Growing concern that public health laws may be inadequate to the challenges that confront public health practitioners has led to adoption of a Healthy People 2010 objective for improved laws and policies. It has also led to concerted efforts to strengthen the legal foundation for public health practice. In this editorial, the authors present a framework for collaborative research, analysis, and development to strengthen public health laws, skill in applying laws, and law-related information resources.
More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed.
The field of bioethics arose in the late 1960s in response to the emerging ethical dilemmas of that era. The field for many years focused in general on the dilemmas generated by high-technology medicine rather than on issues of population health and the ethical problems of public health programs and regulations. The time has come to more fully integrate the ethical problems of public health into the field of public health and, at the same time, into the field of bioethics. Public health raises a number of moral problems that extend beyond the earlier boundaries of bioethics and require their own form of ethical analysis.
The public health community has made important, original contributions to the debate over universal access to health services in the United States. Well before the decision of the American Public Health Association in 1944 to endorse a health plan encompassing virtually the entire populace, prominent public health practitioners and scholars embraced universality as an essential principle of health policy. Influenced by Arthur Newsholme, C.-E. A. Winslow began to promote this principle in the 1920s. Many others came to justify universal medical care as a corollary of the traditional ideal of all-inclusive public health services. By the 1940s, most leaders in the field saw national health insurance as the best way to attain universal access. For the past 30 years, advocates of universalism have asserted a social right to health services.
Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Addressing housing issues offers public health practitioners an opportunity to address an important social determinant of health. Public health has long been involved in housing issues. In the 19th century, health officials targeted poor sanitation, crowding, and inadequate ventilation to reduce infectious diseases as well as fire hazards to decrease injuries. Today, public health departments can employ multiple strategies to improve housing, such as developing and enforcing housing guidelines and codes, implementing “Healthy Homes” programs to improve indoor environmental quality, assessing housing conditions, and advocating for healthy, affordable housing. Now is the time for public health to create healthier homes by confronting substandard housing.
Use of multilevel frameworks and area-based socioeconomic measures (ABSMs) for public health monitoring can potentially overcome the absence of socioeconomic data in most US public health surveillance systems.
Public health officials contributed to the early 20thcentury campaign against Mexicans and Filipinos in Los Angeles. In 1914, the newly established city and county health departments confronted the overwhelming task of building a public health infrastructure for a rapidly growing population spread over a large area. However, for several years public health reports focused almost exclusively on the various infectious diseases associated with Mexican immigrants.
The growing use of social science constructs in public health invites reflection on how public health researchers translate, that is, appropriate and reshape, constructs from the social sciences. To assess how 1 recently popular construct has been translated into public health research, we conducted a citation network and content analysis of public health articles on the topic of social capital.
The prevailing views on the role of public health professionals refer to professionals in the academic world, without taking into account the fact that many public health professionals are government employees. For example, the American Public Health Association states that public health professionals play an active role in communicating public health information to nonscientific audiences, such as the general population or the mass media.
During the American occupation of Japan (1945–1952), young public health officers from the US Army Medical Corps were posted in local US Army military government teams. These young doctors (aged 25 to 27 years), who had not absorbed the strong anti-Japanese tradition of the US military during World War II, seem to have alleviated the initial resentment felt by the Japanese toward the new governors of their homeland. The case of the Kyoto Military Government Team illustrates the Kyoto citizenry’s positive view of some American-directed public health measures. The team’s services helped to counter widely held negative views on colonialism, occupation, and public health; lessened resentment toward the unilateral command structure of the occupation forces; and contributed to improved relations between the United States and Japan at the local level.
Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities.
This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance.
Although not recognized as such, a National Laboratory System (NLS) has existed since the inception of public health laboratory (PHL) testing more than a century ago. The NLS has always relied upon the participation of clinical laboratories, both to report test results that represent public health threats and to submit specimens and isolates to PHLs for additional or confirmatory testing. Historically, a number of factors have hindered the strengthening of the relationships between clinical laboratories and PHLs, but the reality of bioterrorism and subsequent focus on strengthening public-private relationships has stimulated the development of a more robust NLS.
Instruments designed to measure the performance of public health systems at state and local levels were supported by the Centers for Disease Control and Prevention (CDC) and implemented in 2002. This article describes the process and outcomes of a system and tool designed to measure performance of State Public Health Laboratory Systems, accomplished by the Association of Public Health Laboratories (APHL) in partnership with CDC. We describe the process used to develop the instrument and its subsequent pilot testing and field testing in 11 states.
