Structural and Functional Foundations of Public Health Niyi Awofeso, 2012. http://www.health.gov.au/internet/main/publishing.nsf/content/67596e625213cbcfca25785b00105b24/$ File/SES%20Org%20Chart%20190511.pdf Source: CDHA, Canberra 2009, Niyi Awofeso, 2009 1
Aims Understand the evolution of Public Health Agencies, and how they differ from Public Health Systems. Be familiar with basic Public Health organizational structures and action-based structures. Highlight core functions of Public Health in Australia, and internationally. 2
Recommended Readings Lower et al. Implementation of Australian Public Health Functions in Western Australia. Australian New Zealand Journal of Public Health, 2004; 28: 418-425. 3
Evolution of Public Health Agencies Public health agencies originated as charities. Quest for social justice: moral foundation of modern public health. Related to Koran s Zakat ul Ma al; Christian charities. 1842: The Chadwick Report highlighted how the 4 Ds of industrialisation - dirt, disease, deprivation, and death - were creating serious public health issues. Report accepted by Peel s government in 1844. The Irish Potato Famine from 1845 caused 1.5 million deaths & millions of economic refugees. UK Cholera epidemic of 1847/48 strengthened support for centralised action to address public health. 4
Public Health: From charity to rights Article 12 of the 1976 International Covenant of Economic, Social and Cultural Rights recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. This human right is characterised by: Universality, Progressive realization and irreversibility, Availability, Accessibility, Non-discrimination and equity, Quality & Cost-freeness. http://www.internationalbudget.org/themes/esc/health.pdf 5
Evolution of Public Health Agencies http://www.sesiahs.health.nsw.gov.au/public_health_unit/public_health_history.asp 1848 Public Health Act. Edwin Chadwick s view: filth & immorality of the poor - not economic policies - were principal causes of disease. Eligibility criteria for establishing Local Boards of Health: Total Mortality Rate > 23/1000 or > 10% taxpayers vote in support of Health Boards. http://www.indexmundi.com/g/r.aspx?c=as&v=26 The Sanitary Act of 1866: compulsion for local authorities to set up health boards. The Public Health Act of 1875 made compulsory the appointment of a Medical Officer of Health in every sanitary district of England and Wales. Australia: http://www.dhs.vic.gov.au/nphp/publications/broch/sectn002.htm ; 6
Powers of local boards of health Employees: A local board of health was allowed to appoint a number of employees including a surveyor, an inspector of nuisances, a clerk, a treasurer and an officer of health (who had to be a qualified doctor). Sewers: Street Cleansing: Public Lavatories: Slaughterhouses: Street Paving: Pleasure Grounds: Water Supply: Burials: 7
Evolution of Public Health Agencies The phrase Public Health was coined by Edwin Chadwick in his 1842 Report to distinguish actions governments and societies as opposed to private individuals should take to preserve and protect the people s health. Based on this perspective, public health agencies were structured primarily as government agencies, managed, initially by General & Local Boards of Health in the UK, and currently by Area Health Services in Australia (http://www.wacountry.health.wa.gov.au/default.asp?documentid=396). 8
Queensland Health Org. Structure 9
NSW Public Health Structure http://www.health.nsw.gov.au/seslhd/ 10
NSW Public Health Functions http://www.health.nsw.gov.au/resources/govreview/pdf/governance_report.pdf 11
Example: Public Health Agency of Canada (http://www.phac-aspc.gc.ca/index-eng.php ) What We Do: The role of the Public Health Agency of Canada is to: Promote health; Prevent and control chronic diseases and injuries; Prevent and control infectious diseases; Prepare for and respond to public health emergencies, and strengthen public health capacity FAQ: H1N1 Flu Virus (Human Swine Flu) is a strain of the influenza virus that usually affects pigs, but which may also make people sick. H1N1 flu virus (human swine flu) is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu 12
Example: US Public Health Agency 13
Example: organizational Structure, Uganda Ministry of Health 14
Characteristics of contemporary Public Health Agencies They are bestowed with legal powers to initiate and implement policies primarily related to health health authorities They are under administrative and financial control of government Departments of Health. Few exceptions. They have primary responsibilities for public health inspections, surveillance, audits, and coordination of health issues in the community. In Australia, most public health agencies (i.e. Area Health Services) have administrative and financial control of public hospitals. 15
