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Pharmacy in Public Health:
Public Health Systems
Course, date, etc. info
Learning Outcomes
• Explain why public health issues in one country often
become an issue in another country
• List key functions or duties of a public health
organization
• Describe the structure of the U.S. public health
system
• Describe the international public health system
• Explain ways that pharmacists can be involved in the
various levels of the U.S. or international systems
Introduction
• Disease and other public health problems
often cross borders
• Need to share information and coordinate responses
• Most interventions are local, but impact can
be global
• The public health system has grown as its
functions have expanded
• Public and private organizations are involved at all
levels
Case: Spread of Infectious Disease
• SARS case
shows
how a
novel
infectious
disease
can go
from local
to global
quickly
Functions of the U.S. System
• Functions and system have grown over time
• Original focus on reducing spread of disease
• Health improvement, social justice, and
environment protection added as needs arose
• Can summarize major areas with the “Ten
Essential Public Health Services” list
10 Essential U.S. Public Health Services
General Area
Specifics
Monitor
Health status to identify and solve community health problems
Diagnose and investigate
Health problems and health hazards in the community
Inform, educate and
empower
People about health issues
Mobilize
Community partnerships and action to identify and solve health
problems
Develop policies and plans That support individual and community health efforts
Enforce
Laws and requirements that protect health and ensure safety
Link
People to needed personal health services and assure the
provision of healthcare when otherwise unavailable
Assure
Competent public and personal health care workforce
Evaluate
Effectiveness, accessibility, and quality of personal and
population-based health services
Research
For new insights and innovative solutions to health-problems
(Table 3.1, pg 47. Source CDC. National Public Health Performance Standards
Program.)
U.S. Public Health System
Figure 3.7, pg 59
U.S. Public Health
• Source of authority
• Authority to act on behalf of all U.S. citizens
• The is no Constitutionally established role for
federal government in matters of health or public
health unless
• Federal tax laws and oversight of how public funds are used
• Interstate commerce laws that allow federal intervention if
state or national borders are crossed
• Treaties with the American Indian tribes to establish and
limit federal role
• Each state retains “police power” in most matters
of public health
• These powers can be delegated to local governments
Federal Divisions and Agencies
• HHS (Department of Health and Human Services)
• Primary federal agency for public health
• 11 divisions within it
• U.S. Public Health Service is now found within the HHS
• Roles
–
–
–
–
Sets national priorities for health and public health
Supports and funds programs and research
Monitors health of the nation
Interacts with international partners to promote
health
Major Divisions of HHS
Agency
AHRQ
HHS agencies for health (public health) services
Agency for Healthcare Research and Quality
ATSDR
Agency for Toxic Substances and Disease Registry
CDC
Centers for Disease Control and Prevention
FDA
Food and Drug Administration
HRSA
Health Resources and Services Administration
IHS
Indian Health Service
NIH
National Institutes of Health
SAMHSA Substance Abuse and Mental Health Services Administration
CMS
HHS Agencies for human (welfare) services
Centers for Medicare & Medicaid Services
ACF
Administration for Children and Families
AoA
Administration on Aging
(Table 3.4, pg 61. Source: HHS.)
State & Tribal Organizations
• State Health Departments
•
•
•
•
Structure and function vary by state
Usually multiple divisions within the department
Services as connection between local and federal groups
Has police power that it can delegate to local departments
• State Health Boards (Boards of Health)
• Provide oversight of state-level departments
• Hires and advises the director (Health Officer)
• Usually appointed to the position by the Governor
• Tribal Health Departments
• Similar functions as state health departments but usually
smaller in size
• Advisory functions may be provided by mechanisms other
than a health board
Local Public Health Organizations
• Local health department
• Derives its police power from the local government
which was delegated from the state
• Level where one-on-one interactions occur as well as
community interventions
• May consist of a single health officer or a multidepartmental organization
• Many cities and counties form combined departments
through inter-governmental agreements
• Local health boards
• Hires and advises the director of the local health
department
• Appointed to the position by mayor or local government
Global Public Health System
Figure 3.5, pg 56
Functions of WHO

Provide leadership on important health matters

Partner with other public or private organizations as needed

Shape the research agenda and ensure new knowledge is disseminated

Develop standards and set norms and monitor implementation

Promote policy options that are ethical and evidence-based.

Provide technical support and expertise

Monitor and assess the trends in health

Promote change and support the development of its own sustainable
institutional capacity
(Table 3.2, pg 53. Source WHO, International. The Role of WHO in Public Health.)
Pharmacy Roles in Public Health
At the local or state level

Be aware of health boards and task forces

Become involved in education and awareness programs

Report unusual sales volumes for medications or patient complaints

Be an advocate for local citizens and keep eyes open for issues
At the federal level

Participate on task forces within professional organizations

Serve on review panels or government committees

Use national voluntary reporting systems
At the international level

Participate in voluntary medical and humanitarian aid

Raise awareness for international travelers of risks and prevention

Donate money or supplies
Summary
• Because disease can cross borders, public health
systems need to collaborate across borders
• Public health systems exist at local, state, tribal,
national, and international levels
• Both private and public organizations included
• Within the U.S., states have most of the authority
related to public health
• International organizations must rely on voluntary
cooperation to achieve solutions
• Pharmacy can be involved at all levels
Back to the SARS Case
• What did you notice about where and when local,
state, national, and international public health
agencies became involved?
• What happened at the local level in the different
countries?
• How did voluntary versus mandatory reporting
affect the spread of SARS?
• How did the U.S. respond to the threat?
• Federal actions
• State or local actions
• Pharmacy actions
Lai’s List from SARS case
Prepare for:
Patient surge (increased number
of patients)
Sicker patients
Worried Well
Poor communication or
information
Cause
If local hospitals are closed or put under
quarantine, patients will seek other sources of
care and information.
These patients may be sicker than usual but
barred from hospital
Patron who have respiratory symptoms but no
history of exposure
Health officials may change information
frequently to adjust to evolving situation.
Issues
Increase staffing to handle increased traffic
Prepare information for patients
Pharmacists need to review info and help
triage patients
Provide information and reassurance
Seek reliable information sources
Seek local info for current
quarantine/treatment info
Protecting workforce from
Healthcare workers are highly likely to become Use standard and respiratory precautions.
exposure
infected if they work closely with a SARS
Handle items for potentially exposed SARS
patient
patients while wearing gloves.
Need to limit exposure time and closeness
Frequent handwashing
Face masks if counseling coughing or
feverish patients.
Use telephone for counseling
Drop off prescriptions at homes
Bill via credit card numbers to avoid
handling checks or money
Monitor pharmacy staff
Fever is an early sign of SARS.
Take temperature of workers once a shift.
If a family member is sick, put employee on sick If fever is present, send worker to
leave
designated SARS clinic site.
Requests to dispose of potentially Family members of potential SARS cases may Determine local health department
contaminated medications
have unused medications they want to throw
recommendations for disposing of unused
away.
medication products that had been
dispensed to a SARS patient.
Requests for ineffective
Remedies for self-treating SARS may be
Provide patients with most current
prevention and treatment options requested by patients even though they are not treatment and prevention information
effective
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