SECTION 4 Public Health Because health is the result of the entire fabric of training programs. Chapter 15 provides more details on environment and life of a population, a true public health training for physicians pproach must be intersectoral; that is, it must consider the health impact of policies in every sector of a society and government, not just in the health sector or medical ca V. ASSESSMENT AND FUTURE TRENDS sector. Moreover, a true public health approach must also consider the health impact of policies on the planet more In its 2002 report the IOM assessed the state of the U.S broadly, being mindful of the health of entire ecosystems public health system as follows see Chapter 30). The perspectives of the Ottawa Charter and intersectoral policy analysis are foundations for the broader, The governmental public health infrastructure has more community action-oriented approach to public health from political neglect and from the pressure of political agendas currently emphasized in Europe and elsewhere. This and public opinion that frequently override em approach is sometimes called"the new public health" Under the glare of a national crisis [attacks of 9/11/2001], policy the"healthy communities"approach. The healthy com makers and the public became aware of vulnerable and outdated munities movement is also active in the United States"(see health information systems and technologies, an insufficient and inadequately trained public health workforce, antiquated The United States is fortunate to be home to many vol laboratory capacity, a lack of real-time surveillance and epide untary health agencies and other nongovernmental organi zations(NGOs)whose focus is to prevent or control diseases tions gical systems, ineffective and fragmented communica- networks, incomplete domestic preparedness and and promote health. Some focus on certain diseases(e. g emergency response capabilities, and communities without American Heart Association [AHA), American Lung Asso- to essential public health services. These problems leave ciation [ALA)), and others confront a related group of dis the nations health vulnerable--and not only to exotic germs ases(e.g, American Cancer Society [ACS]). Sometime nd bioterrorism ps join forces; cigarette smoking is a major risk factor for heart disease, lung disease, and cancer, so the AHA, Ala In response to this report and other voices, DHHS has nd aCs have worked together to curtail smoking. These grant programs to organizations raise money for research, public education, upgrade and integrate information systems, and developed patient care, such as Planned Parenthood, which strives for health departments. However, much remains to be done so agencies strive to fill the gaps left by the public health sysle a comprehensive approach to reproductive health. These that the public health system can maintain the gains made n the 20th century and prepare for the challenges of the 21st At the same time, these agencies form important stakehold entury ers that can substantially influence the success or failure of public health initiatives MMARY ⅣV. ORGANIZATIONS IN Public health services in the United States are provided by the federal, state, and local levels of government, although PREVENTIVE MEDICINE the primary authority for health lies with the states. The federal government becomes involved in health mostly by Many organizations in the United States emphasize public regulating international and interstate commerce and btt ealth and preventive medicine; the largest is the American power to tax for the general welfare. Local governmen Public Health Association(APHA), with annual meetings become involved in health as the states delegate authority for typically bringing together 12,000 to 15,000 people. APHa health to them. The fundamental health responsibilities have has gradually changed from an organization focusing or expanded greatly from the"basic six "minimum functions, science and the practice of public health to one emphasizing when infectious diseases were the greatest concern, to a large though and diverse set of functions that now include the control of some sections still emphasize science or practice. It publishes chronic diseases, injuries, and environmental toxins(preven the American Journal of Public Health and welcomes as tive medicine). In the intersectoral approach to public health, members anyone who is trained in, working in, or just inter all public policies are scrutinized for their impact on health estedinpublichealth(www.apha.or Other organizations that promote the health of commu- Ref nities include American College of Preventive Medicine erences (ACPM) and Association of Teachers of Preventive Medi- 1. Institute of Medicine(IOM): The future of the publics health cine(ATPM). With ATPM, ACPM copublishes the american in the 21st century, Washington, DC, 2002, National Journal of preventive Medicine and cosponsors a yearly con- AcademiesPress.http://books.napedu/catalog/10548.htmlon ference on prevention science and policy. ATPM members include university faculty, preventive medicine residency 2.USDepartmentofHealthandHumanServices:2012.http:// program directors and faculty, and others interested in 3. IOM: The future of public health, Washington, DC, 1988, ching health promotion and disease prevention in schools of medicine, public health, and other health professions. The 4. Centers for Disease Control and Prevention(CDC): Injury goal of ATPM is to improve e research, training, and practice bicycle helmets. MMWR 44: 1-17, in preventive medicine and to support the funding for 1995