Chapter 4

Public Health: What It Is and How It Works, 2^nd Edition

CHAPTER 4: LAW, GOVERNMENT AND PUBLIC HEALTH

Objectives
Directions
Individual Exercises
Group Exercises
Late Breakers
Self Assessment

Objectives

After completing this part of the textbook, learners will be able to:

identify strategies used by governments to influence the health status of their citizens
describe how various forms of law contribute to the ability of governments to influence health
describe how administrative law processes are carried out by public health agencies
name the various federal health agencies and describe their purpose and major activities
identify different approaches to organizing health responsibilities within state government
describe common features of local health departments in the U.S.

describe how public health’s activities are carried out by state and local government

Directions

Read Chapter 4 of the Public Health: What It Is and How It Works, 2^nd edition.
Review each of the debate positions discussed in class. After reviewing these positions, identify the position that you feel is most effectively presented in this debate and why. Submit your response and prepare to discuss the reactions from other learners during class.
After you have completed this chapter, begin the series of individual exercises for learners listed below. Several of the Internet web sites you visited in previous modules will be useful for exercises related to Chapter 4.
Work with your group to complete the group exercises described below. By now you should be well established in your group.
After completing the individual and group exercises, take the self-assessment quiz for Chapter 4.
Each learner is required to attend a meeting of an official board of health and to provide a brief report on that meeting (no more than 300 words describing the issues raised, interests represented, and roles demonstrated by the board at that meeting). Since most boards of health meet only once a month, it is important that you plan this visit well in advance.

Individual Exercises

Everyone will submit a brief response (approximately 100 words) to each of the following discussion questions and exercises.

What is the basis for the historical tension between the powers of the federal government and the powers of states in public health matters?
How extensive is administrative law in public health, and how does it work? Cite a recent example of important public health rules or regulations in the news media. (Several media web sites are included in the catalog of public health web sites on the Additional Resources document.)
Describe the basic structure of a typical local health department (LHD) in the United States in terms of type and size of jurisdiction served, budget, staff, and agency head. (The National Association of County and City Health Officials web site may be useful here!).
For the prevention of motor vehicle injuries (see "Public Health Achievements in Twentieth-Century America: Motor Vehicle Safety" from pages 155-159 of the text), how are responsibilities assigned or delegated among the three levels of government (federal, state, local) and among various agencies of those levels of government? Who is responsible for what?
What are the primary federal roles and responsibilities for public health in the United States? How do those roles and responsibilities comport with PHS agency budget requests for federal fiscal year 1999 (see text Figure 4-4) or with proposals included in the federal budget for fiscal year 2001 ?
Review both the History of Selected Public Health Events in Chicago (from Module 1) and History of CDC (Exhibit 4-2 in Chapter 4 of the text). Do you think that the evolution of the local and federal public health agencies described in these documents has taken parallel pathways? How has their development differed in terms of roles and responsibilities? What are the implications of these similarities and differences for public health problems that require more than one level of government?
Access the web sites of any 2 U.S. state health departments in the U.S. and compare and contrast the 2 organizations in terms of their structure, general functions, specific services, resources, and other important features. (The Association of State and Territorial Health Officials' link to State health agency web sites may be useful here.)
Develop a "Top 10" list of the most important lessons and themes from this part of the textbook.

Group Exercises

Each group should complete Public Health Practice Exercise 1. Completion of this exercise extends over the period covering Chapters 2 through 4 of the course.

Late Breakers

This is a compendium of additional references and web links to selected sources cited in the readings. Also included are selected materials that have become available since the publication date of the text. All links to case studies, web sites, and other documents can also be found on the "Additional Resources" site.

Dillenberg J, Atchison CA, et al. Estimated Expenditures for Essential Public Health Services—Selected States, Fiscal Year 1995. MMWR 1997;46:150-152
Gordon RL, Gerzoff RB, Richards TB. Determinants of US Local Health Department Expenditures, 1992 through 1993. AJPH 1997;87:91-95 (abstract)
U.S. Public Health Service. Plagues and Politics (a video history of the US Public Health Service, 24 minutes. (To view and hear this video clip you will need a sound card on your computer and the RealVideo player which is available for free from http://www.real.com)
University of Washington School of Public Health and Community Medicine, Northwest Center for Public Health Practice. "The Invisible Safety Net: Part 2"--a CDC-funded video describing public health and its core functions. Seattle WA; 1994. (To view and hear this video clip you will need a sound card on your computer and the RealVideo player that is available for free to download from http://www.real.com.)

Self Assessment

A brief self-assessment quiz is available by clicking on Quiz 4.