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The Role Of Governments In Public Health: An Overview And Legal Framework

HHS Secretary Xavier Becerra and State Leaders Discuss Black Maternal Health Week | April 14, 2022

Governments at every levelâfederal, tribal, state, and localâplay important roles in protecting, preserving, and promoting the public’s health and safety . In the United States, the government’s responsibility for the health of its citizens stems, in part, from the nature of democracy itself. Health officials are either directly elected or appointed by democratically elected officials. To the extent, therefore, that citizens place a high priority on health, these elected officials are held accountable to ensure that the government is able to monitor the population’s health and intervene when necessary through laws, policies, regulations, and expenditure of the resources necessary for the health and safety of the public.

Modern public health agencies wield considerable power to make rules to control private behavior, interpret statutes and regulations, and adjudicate disputes about whether an individual or a company has conformed to health and safety standards. In the area of health and safety , public health agencies are expected to have the expertise and long-range perspective necessary to assemble the facts about health risks and to devise solutions.

Special Concerns About The Capacity To Meet Local Public Health Needs

In The Future of Public Health , the IOM committee concluded that âno community, no matter how small or remote, should be without identifiable and realistic access to the benefits of public health protection, which is possible only through a local component of the public health delivery systemâ . The rationale behind this finding is clear: If a community is going to be able to meet its own health needs, it must have access to an identifiable public health infrastructure to provide the essential public health services. Today, concerns remain about the availability of an adequate local public health infrastructure, particularly in terms of staffing and communications systems, to provide these services.

Either we are all protected or we are all at risk.

Dr. Jeffrey Koplan,

Formerly, Centers for Disease Control and Prevention

Strengthening The Management Capacity Of Dhhs

From 1993 to 1997, DHHS, like all federal government departments, conducted a reinvention exercise to determine what work it should do and how it could do that work more effectively and responsively. A recent monograph on DHHS and the impact of departmental reinvention efforts in the late 1990s identified two issues of particular significance: the effect of the balance between centralization and decentralization on the management of departmental activities and the relationship of the department with other agencies .

Centralization versus Decentralization: Models for Managing DHHS

If regional offices are to become an integral and valuable part of DHHS, they will require managerial attention and resources for significant staff development or redeployment to obtain the expertise needed in certain program areas .

Interagency Collaboration

This lack of integration is especially evident in the area of health, where health-related programs are already fragmented within DHHS and are widely distributed across cabinet and subcabinet departments outside DHHS. For example, when EPA became an independent agency, it assumed the regulatory functions of environmental protection, yet the key expertise in the human health effects of environmental hazards remains at DHHS in the National Center for Environmental Health at CDC, ATSDR, the National Institute of Environmental Health Sciences at NIH, and some parts of FDA.

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Federal Public Service Workplace Mental Health Strategy

The health and wellness of the federal public service and its employees are vital to each organizations success. We are at our best when our bodies, minds and workplaces are healthy, respectful and supportive, enabling us to work, build and innovate. Having the right workplace conditions will generate high levels of employee engagement while creating high performance organizations.

The federal public service workplace mental health strategy is an important first step in the Governments efforts to build a healthy, respectful, and supportive work environment that strengthens the public service.

The Strategy focuses on three strategic goals:

  • changing culture to be respectful to the mental health of all colleagues
  • building capacity with tools and resources for employees at all levels
  • measuring and reporting on actions
  • Centers For Disease Control And Prevention

    FGDC Steering Committee  Federal Geographic Data Committee

    The CDC is the United States’ primary health protection agency. It conducts research and analysis to protect the population from health threats. The CDC focuses on science and technology to prevent diseases, manages the nation’s biggest health problems that cause death and disability, and promotes healthy and safe behaviors, communities, and environments.

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    Financing The Public Health Infrastructure

    State and local governments traditionally have had financial responsibility for basic governmental public health services, such as workforce training, the development of information systems and the organizational capacity to conduct disease surveillance and prevention programs, the management of public health laboratories, the implementation of population-based prevention and health education programs, and other protections such as water and air quality management, waste disposal, and pest control. Yet the federal government also has a financial responsibility for assuring the capacity of the public health infrastructure at the state and local levels. Unlike the areas of medical care and biomedical research, however, the federal government has never made a similar level of investment in the public health infrastructure, such as the clinical laboratories, surveillance systems, or environmental monitoring systems needed to monitor health and health threats at the state and community levels. In the past, in response to perceptions of great national need, substantial federal investments played a crucial role in the development of the hospital industry and of the biomedical research capacity as well as the expansions of medical schools. What a national government pays for is a critical statement about priorities.

    Lawsuits Against Trump Administration

    In February 2019, Becerra, Governor Gavin Newsom, and 15 other states filed a lawsuit against the Trump administration over the president’s to fund a wall at the southern U.S. border. As of September 26, 2019, Becerra had sued the Trump administration 62 times in total.