Encumbrances on Public Health Agencies Funding limitations Limited mandate to engage in advocacy activities Limited scope for engaging in human rights issues Limited scope for intersectoral collaboration Limited influence on health issues outside of geographical area of funding 16
What are Public Health Systems? http://www.youtube.com/watch?v=iis6zqxupau Government & private agencies and organizations whose primary objectives include promoting physical and mental health and preventing disease, injury, and disability. In ideal circumstances, public health agencies (e.g. PHUs) form the nerve centre of public health systems. In poorly managed societies (e.g. Somalia and Afghanistan), public health systems may or may not include public health agencies. 17
Components of well-functioning health systems: http://www.who.int/healthsystems/en_hsskeycomponents.pdf 18
Example: US Public Health System The U.S. public health system comprises a wide array of governmental and nongovernmental entities, including: over 3,000 county and city health departments and local boards of health; 159 state and territorial health departments; tribal health departments; more than 160,000 public and private laboratories; parts of multiple federal departments and agencies; hospitals and other healthcare providers; and volunteer organizations such as the Red Cross. Lister, 2005 19
List 4 Public Health System actors that are not part of public health agencies in Australia 1) 2) 3) 4) What are likely collaboration problems between public health agencies and nongovernment public health system participants? 20
Organizational Structures of Public Health: Australian Health Care System (CDHA, 2005) 21
Australia s Health Care System [Source: Australia Health 2008, p9] 22
Action-based structures of Public health Public health s action-based areas. Source: CDC, 2008 23
Action-based structural areas: balancing two broad areas of emphasis Public health s structural areas. Source: CDC, 2008 24
What are core Public Health functions? Those activities (processes, practices, services and programs) which are undertaken in order to protect and promote health, and to prevent illness, injury and disability (Foege, 2004) In practice, mix and hierarchy of Public Health functions depend on relative emphases placed on upstream and downstream health issues. Which public health functions are related to emergency management of disasters like tsunamis? 25
Public health functions in Australia Delphi Study (1999) 1. Research, monitoring and assessment of health status and determinants; 2. Ensuring healthy and safe environments; 3. Health education and community development; 4. Public health policy development and implementation; 5. Public health education and training; 6. Public health management; 7. Prevention, surveillance and control of communicable diseases; 8. Prevention and surveillance of non-communicable diseases; 9. Prevention and surveillance of injuries; 10. Healthy growth and development programs and services; 11. Programs and services for specific population groups 26
WHO Public Health Functions (1998) minimum set of standards Prevention, surveillance and control of communicable and non-communicable diseases; Monitoring the health situation; Health promotion; Occupational health; Protecting the environment; Public health legislation and regulations; Public health management; Specific public health services; and Personal health care for vulnerable and high risk populations. 27
US Public Health Functions 3 core functions: Assessment, Policy, and Assurance 28
Assessing public health functions (Source: Commonwealth Fund, 2010) 29
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Public Health Functions in Developing Countries Virtually no formal statement of home-grown public health functions developed so far by Sub-Saharan African countries. Most adopt WHO approach Limited research capacity, poor infrastructure and inadequate workforce In 2006, with a grant from the Bill and Melinda Gates Foundation, the International Association of National Public Health Institutes (IANPHI) was formally created to represent, support, and strengthen the international community of NPHIs in developing locally-relevant public health functions. 31
Assessing public health functions in India (Gupta et al, 2004) 32
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Potential Applications of Public Health Functions Performance Standards measurement Foundation for public health activities Expenditure mapping Determining the capacity required to deliver each function ; assessing whether this capacity currently exists; and building public health capacity where required. Education and training 34
Aims Understand the evolution of Public Health Agencies, and how they differ from Public Health Systems. Be familiar with basic Public Health organizational structures and action-based structures. Highlight core functions of Public Health in Australia, and internationally. 35
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