01-07A - Introduction To Healthcare and Public Health in The US - Unit 07 - Public Health Part 1 - Lecture A

Introduction to Health Care and
Public Health in the US

Public Health (Part 1)
Lecture a
This material (Comp1_Unit7a) was developed by Oregon Health and Science University funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Learning Objectives
2
Discern the main differences and similarities between
public and private health (Lecture a)
Delineate the historic timeline and achievements of
public health in the US (Lecture a)
Define and discuss key terminology of public health
(Lecture b)
Illustrate the general organization of public health
agencies and public health data flow (Lecture b)
Evaluate and explain the impact and value of public
health (Lecture c)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Health Care and Public Health in the US
Public Health, Part 1
Lecture a
What is Public Health?
Private Health
Clinicians, Health
Practitioners
Treat Individual
Health Problems
Action usually taken
after illness/injury
occurs

Public Health
Agencies
Treat/Maintain
Health of
Populations
Actions include
Education, Policy,
Research,
Monitoring
3
Lecture a
Determination of Public Health Interest
4
Lecture a
In order for a condition to realistically be of interest to public health, it usually
needs to match some degree of each of the following criteria:
The condition/disease must be a) severe enough in its effects to warrant some
type of intervention/monitoring, b) preventable or at least able to be mitigated
by health interventions, behavioral modifications, etc., and c) prevalent enough
in the population to warrant some type of intervention/monitoring.

7.1 Figure: Severity, Preventability, Prevalence

History of Public Health in the US
5
Lecture a
The Official Beginning

1798: An act passed that established a federal
network of hospitals for ill/disabled merchant
seamen. The Federal government deducted
monthly sums from seamens wages. This act
was widely considered to have laid the
foundation for the national public health service.

(Note: Public Health had earlier beginnings in
other parts of the world, which are not
addressed here).
1800s
1800: Technique of smallpox vaccination introduced into the US

1878: National Quarantine Act passed, starting transfer of
quarantine functions from state to federal level (at that time, the
Marine Hospital Service).

1891: Immigration legislation passed, assigning medical
examination of immigrants to the Marine Hospital Service. Wording
of the law directed the exclusion of all idiots, insane persons,
paupers or persons likely to become public charges, persons
suffering from a loathsome or dangerous contagious disease (and
also criminals).
1893: First US school of public health and preventive medicine
established, the Army Medical School (renamed Walter Reed Army
Institute of Research in 1953).

6
Lecture a
1900 1944
1900: Pneumonia and influenza are leading causes of death in the
US.
1902: The Marine Hospital Service changed to the Public Health and
Marine Hospital Service. In 1912, renamed the Public Health
Service.
1910: The high rate of tuberculosis in the garment industry was one
of the triggers leading to the entry of the Public Health Service into
the arena of workplace health and safety.
1916: First non-military school of public health in the US established
at Johns Hopkins University (enabled by Rockefeller Foundation
grant).
1921: Bureau of Indian Affairs Health Division created (Predecessor
of the Indian Health Service).
1935-40: Passage of the Social Security Act and the Federal Food,
Drug and Cosmetic Act.
1944: Massive use of penicillin drastically changes treatment of
infections and Sexually Transmitted Diseases.

7
Lecture a
1946:
Establishment of the Communicable Disease Center,
predecessor of the Centers for Disease Control and Prevention
(CDC)
The CDCs overwhelming first focus was mosquito control to
fight malaria, primarily through application of the pesticide DDT
The new center was actually an outgrowth of the wartime agency
MCWA - Malaria Control in War Areas

From that beginning, CDC grew into its current emphases of working
with states and other partners to monitor and prevent outbreaks,
maintain national health statistics, and to prevent and control
infectious and chronic diseases, injuries, and environmental health
hazards.
8
Lecture a
1950s
1953: Creation of the Department of
Health, Education and Welfare. In 1979,
the Department of Education was split off,
leaving the separate Department of Health
and Human Services (HHS).
1955: Salk polio vaccine licensed. Indian
Health Service moved to HHS.
9
Lecture a
1960s
1961-69: Migrant Health Act passed, providing clinics for
agricultural workers. The first Surgeon Generals Report
on Smoking released. Medicare and Medicaid programs
were created. Older Americans Act created social and
nutritional programs. Head Start program created.
International Smallpox Eradication program established.
1967: CDC assumes foreign quarantine functions.
1969: CDC provided quarantine procedures, equipment,
for the Apollo moon landings and other US space travels.
10
Lecture a
1970s
1970-1979: National Health Service Corps
created. National Cancer Act passed.
Worldwide eradication of smallpox in
1977.
Health Care Financing Administration
created to manage Medicare and
Medicaid.
11
Lecture a
1980s
AIDS-HIV
1981 AIDS identified
1984 HIV virus identified by PHS and French scientists
1985 HIV detection blood test licensed
Also, passage of National Organ
Transplantation Act and McKinney Act
(health care for homeless). Agency for
Health Care Policy and Research created.
12
Lecture a
1990s
Human Genome Project established; Nutrition
Labeling and Education Act passed; Ryan White
Comprehensive AIDS Resource Emergency
(CARE) Act began providing support for people
with AIDS; establishment of Vaccines for
Children Program (free immunizations to
children in low-income families); Enactment of
the Health Insurance Portability and
Accountability Act (HIPAA); State Children's
Health Insurance Program (SCHIP) created
(enabling states to extend health coverage to
more uninsured children).
13
Lecture a
2000-2009
Human genome sequencing published; HHS
responds to anthrax bioterrorism attack; creation
of Office of Public Health Emergency
Preparedness; Medicare Prescription Drug
Improvement and Modernization Act of 2003
expands Medicare
American Recovery and Reinvestment Act
(ARRA) of 2009 includes the HITECH stimulus
opportunity.
14
Lecture a
Summary Lecture a

15
Similarities and differences between public
and private health
Importance of criteria for assigning public
health
Review of history of public health in the
US
Lecture a
References Lecture a
References
Historical Highlights. (2010). Retrieved December 6, 2011, from US Department of Health &
Human Services website: http://www.hhs.gov/about/hhshist.html.
Our History - Our Story. (2011). Retrieved December 6, 2011, from Centers for Disease Control
and Prevention website: http://www.cdc.gov/about/history/ourstory.htm.
Charts, Tables, Figures
7.1 Figure: Severity, Preventability, Prevalence Created by Magnuson, JA (2010).

16
Lecture a

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