    The Trump administration opened 1 million acres in California to and drilling in December 2019. Under the new policy, the proposed new lease sales for oil and gas extraction along “California’s and , touching eight counties and including 400,000 acres of public land”. California officials and agencies, including Becerra, filed a lawsuit against the Bureau of Land Management in January 2020.

    Despite the multiple lawsuits against the Trump administration filed with other state attorneys general, Becerra had not joined antitrust efforts against any major tech companies. His office would not disclose whether it had examined any tech companies and had not endorsed any joint investigations with other states. On December 9, 2020, it was reported that Becerra’s office had joined 47 other states and the in an antitrust lawsuit against , headquartered in California.

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    Improving The Operation And Management Of The Governmental Public Health Infrastructure

    Successfully implementing health policy based on multiple determinants of health and their impact on the health of communities and populations will depend on the effective performance of public health agencies at all levels of government. The committee has discussed the need to strengthen specific aspects of the governmental public health infrastructure at the federal, state, and local levelsâthe competency of the workforce, the integration and enhancement of information and communication networks, and the improvement of the laboratory and organizational capacities to ensure that the essential public health functions are available to all Americans. Another important priority is to improve the management and coordination of the work of public health agencies as they support this goal of protecting and improving the health of the population.

    The State And Local Governmental Public Health Infrastructure

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    Although the states carry the primary constitutional responsibility and authority for public health activities in the United States, public health administration first began in cities in the late eighteenth century . The burgeoning social problems of industrial cities convinced legislatures to form more elaborate and professional public health administrations within municipal governments . City boards of health were established to obtain effective agency supervision and control of health threats facing the population. Only after the Civil War did states form boards of health. County and rural health departments emerged in the early twentieth century . Today, there are more than 3,000 local public health agencies, 3,000 local boards of health, and 60 state, territorial, and tribal health departments .

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    The Federal Public Health Infrastructure

    In contrast to state and local public health agencies, the federal government has a limited role in the direct delivery of essential public health services. Nevertheless, it plays a crucial role in protecting and improving the health of the population by providing leadership in setting health goals, policies, and standards, especially through its regulatory powers. It also contributes operational and financial resources: to assure financing of health care for vulnerable populations through Medicare, Medicaid, Community and Migrant Health Centers, and IHS programs to finance research and higher education and to support development of the scientific and technological tools needed to improve the effectiveness of the public health infrastructure at all levels.

    Freedom Of Information Act Processing Performance

    In the latest Center for Effective Government analysis of 15 federal agencies which receive the most Freedom of Information Act requests published in 2015 , the DHHS ranked second to last, earning an F by scoring 57 out of a possible 100 points, largely due to a low score on its particular disclosure rules. It had deteriorated from a D- in 2013.

    • 1949: Hospital Construction Act PL 81-380
    • 1950: Public Health Services Act Amendments PL 81-692
    • 1955: Poliomyelitis Vaccination Assistance Act PL 84-377
    • 1956: Health Research Facilities Act PL 84-835
    • 1960: Social Security Amendments PL 86-778
    • 1962: Vaccination Assistance PL 87-868
    • 1963: Mental Retardation Facilities Construction Act/Community Mental Health Centers Act PL 88-164
    • 1964: Nurse Training Act PL 88-581
    • 1965: Medicare |Medicare PL 89-97
    • 1965: Mental Health Centers Act Amendments PL 89-105
    • 1965: Heart Disease, Cancer, and Stroke Amendments PL 89-239
    • 1966: Comprehensive Health Planning and Service Act PL 89-749
    • 1970: Community Mental Health Service Act PL 91-211

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    Mental Health In The Workplace: Why It Matters

    Like physical health, mental health is a key aspect of an individuals wellness. Good mental health is vital to everyones engagement in life, their resiliency and their productivity. The World Health Organization defines mental health as follows:

    A state of well-being in which the individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his own community.

    Mental illnesses can take several forms, but depression is by far the most frequently diagnosed mental health condition in the workforce. Depression is now the leading cause of workplace disability in Canada and internationally.

    Anxiety often occurs in conjunction with depression, and chronic job stress leading to burnout is on the rise. Some employees also live with post-traumatic stress disorder or other serious conditions. These challenges are difficult for affected individuals and their families. They are also costly to Canadians in terms of these employees lost potential, accomplishment and contribution.

    Measure Report And Continuously Improve

    Department of Health and Human Services: bureaucracy, citizenship, en ...

    We must agree on a modest number of indicators that we can use to measure progress, frequently take the pulse of our organizations and our workforce, and be transparent about progress.

    Enterprise-wide Objectives

    To guide this work, work plans will be developed based on the following objectives:

    • 3.1 Identify and introduce a set of target measurements to assess and monitor the impact of the Strategy, including measures to overcome data gaps.
    • 3.2 Continue to leverage existing resources, including the triennial Public Service Employee Survey, and use more frequent and targeted surveying and engagement with employees on workplace issues to further understand and measure factors related to mental health in the workplace.
    • 3.3 Report regularly to public servants and Canadians.

