CH AP T ER 25 Public Health System: Structure and Function with similar responsibilities are paid from different payrolls ll. BROADER DEFINITIONS OF PUBLIC e.g.,county, city, state, grant funders). In addition to running these services, the health director HEALTH POLICY serves as the chief health policy advisor to local elected offi cials for public health, community assessment, access to The current view of public health policy in the United medical care, and financing of health and medical care. The States is narrower than that in the world public health director also serves as the chief public health educator for ene. According to the Ottawa Charter for Health Pro- politicians and the public, to ensure ongoing funding, grass- motion, which guides much of the international work in roots support, and collaboration with community groups this area, health promotion requires that all policies be and health care institutions reviewed for their health impact and adjusted to strengthen rather than hinder, the effort to achieve good health, as 3. Environmental protection follow Among the functions of local health det,d inspecting septic Health promotion goes beyond health care. It puts health on the akers in all sectors and at all levels, di systems are among the most important them to be aware of the health consequences of their decisions and to accept their responsibilities for health RESTAURANT INSPECTION Health promotion policy combines diverse but complemen tary approaches including legislation, fiscal measures, taxation Most contamination occurs through just a few breakdowns: and organizational change. It is coordinated action that leads to unwashed hands, improper cooking, improper storage, health, income and social policies that foster greater equity Joint unclean utensils, and contact between food and nonfood ributes ing safer and healthier goods and surfaces. Local food regulations vary by county and district services, healthier public services, and cleaner, more enjoyable However, most local health departments inspect restaurants environments episodically, assign points for violations of code depending Health promotion policy requi on the gravity of violations, and provide grades to restau in non-health sectors rants as a summary assessment (A-F or colors ). Health and ways of removing them. The aim must be to make the nspectors particularly look at five critical items(sometimes healthier choice the easier choice for policy makers as well. called"red items") that pose an immediate health hazard, The switch from public health policy to healthy public poli a Improper hand hygiene ies is subtle but important. The point of this app Food is not kept at temperatures high enough or low that all public policies must be evaluated and, if necessary enough to inhibit bacterial growth modified for their impact on public health a Incorrect sanitizer concentrations of dishwasher or clean ing solutions a Cross-contamination between raw and cooked products l. INTERSECTORAL APPROACH TO ■ Plumbing hazards PUBLIC HEALTH If an establishment is found to pose an immediate hazare or if it has a history of persistent failure to comply with So far, this chapter has emphasized the role of specific recommendations, health inspectors can shut it down. In . S. public health agencies at the federal, state, and local those cases, the establishment usually cannot reopen until vever, as the Ottawa Charter emphasizes, many the health inspector has returned to confirm that the viola- duties with public health implications are carried out tions have been corrected. Some departments also perform by government agencies that are not usually considered compliance inspections for restaurants with borderline"health agencies. Departments of agriculture are respon scores to document improvement sible for monitoring the safety of milk, meat, and other agri cultural products and controlling zoonoses(animal diseases WASTEWATER DISPOSAL that can be spread to humans). The U.S. Department of Agriculture (USDA)also administers the program for Many rural areas have no central sewage system. Every new Women, Infants, and Children(WIC), which supports low building needs a septic tank and a drain field, the size of income women and children up to age 5 who are at nutri- which varies with the drainage pattern and depth of the tional risk by providing foods to supplement diets and topsoil. Otherwise, raw sewage may contaminate an aquifer financial support. This program has a substantial impact on and pollute everybodys drinking water. Given the amount food choices, childhood obesity, and oral health. Depart- of money involved in developing land and the potential for ments of parks and recreation must monitor the safety of damage, the health director and environmental staff need to water and sewage disposal in their facilities. Highway depart- coordinate closely with local and county officials in planning ments are responsible for the safe design and maintenance and zoning and the granting of building permits. of roads and highways. Education departments are charged In an age of vanishing rain forests, receding polar ice caps, with overseeing health education and providing a safe and and progressive climate change, environmental protection healthful environment in which to learn. Government has taken on new meaning, Such issues as conservation and departments that promote a healthy economy are crucial biopreservation intersect meaningfully with public health, as well, because when an economy falters, the people's health addressed in Chapter 30