ASTHO: THE WHO, WHAT & WHY

Understanding Why Public Health Matters

WHO WE ARE
WHY WE DO
WHAT WE DO
 LEADERSHIP

POLICY & ADVOCACY

CAPACITY BUILDING
HOME
ADVOCATE
 RESEARCH & REFERRAL
SUCCESS STORIES
CASE STUDIES
FOCUSED TECHNICAL ASSISTANCE
LEARNING COMMUNITIES
DEMONSTRATION PROJECTS
LEARNING COLLABORATIVES
OUR LEADERSHIP
OUR AFFILIATES
HOW WE WORK
WITH STATES
Governmental public health at
the local, state, and federal
levels
Governmental Public Health
Who has responsibility for the publics health?
Health is devolved to the states what does that mean?
Every state governmental organized slightly differently how so?
Local delivery of public health services is varied and usually the result
of local and state politics
Governmental public health plays a critical role in health promotion
and disease prevention as well as gap filling
Your Day Today
How was governmental public health involved?
Core Functions of Public Health Steering Committee:
Public Health in America
Core Functions of Public Health
Assessment
Policy development
Assurance
Purpose of Public Health
Prevent epidemics and spread of disease
Protect against environmental hazards
Prevent injuries
Promote and encourage healthy behaviors
Respond to disasters and assist communities in recovery
Assure the quality and accessibility of services

http://iom.edu/Reports/1988/The-Future-of-Public-Health.aspx
http://www.health.gov/phfunctions/public.htm
Ten Great US Public Health Achievements (19001999)
Vaccinations
Safer workplace
Safer and healthier food
Motor vehicle safety
Control of infectious diseases
Decline in deaths from coronary heart disease and
stroke
Family planning
Recognition of tobacco use as a health hazard
Healthier mothers and babies
Fluoridation of drinking water

Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
What does What does
medicine do? public health do?
Saves lives one at a time Saves lives millions at a time
Federal Public Health Responsibilities

Ensure all levels of government have the capabilities to provide essential

public health services
Act when health threats may span more than one state, a region, or the
entire nation
Act where the solutions may be beyond the jurisdiction of individual states
Act to assist the states when they lack the expertise or resources to
effectively respond in a public health emergency (e.g., a disaster,
bioterrorism, or an emerging disease)
Facilitatethe formulation of public health goals (in collaboration with state
and local governments and other relevant stakeholders)

Source: Trust for Americas Health. Public Health Leadership Initiative: An Action Plan for Healthy People in Healthy Communities in the
21st Century. Washington, DC. 2006.
State Health Agency Funding by Source (n=48)

Other State Funds

16% State General
Funds
23%
Other Sources
5%

Fees and Fines

7%

Medicare and
Medicaid
4%

Federal Funds
45%

Source: ASTHO: Profile of State Public Health, Volume Two, 2011

Source: Association of State and Territorial Health Officials. ASTHO Profile of State Public Health, Volume Three. Washington, DC: Association of State and Territorial Health Officials. 2014. 35
Local Governmental Public Health

TYPES OF LOCAL AND STATE GOVERNMENTAL

PUBLIC HEALTH HEALTH RELATIONSHIPS

Local

Mixed

Shared

State
State and Local Health Department
Governance Classification System
Local/DecentralizedLocal health departments are units led by local governments,
which make most fiscal decisions.

MixedSome local health departments are led by state government, and some are
led by local government. No one arrangement predominates in the state.

State/CentralizedAll
local health departments are units of state government,
which makes most fiscal decisions.

SharedAll local health departments are governed by both state and local
authorities.

Source: ASTHO Profile of State Public Health, Volume Two, 2011

Territorial Health Agencies/Insular Areas
The 6 US territories
Puerto Rico
Guam
US Virgin Islands
American Samoa
Commonwealth of the Northern Mariana Islands
District of Columbia

The 3 Freely Associated States (sovereign nations in a Compact of

Free Association with the US)
Republic of the Marshall Islands
Federated States of Micronesia
Republic of Palau
Tribal Public Health

TribalHealth Departmenta corporation or organization

operated under the jurisdiction of a federally recognized tribe,
or association of federally recognized tribes, and is funded by
the tribe(s) and/or contract service(s) from the Indian Health
Service (IHS).

Tribal
Health Organizationsinclude Tribal Health
Departments, Indian Health Service Units, Area Indian Health
Boards and Urban Indian Health Centers (a much broader
group, and relates to a variety of entities that might provide
health services in a tribal setting).
Public Health System

Civic Groups
Schools Nursing Homes
EMS Neighborhood Community
Organizations Nonprofit Centers
Organizations

Hospitals Home Health

Drug Public Health
Laboratories
Treatment Agency
Doctors
Mental Health
Law Faith Institutions
Enforcement Fire
CHCs Tribal Health Transit

Employers Elected Officials

Corrections
Source: Public Health Practice Program Office, Centers for Disease Control and Prevention , National Public Health Performance
Standards Program, User Guide (first edition), 2002. (Current version available at www.cdc.gov/nphpsp)
A system of partnerships that includes,
but is not limited to . . .
Media Churches Schools
Businesses

Philanthropy
Federal DHHS Healthcare
State Health Departments Providers
Justice and Law Local Health Departments
Enforcement Tribal Health
Environmental
Health
Community
Coalitions Mental
Transportation Community Health
Services
An integrated system of partnerships to
improve health

Media Churches Schools

Businesses

Philanthropy

Federal DHHS Healthcare

State Health Departments Providers
Justice & Law Local Health Departments
Enforcement Tribal Health
Environmental
Health

Community
Coalitions Mental
Transportation Community Health
Services
Safety Net or Gap Filling Programs
TANF (ACF)
Community Health Center Program (HRSA)
Maternal and Child Health Block Grant (HRSA)
Maternal, Infant & Early Childhood Home Visiting (HRSA)
SNAP & WIC (USDA)
Substance Abuse Block Grant (SAMHSA)
Ryan White HIV/AIDS Program (HRSA)
Prevent Block Grant (CDC)
317 Immunization Program (CDC)
Title X Family Planning Program (HHS/OPA)
Public Health Emergency Preparedness (CDC)
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