Nongovernmental health agencies are funded primarily by

Chapter 2

Organizations that Help Shape Community and Public Health

Chapter Objectives (1 of 2)

After studying this chapter, you will be able to:

Explain the need for organizing to improve community and public health.

Explain what a governmental health organization is and give an example of one at each of the following levels—international, national, state, and local.

Explain the role the World Health Organization (WHO) plays in community and public health.

Briefly describe the structure and function of the United States Department of Health and Human Services (HHS).

State the three core functions of public health.

List the 10 essential public health services.

Explain the relationship between a state and local health department.

Chapter Objectives (2 of 2)

Explain what is meant by the term Whole School, Whole Community, Whole Child (WSCC).

Define the term quasi-governmental and explain why some health organizations are classified under this term.

List the four primary activities of most voluntary health organizations.

Explain the purpose of a professional health organization/association.

Explain how philanthropic foundations contribute to community and public health.

Discuss the role that service, social, and religious organizations play in community and public health.

Identify the major reason why corporations are involved in community and public health, and describe some corporate activities that contribute to community and public health.

Introduction

Only in past ~100 years have communities taken explicit actions to deal aggressively with health issues continuously

Community response to own problems hindered by various issues

Three classifications based on funding sources, responsibilities, and organizational structure

Governmental

Quasi-governmental

Nongovernmental

Governmental Health Agencies

Part of governmental structure

Federal, state, or local

Funded primarily by tax dollars

Managed by government officials

Authority over some geographic area

Exist at four levels

International, national, state, local

International Health Agencies

World Health Organization (WHO) most widely recognized international governmental health organization

Headquartered in Geneva, Switzerland

Six regional offices around the world

Not oldest world health-related international agency, but largest

History of WHO

1945: charter of the United Nations; article calling for establishment of health agency with wide powers

1946: UN representatives created and ratified the constitution of WHO

1948: constitution went into force and WHO began work

Organization of WHO

Membership open to any nation that has ratified constitution and receives majority vote of World Health Assembly

World Health Assembly – delegates of member nations

Approves WHO programs and budget

194 member countries

WHO administered by different levels of staff

Purpose and Work of WHO

Primary objective: attainment of the highest possible level of health by all peoples

Six core functions to achieve objective

Work financed by member nations

Most notable work: helping to eradicate smallpox

Work guided by 12th General Programme of Work and the UN’s Millennium Declaration

2003 Millennium Summit established Millennium Development Goals

Sustainable Development Goals established in 2015 to build on the MDGs

National Health Agencies

Each nation has department or agency within its government responsible for protection of health and welfare of its citizens

U.S. primary national health agency: Department of Health and Human Services (HHS)

Other federal agencies contribute to health – Dept. of Agriculture, EPA, OSHA, DHS

Department of Health and Human Services

Headed by Secretary of Health and Human Services

appointed by president; member of cabinet

~25% of federal budget; largest department in federal government

New healthcare reform law provides series of new duties and responsibilities for HHS

Organized into 11 operating agencies; 10 regional offices

Operating Agencies of the DHHS (1 of 2)

Administration for Community Living (ACL)

Administration for Children and Families (ACF)

Agency for Healthcare Research and Quality (AHRQ)

Agency for Toxic Substances and Disease Registry (ATSDR)

Centers for Disease Control and Prevention (CDC)

Operating Agencies of the DHHS (2 of 2)

Food and Drug Administration (FDA)

Centers for Medicare and Medicaid Services (CMS)

Health Resources and Services Administration (HRSA)

Indian Health Services (IHS)

National Institutes of Health (NIH)

Substance Abuse and Mental Health Services Administration (SAMHSA)

State Health Agencies

All 50 states have their own state health departments

Purpose: to promote, protect, and maintain the health and welfare of their citizens

Usually headed by a medical director who is appointed by the governor

Purposes represented in “Core Functions of Public Health” (assessment, policy development, assurance)

Core Functions of Public Health and 10 Essential Services

Reproduced from: Centers for Disease Control and Prevention (2014). The Public Health System and the 10 Essential Public Health Services. Available at http://www.cdc.gov/nphpsp/essentialservices.html

State Health Departments

Most organized into divisions or bureaus

Play many different roles

Can establish health regulations

Provide link between federal and local health agencies

Serve as conduits for federal funds aimed at local health departments

Have laboratory services available for local health departments

Local Health Departments

Responsibility of city or county governments

Jurisdiction often depends on size of population

State mandated services provided locally

Restaurants, public buildings, and public transportation inspections; detection and reporting of certain diseases; collection of vital statistics

Approximately 2,800 in the United States

Organization of Local Health Departments

Whole School, Whole Community, Whole Child (WSCC) Model

Schools under category of governmental health agency – funded by tax dollars

Schools have great potential for impacting community health

Ecological approach directed at the whole school

Expands on the 8 elements of the coordinated school health (CSH) approach

Expanded components – social and emotional climate, physical environment, community involvement, and family engagement

Quasi-Governmental Health Organizations

Some official health responsibilities; operate more like voluntary health organizations

Operate independently of government supervision

Derive some funding and work from government

Examples: American Red Cross, National Academy of Sciences, National Science Foundation

The American Red Cross

Official duties

Provide relief to victims of natural disasters

Serve as liaison between members of armed forces and their families during emergencies

Nongovernmental services

Blood drives, safety services, community volunteer services, international services

Part of international movements

Nongovernmental Health Agencies

Funded by private donations or membership dues

Arose due to unmet health need

Operate free from governmental interference

Meet specific IRS guidelines with tax status

Many types

Voluntary, professional, religious, social, philanthropic, corporate, service

Voluntary Health Agencies

Created by one or more concerned citizens that felt a specific health need was not being met by governmental agencies

Most exist at national, state, and local levels

National often focused on research, state links national with local offices, local often carry out programming

Usually combination of paid staff and volunteers

Purpose of Voluntary Health Agencies

Four basic objectives

Raise money to fund programs and/or research

Provide education to professionals and the public

Provide services to those afflicted

Advocacy

Fundraising is a primary activity

Examples, ACS, AHA, March of Dimes, MDA

Professional Health Organizations

Made up of health professionals who have completed specialized training and have met standards of registration/certification or licensure for their fields

Mission: to promote high standards of professional practice

Funded primarily by membership dues

Examples: American Medical Association, American Public Health Association

Philanthropic Foundations

Endowed institutions that donate money for the good of humankind

Fund programs and research on prevention, control, and treatment of many diseases

Some have broad support, others very specific

Examples: Bill and Melinda Gates Foundation, Commonwealth Fund, Robert Wood Johnson Foundation, local Community Foundations

Service, Social, and Religious Organizations

Many do not have health as primary mission, but make significant health-related contributions

Examples: Kiwanis, Elks, Shriners, Lions, FOP

Contributions of religious groups to community health are substantial

History of volunteerism, influence on families, donation of space, sponsorship of programs (food banks, shelters)

Corporate Involvement in Community Health

Biggest role is provision of healthcare benefits

Worksite health promotion programs aimed at lowering healthcare costs and reducing absenteeism

Safety, counseling, education courses, physical fitness centers

Discussion Questions

How have voluntary health organizations impacted health outcomes?

How does the Department of Health and Human Services impact individuals?

How can the World Health Organization overcome the obstacles they face?