SECTION 4 Public Health strict risks being overturned by the courts on the grounds that it is unreasonable Box 25-2 Ten Greatest Public Health The courts have generally upheld local and state health Ach ents of 20th Ct encu department laws and regulations when they pertain to the control of communicable diseases. The courts have also upheld laws relating to safe water and subsurface sewage 2. Motor vehicle safe disposal, immunization, regulation of restaurants and food 3. Improvements in workplace safety stores, quarantine or treatment of persons with an infectious 4. Control of infectious diseases disease, investigation and control of acute disease outbreak 5. Decline in deaths from coronary heart disease and stroke 6. Safer and healthier foods and abatement of complaints relating to the spread of infec 7. Healthier mothers and infan tious disease(e. g, rabid animals Outside the area of communicable diseases 9. Fluoridation of drinking water legislatures nor courts have been as supportive 0. Recognition of tobacco use as a health hazard and regulations. Laws yclists and b o wear helmets sometimes have not been enacted or have FromUsCentersforDiseaseControlandPreventionhttp:/ been repealed, despite abundant evidence of their benefits If an individual risk factor for disease can be she a negative public impact, however, such as passive inhalation, legislatures usually support controls, pro the direct fiscal impact is minimal(see Chapter 26) system to be in"disarray, and the "basic six"functions have reappeare important functions of local health D. Responsibilities of Local Public departments ublic health agencies perennially struggle to garn Health Department enough popular and government support to promote health 1.“ Basic six”to0 Essential services and prevent disease effectively. Nonetheless, Americans have benefited greatly from the many achievements of public The best-known description of the responsibilities of local health efforts, in conjunction with laboratory research, clini- health departments emerged in 1940, when six primary areas cal medicine, and sanitary and safety engineering. Box 25 of responsibilities were defined as follows provides the CDC's list of the 10 leading public health achieve- 1. Collecting vital statistics ments of the 20th century. For the 21st century, the following 2. Controlling communicable diseases domains have been defined as "winnable battles, " the public 3. Protecting maternal and child health health priorities areas with proven effective interventions 4. Monitoring and protecting environmental health 5. Promoting health education a Global immunization against polio, measles, rubella, 6. Maintaining public health laboratorie meningitis, pneumococci, and rotaviruses These functions of local health departments, later known as Health care-associated infections the"basic six continue to influence the direction of local a Human immunodeficiency virus(HIV) infection itic filari departments, despite the many changes in the nature of blic health problems over time. However these six func a Mother-to-child transmission of Hiv and congenital tions are not fully adequate to deal with some more recent yphilis public health problems, such as environmental pollution n Motor vehicle injuries rossing state lines and the increased incidence of chronic Nutrition, physical activity, and obesity degenerative diseases. For a time,public health leader Teen pregnancy debated the proper functions and responsibilities of Tobacco use(especially smoking) health departments at the local and state level. To help health departments in evaluating their work, the CDC has 2. Health Director's Dutie created a National Public Health Performance Standards The programs run by a local health department vary by Public health departments cannot carry out their respo region or county and depend on available funding, state and sibilities without funding by legislative bodies. From the local priorities, and availability of other providers and insti- 1950s to the early 1970s, the danger of infectious diseases tutions. Some local health departments manage a complex seemed to be waning. Consequently, and despite occasional set of services, including mental health and primary care for warnings that communicable diseases were still major underserved populations, which involves managing tea threats, legislatures saw infectious diseases as a diminishing and human resources, analyzing organizational perfor threat, and funding for public health agencies decreased mance,and overseeing budgeting analysis. Health directors The emergence of legionnaires disease and Lyme disease in must adhere to applicable federal and state rules when they the mid-1970s was soon followed by toxic shock syndrome, hire, evaluate, and fire employees. Directors must also ensure AIDS, multidrug-resistant tuberculosis, and the resurgence that employees are supervised appropriately, including of other infectious diseases . By the time society began to regular performance evaluation, pay equity to comparable awaken to the problem of the emerging public health dis- jobs, and compliance with grievance process(see Chapter eases,the IOM and others considered the public health 28). Particular challenges arise if different staff members