Public Health System: Structure and function CHAPTER OUTLINE ADMINISTRATION OF U.S ADMINISTRATION OF U. S PUBLIC HEALTH 309 PUBLIC HEALTH A. Responsibilities of the Federal G Commerce 309 A. Responsibilities of the Federal Government 2. Taxation for the General Welfare 309 3. Provision of Care for Special Groups 310 The public health responsibility of the U.S. Federal Govern 4. Funding Federal Legislation 310 ment is based on two clauses from article 1, section 8 of the 5. Coordination of Federal Agencies 3I0 U.S. Constitution. First, the Interstate Commerce Clause B. Responsibilities of States 312 gives the federal government the right" to regulate Com- C. Responsibilities of Municipalities and Counties 33 merce with foreign Nations, and among the several States and with the Indian Tribes Second, the general welfare Basic six " to 10 essential services 314 Clause states that the Congress shall have Power to lay and 2. Health Director's Duties 314 collect Taxes.. for the common Defense and general Welfare 3. Environmental Protection 315 of the United States, Federal responsibility also is inferred II, BROADER DEFINITIONS OF PUBLIC HEALTH POLICY 315 from statements that Congress has the authority to creat and support a military and the authority to negotiate with Ill. INTERSECTORAL APPROACH TO PUBLIC HEALTH 315 Indian tribes and other special groups IV, ORGANIZATIONS IN PREVENTIVE MEDICINE 316 V. ASSESSMENT AND FUTURE TRENDS 316 . Regulation of Commerce VI. SUMMARY 316 The regulation of commerce involves controlling the entry REVIEW QUESTIONS, ANSWERS, AND EXPLANATIONS of people and products into the United States and regulating commercial relationships among the states. People may be excluded from entry to the United States if they have infec- tious health problems, such as active tuberculosis. Products The U.S. Institute of Medicine(IOM)describes the chal- may also be excluded from entry, such as fruits and vegeta- lenges inherent in organizing the public health system for bles if infested with certain organisms (e. g, Mediterranean the 2lst century as follows fruit fly) or treated with prohibited insecticides or fungi cides In the past, similar prohibitions have been extended to The systems and entities that protect and promote the publics the importation of animal products from cattle that might health, already challenged by problems like obesity, toxic envi- contain the prions of bovine spongiform ronments, a large uninsured population, and health disparities, and, as recently in 2011, produce that might be contami- must also confront emerging threats, such as antimicrobial nated with Escherichia coli resistance and bioterrorism. The social, cultural, and global cor The regulation of commercial relationships between texts of the nations health are also undergoing rapid and dra- states has increased over time. Contaminated food products matic change. Scientific and technological advances, such as hat cross state lines are considered to be "interstate com- genomics and informatics, extend the limits of knowledge and merce"; what crosses state lines are harmful microorganisn human potential more rapidly than their implications can be The federal government takes the responsibility for inspect- absorbed and acted upon. At the same time, people, products ing all milk, meat, and other food products at their site of d germs migrate and the nations demographics are shifting production and processing.(In contrast, the state or local in ways that challenge public and private resources government is responsible for inspecting restaurants and food stores. Likewise, polluted air and water flowing from The U.S. public health system was designed at a time state to state are deemed to be "interstate commerce"in pol when most threats to health were infectious, before com lution and come under federal regulation puter information systems, and when local autonomy pi vailed. This chapter describes the structure of the U.S. health 2. Taxation for the General Welfare challenges. Public health systems in other countries are likely The power to "tax for the general welfare"is the constitu- structured very differently but still need to adapt to the same tional basis for the federal government,'s development of challenges most of its public health programs and agencies, including 309