne Pathogen Standard
developed behavior standards for employees who deal with
blood products such as wearing gloves and other equipment,
disposal of blood collection materials, etc.
Surgeon General/U.S. Public Health Service
The Surgeon General is the U.S. chief health educator who
provides information on how to improve U.S. health.
The U.S. Public Health Service Commissioned Corps consists of
6,000 public health professionals that are stationed within
federal agencies and programs.

Department of Homeland Security (DHS)
The Department of Homeland Security (DHS) was established in
2002 as a result of the 2001 terrorist attack on the United
States.
The Federal Emergency Management Agency (FEMA) which is
responsible for managing catastrophic events was integrated
into the DHS in 2003.
Together, they are responsible for coordinating efforts at all
government levels to ensure emergency preparedness for any
catastrophic events.
Department of Homeland Security (DHS)
DHS has also developed a National Incident Management
System (NIMS) which provides a systematic, proactive
approach to all levels of government and private sector agencies
to collaborate to ensure there is a seamless plan to manage any
major incidents.
Council of State and Territorial Epidemiologists (CSTE)
1992: headquartered in Atlanta, GA, the Council of State and
Territorial Epidemiologists (CSTE) is a professional
organization of over 1,000 public health epidemiologists that
work in state and local health departments.
They provide technical assistance to ASTHO and to the CDC for
research and policy issues.
State Health Department’s Role in Health care
The U.S. constitution gives state government the primary role in

health care for their citizens Most states have several different
agencies that are responsible for specific public health services.
There is usually a lead state agency with approximately twenty
agencies that target aging, environment, alcoholism and abuse,
etc.
State Health Department’s Role in Health Care
State health departments have the authority to collect health
data, manage vital statistics, declare health emergencies and
conduct health planning and formulate health policy.
Vital statistics collected include deaths, births, marriages, and
health and disease status of their populations. These statistics
are important to collect because they serve as a basis for
funding.
State Health Department’s Role in Health Care
Most state agencies provide technical assistance to their local
health departments in the following areas:
quality improvement,
data management,
public health law,
human resource management, and
policy development.
State Health Department’s Role in Health
States also provide prevention services in the following areas:
tobacco control and prevention,
obesity,
injury prevention,
HIV/AIDs,
diabetes, and
sexually transmitted diseases.

State agencies are funded primarily by federal sources (45%),
with state resources (24%), Medicaid/Medicare (15%) with the
remaining sources are fines and fees (4%), indirect federal
funding (3%) and other minor sources (9%)
The Association of State and Territorial Health Officials
(ASTHO)
The Association of State and Territorial Health Officials
(ASTHO) is a not for profit organization that provides support
for state and territorial health agencies.
They provide research, expertise and guidance for health policy
issues.
The federal government looks to ASTHO for their expertise in
developing health policy. They frequently testify in front of
Congress regarding major health issues.
Local Health Department Role in Health Care
Local health departments are the government organization that
provides most direct services to the population. There are
approximately 3,000 local health departments across the U.S.
It is difficult to generalize what types of services are offered by
local health departments because they do vary according to
geographic location but most are involved in communicable
disease control.
Local health departments receive funding from their state
government and federal government direct funding.
Due to population size and coverage, local health department
funding varies state to state.

Local sources are the greatest contributor to funding local
health departments (29%), followed by state allocations (23%),
and federal funding (13%).
As a result of continued lack of funding, more local health
departments are collaborating with schools, community
organizations, other local governmental organizations such as
social services and health care providers to provide services
Regionalization of Local Health Departments
Over the last 10 years there has been a trend to regionalize local
health departments in order to maximize service to their
populations.
Counties normally providing health services separately have
formed regional health departments which means that smaller
local health departments unite as one operation to provide
services within a geographic area.
Emergency Preparedness in Local Health Departments
As a result of the threat of bioterrorism to the United States, all
local health departments’ roles have changed since September
11, 2001.
The Centers for Disease Control awarded funding to state health
agencies to help the local health departments to develop plans
for bioterrorism attacks.
Although bioterrorism is a new public health threat, emergency
preparedness also includes responses to natural disasters or
disease outbreaks.
The Centers for Disease Control has developed a checklist to
guide local health departments when a disaster occurs.
Assess the situation – The local health department has to assess

the capability of the community and itself to respond quickly to
a threat. It is also important to assess the impact of the threat.
Epidemiological capability and laboratory analyses: Local
health departments should have a surveillance component in
place to track susceptible populations and access to laboratory
services as needed.
Communication: Communication protocols need to be in place
for key health and medical agencies.
Community reassurance: Address requests for assistance and
information.
Clinical interventions: Depending on the type of disaster,
interventions must readily available to provide to the
population.
Coordination of Health care systems: Coordinate with federal
and state on-site assistance.
Workforce training: It is vital that all workers involved in the
disaster plan be trained. Volunteers also need to be trained so
they understand the hierarchy of implementing a disaster plan.
Special populations: Address the needs of the elderly, disabled
and young children.
Legal issues: Stay apprised of any legal issues.
The National Association for County and City Health Officials

(NACCHO)
1993: NACCHO is the advocacy organization for local health
departments. They provide support to nearly 3,000 member
local health departments which include city, county, district,
metro and tribal agencies.
They are staffed by nearly 100 physician and public health
experts and a 32 member Board of Directors.
The National Association for County and City Health Officials
(NACCHO)
The NACCHO also developed standards and defined the role of
local health department’s activities (see Table 3-1).
Other frequent local contributors to public health activities
include social service agencies, elementary and secondary
public schools, housing departments, fire and police
departments, parks and recreation, libraries, waste management
and water and sewer authorities.
Public Health Accreditation Board (PHAB)
The PHAB was established as a nonprofit organization to
administer the voluntary, national accreditation program for
state and local health departments based on the
recommendations of the steering committee of the Exploring
Accreditation project.
The development process will allow sufficient time for the
creation of a successful program to include:
Development of standards and metrics for state and local health
departments,
Creation of an assessment process for applicants,
Public Health Accreditation Board (PHAB)
Establishment of a process to determine recognition/approval of
existing state-based accreditation programs,

Implementation of a pilot testing phase for state and local
public health departments.
Voluntary standards have been developed and are in the process
of receiving public comments.
The government plays an important role in the quality of the
U.S. health care system.
The federal government provides funding for state and local
government programs.
Federal health care regulations are implemented at the state and
local level and are enforced at these levels.
More local health departments are working with local
organizations to provide services such as immunizations,
education and prevention.
NACCHO and ASTHO are important support organizations for
both state and local governments.
They support them by providing policy expertise, technical
advice and lobby at the federal level for appropriate funding
and regulations.

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