© 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 .

1. © 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.

2. 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.

3. 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

4. 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?

5. 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;

6. 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

7. 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.

8. 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).

9. 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

10. 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

11. 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.
Healthy People Reports
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
Healthy People Reports
The Healthy People 2010 report, Understanding and Improving
Health, based on the previous Healthy People reports and their
progress, was released in 2000.

12. 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

13. 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.
Nongovernmental Public Health Activities
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.
Nongovernmental Public Health Activities
Nonprofit agencies such as the American Cancer Society,
American Heath Association and American Lung Association
have active health promotion and health screening programs at

14. 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

15. 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.

16. Summary of Chapter 4
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.
Assessment 2 – Essay (20%)
Learning outcome 2, 3 & 4
Weight: 20%
Due: Week 9 (Thursday 10 April 2014)
Words: 1200-1500 wordsObjective:
Prepare an essay that demonstrates research and analysis of
scholarly articles. The essay should be clear and demonstrate
an understanding of the critical key issues and relate this to the
relevant theories, research and related material. Your textbook
should serve as an initial starting point for commencement of
your work.
General Instructions:
Choose one (1) question from the list below. Your essay needs
to have at least 10-12 references in it. Use the prescribed
textbook and 1-3 other current relevant textbooks. At least five
(5) of your references should be recent, relevant, peerrefereed
journal articles sourced from credible databases (namely Google
Scholar, Ebsco Host (Business Source Premier) or Emerald).

17. Avoid general internet sites.
There are two (2) parts to undertaking and completing this
assessment task. Firstly as a hurdle requirement you need to
submit an annotated bibliography which basically summarises
contrasting perspectives or approaches from the scholarly
research (Due week 4). This could include contrasting models or
frameworks related to the particular essay topic. You must
paraphrase two (2) articles. More specifically you need to
address the following:
· Paraphrase the author(s) key theories, research approach and
findings
· Discuss and critique the underpinning theories, arguments and
point out potential strengths and limitations to the author(s)
perspective
· Contrast the respective author(s)views and or research
methodology highlighted in the respective journal articles
Having completed the annotated bibliography task, and received
feedback, you will then complete your essay by undertaking
more extensive research on the chosen essay topic (refer list
below).
Essay Questions:
1. Discuss various perspectives on information technology and
its impact on globalism, global development and international
management.
1. There are various Knowledge Management (KM) challenges
between international alliance and joint venture partners.
Discuss.
1. Discuss some cultural variables that can affect
communication between Australians and Indonesians when
doing business.

18. Criteria for Grading Written Work:
1. Planning (30%) – selecting and weighing relevant and
reliable evidence, and structuring valid arguments based on that
evidence showing discrimination in selecting key points and
summarising the issues; a coherent, logical ‘flow’ of arguments
from one point to the next; no point discussed in excess of its
relevance to the main question.
2. Content – Understanding (30%) – demonstrating a broad and
deep knowledge of the substantive subject-matter, including but
not limited to the set textbooks and readings, particularly those
most relevant to the question: covering all major viewpoints
relating to the set question or your own selected topic.
3. Content – Analysis (30%) – demonstrating your own
independent and critical thinking in reaching conclusions (e.g.,
not merely restating or describing arguments, or making
untested assumptions, on matters open to dispute).
4. Referencing - (10%) - accurate citation of references using
the Harvard system