    Organization-Specific Objectives

    Deputy Heads will be expected to promote positive mental health and prevent psychological harm due to workplace factors based on the following organization-specific objectives:

    • 3.4 Review available data, current workplace programs, policies and practices to identify risks and areas for improvement.
    • 3.5 Implement corrective action to address risks and improve psychological health and safety in the workplace.
    • 3.6 Establish regular transparent reporting around key data points and indicators.

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    Administration For Community Living

    The ACL focuses on the care and health of older adults, people with disabilities, families, and caregivers. The ACL manages many programs that provide assistance on health and wellness, protecting rights and preventing abuse, strengthening the networks of community-based organizations, and funding research.

    Role Of The Federal Government In Assuring Population Health

    The federal government acts in six main areas related to population health: policy making, financing, public health protection, collecting and disseminating information about U.S. health and health care delivery systems, capacity building for population health, and direct management of services . For most of its history, the U.S. Supreme Court has granted the federal government broad powers under the Constitution to protect the public’s health and safety. Under the power to âregulate Commerce . . . among several statesâ and other constitutional powers, the federal government acts in areas such as environmental protection, occupational health and safety, and food and drug purity . The federal government may set conditions on the expenditure of federal funds , tax commodities whose use results in risky behavior , reduce taxes for socially desirable behaviors , and regulate persons and businesses whose activities may affect interstate commerce .

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    Health Human Resource Strategy

    The Government of Canada is committed to improving Canadians access to sustainable, publicly funded health care services for all Canadians.

    The move toward a dynamic Health Human Resource Strategy builds upon the important work of Commissioner Roy Romanow and the Senate Committee chaired by Michael Kirby, which reviewed Canada’s current health-care system and made recommendations for its improvement.

    Building on the First Ministers’ 2003 and 2004 Accord commitments to health human resources, the Pan-Canadian HHRS was launched in 2004/05 to support effective co-ordination and collaborative health human resources planning across the country.

    Centers For Medicare & Medicaid Services

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    CMS administers the Medicare and Medicaid programs as well as oversees the Children’s Health Insurance Program , the Health Insurance Portability and Accountability Act , the Clinical Laboratory Improvement Amendments and more.

    In 2009, CMS was charged with several key tasks for advancing health IT via the Health Information Technology for Economic and Clinical Health Act, including the implementation of EHR incentive programs, defining the meaningful use of certified EHR technology, drafting standards for the certification of EHR technology, and updating the health information privacy and security regulations under HIPAA.

    Many of these efforts are being done in conjunction with the Office of the National Coordinator for Health Information Technology , which also comes under HHS.

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    Federal Government Resources And Statistics: Health & Human Services

    • Catalog of Federal Domestic AssistanceDatabase of all Federal programs available to State and local governments federally -recognized Indian tribal governments Territories of the United States domestic public, quasi-public, and private profit and nonprofit organizations and institutions specialized groups and individuals.
    • Federal Emergency Management Agency Database of all Federal programs available to State and local governments federally -recognized Indian tribal governments Territories of the United States domestic public, quasi-public, and private profit and nonprofit organizations and institutions specialized groups and individuals.

    Us Department Of Health And Human Services

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    U.S. Department of Health and Human Services, executive division of the U.S. federal government responsible for carrying out government programs and policies relating to human health, welfare, and income security. Established in 1980 when responsibility for education was removed from the Department of Health, Education, and Welfare, it consists of several agencies including the Administration for Children and Families, the Administration on Aging, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Indian Health Service, the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration.

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    Understanding The Us Department Of Health And Human Services

    The Department of Health and Human Services was originally founded as a Cabinet-level department in 1953 as the Department of Health, Education, and Welfare . In 1979, the Department of Education Organization Law created a separate Department of Education. The remaining agencies were reorganized as the Department of Health and Human Services on May 4, 1980.

    The HHS provides grant opportunities and guidance related to the Covid-19 pandemic that individuals can apply for on its website.

    HHS implements parts of the Affordable Care Act, enforces the HIPAA Privacy Rule, ensures that human-subject research conducted by Department-funded institutions obeys regulations, and operates the Head Start program for children. It is also the largest grant-making agency in the country.

    Role Of State And Local Governments In Assuring Population Health

    Federal Leadership Development Programs

    States and their local subdivisions retain the primary responsibility for health under the U.S. Constitution. To fulfill this responsibility, state and local public health authorities engage in a variety of activities, including monitoring the burden of injury and disease in the population through surveillance systems identifying individuals and groups that have conditions of public health importance with testing, reporting, and partner notification providing a broad array of prevention services such as counseling and education and helping assure access to high-quality health care services for poor and vulnerable populations. State and local governments also engage in a broad array of regulatory activities. They seek to ensure that businesses conduct themselves in ways that are safe and sanitary and that individuals do not engage in unduly risky behavior or pose a danger to others , and they oversee the quality of health care provided in the public and private sectors.

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