In 1999, the Centers for Disease Control and Prevention (CDC), the Association of Public Health Laboratories (APHL), and the Federal Bureau of Investigation established the national Laboratory Response Network (LRN) for bioterrorism readiness. A more broad application of the LRN is the National Laboratory System (NLS), an effort to promote the 10 Essential Public Health Services and the Core Functions and Capabilities of State Public Health Laboratories (hereafter, Core Functions). State public health laboratories (PHLs) are responsible for leading the development of both the LRN and the NLS in their jurisdictions. Based on the experience of creating a laboratory network in Wisconsin, leadership principles are provided for developing and strengthening statewide laboratory networks of PHLs and clinical laboratories, which can also include point-of-care testing sites. Each state PHL, in the context of these Core Functions and leadership principles, sets its priorities, budgets, and strategic plans. For a limited investment of personnel and funds that will yield a large benefit to public health, a robust state laboratory system can be established.
Local public health laboratories (PHLs) serve many of the same roles as state PHLs and often perform many or portions of the 11 Core Functions and Capabilities of State Public Health Laboratories; however, they differ in several important ways. First, many local laboratories provide testing at the site of patient care (e.g., sexually transmitted infection clinics) or address local environmental issues (e.g., water quality). Second, local PHLs support the missions of local public health departments, which may differ from those at the state level. Third, local PHLs often serve as conduits, collecting specimens for various state-level screening and disease-control programs; and while they may not perform the testing, local PHLs are responsible for tracking specimens, ordering tests, and reporting results. Fourth, local PHLs often serve as surge capacity for state PHLs, particularly for testing to support emergency response. Last, local PHLs work with and are typically co-located in the local public health agency with other public health programs. Local PHL professionals work as a team with investigators, inspectors, and community and public health medical professionals and, thus, are poised to provide rapid and relevant responses to community needs.
Without the modern tools of surveillance, or the ability to develop a national vaccination campaign, local health departments were often on their own in preparing and combating the spread of the disease during the influenza epidemic of 1918. This article reviews the state of public health before the epidemic, seeking to place the reaction to the disease in the context of the evolution of public health. The epidemic struck at a critical time in the history of the nation and of public health, and we must explore not only the tools and technologies that were available to practitioners at the time, but also the authority provided by local and state public health practitioners to apply these tools. Much of public health was rooted in the experiences and practices developed over the previous century in responding to often dramatic outbreaks of cholera, yellow fever, typhoid, and a host of other infectious diseases.
In 2001, Maryland’s court of appeals was asked to decide whether researchers at Johns Hopkins University had engaged in unethical research on children. During the 1990s, Johns Hopkins’s Kennedy Krieger Institute had studied 108 African American children, aged 6 months to 6 years, to find an inexpensive and “practical” means to ameliorate lead poisoning. We have outlined the arguments in the case and the conundrum faced by public health researchers as they confront new threats to our health from environmental and industrial insults. We examined the case in light of contemporary public health ideology, which prioritizes harm reduction over the historical goals of prevention. As new synthetic toxins—such as bisphenyl A, polychlorinated biphenyls, other chlorinated hydrocarbons, tobacco, vinyl, and asbestos—are discovered to be biologically disruptive and disease producing at low levels, lead provides a window into the troubling dilemmas public health will have to confront in the future.
An emerging approach to public health emergency preparedness and response, community resilience encompasses individual preparedness as well as establishing a supportive social context in communities to withstand and recover from disasters. We examine why building community resilience has become a key component of national policy across multiple federal agencies and discuss the core principles embodied in community resilience theory—specifically, the focus on incorporating equity and social justice considerations in preparedness planning and response. We also examine the challenges of integrating community resilience with traditional public health practices and the importance of developing metrics for evaluation and strategic planning purposes. Using the example of the Los Angeles County Community Disaster Resilience Project, we discuss our experience and perspective from a large urban county to better understand how to implement a community resilience framework in public health practice.
The integration of public health practices with federal health care for American Indians and Alaska Natives (AI/ANs) largely derives from three major factors: the sovereign nature of AI/AN tribes, the sociocultural characteristics exhibited by the tribes, and that AI/ANs are distinct populations residing in defined geographic areas. The earliest services consisted of smallpox vaccination to a few AI/AN groups, a purely public health endeavor. Later, emphasis on public health was codified in the Snyder Act of 1921, which provided for, among other things, conservation of the health of AI/AN persons. Attention to the community was greatly expanded with the 1955 transfer of the Indian Health Service from the US Department of the Interior to the Public Health Service and has continued with the assumption of program operations by many tribes themselves. We trace developments in integration of community and public health practices in the provision of federal health care services for AI/AN persons and discuss recent trends.