Introduction to Public Health Overview Transcript by vev19514

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									                           Introduction to Public Health Overview
                                          Transcript


Screen Title         Intro Animation

About 1823: New York falls victim to cholera! Every day is another day with lives lost!

1834: Pacific coast not safe anymore! Cholera claims several lives in one day!

1834: Cholera strikes down 4,500 in St. Louis and 3,000 in New Orleans!

Today, cholera is no longer a threatening disease in the United States or any other industrialized country in
the world.

How did this change?

Public Health science, along with improvements to water treatment and sewage systems, has protected the
public in the United States.

Hello and welcome to this course on "Introduction to Public Health."
Please click on the Next button to proceed. Happy Learning!



Screen Title             What This Course Offers

This course provides an overview of Public Health, from its historical roots to defining what Public Health is
today. It also describes how governmental Public Health in South Carolina (S.C.) is organized.

The course is designed to enhance the following core Public Health competencies:

• Understand the historical development, structure and interaction of Public Health with other health care
systems
• Identify the individual and organizational responsibilities within the context of the Essential Public Health
Services and Core Functions



Screen Title                Why This Course

Did you know, recent polls have revealed the following:

• 78% of Americans are unaware that Public Health has touched their lives (Public Health Brand Identity
Coalition Survey, 2001)

• Public Health is one of the few professions in which workers need no applied formal education

• 80% of Public Health workers enter the field without formal training in Public Health

All of us have much to contribute to the field of Public Health, even though most of us have different
backgrounds and no formal Public Health training. In fact, this variety is one of the great strengths of Public
Health. Many different people with different skills and training make up the Public Health workforce. Because
we are so diverse, we must all have a common understanding of what Public Health is. That way, we can
work together better and can explain to others how we protect and promote health.
Screen Title            Why Is This Course Important?

Let's understand why this course is important.

Even though we each work at different levels and have different responsibilities within the Department of
Health and Environmental Control (DHEC), we are all Public Health workers.

To work effectively as a team, we need a common understanding of what Public Health is today, as well as
its history. Also, we must understand the various roles we play within DHEC and the broader Public Health
system.

This course provides information to help you, a Public Health worker, to better understand these concepts. It
also equips you with new knowledge to support the agency as it moves into the 21st century.



Screen Title               Who Should Take This Course

This course is important to all personnel involved with Public Health. For this reason, Health Services staff
are required to take the course, which will provide that common Public Health understanding that we need to
best work together. Other staff in DHEC outside of Health Services are encouraged to participate as well.



Screen Title          Course Objectives

Upon completion of this course, you will be able to:

• Define Public Health
• Explain the origins and historical developments of Public Health
• Recall the contributions of Public Health
• Differentiate between medical care and Public Health
• Compare the three levels of prevention and recognize examples of each
• Identify determinants of health
• Recognize the levels of the Ecological Model
• Discuss the core functions and essential services of Public Health
• Recognize real-world applications of the core functions and essential services in Public Health practice
• Identify the general organization of Public Health at the federal, state and local levels
• Explain how the individual Public Health professional fits within the Public Health system



Screen Title            Sponsors and Acknowledgments

This curriculum is a project of the South Carolina Public Health Consortium (SCPHC).

SCPHC is an organization of academic and practice partners at the University of South Carolina (USC) and
the South Carolina Department of Health and Environmental Control (DHEC), committed to strengthening
collaborative leadership to influence Public Health priorities, resources and policies that optimize health and
quality of life for all South Carolinians.

The SCPHC is administered by the Arnold School of Public Health at USC and the Health Services Deputy
Area of the South Carolina Department of Health and Environmental Control.

The South Carolina Public Health Consortium would like to acknowledge
Project Manager: Adrienne Ross
Authors: Dorothy Cumbey, Joe Kyle and Lillian Smith
Contributors: Ernie Bell, Lu Anne Ellison and Matt Petrofes from DHEC and Andrea Williams, Donna
Richter, Jerry Dell Girmarc and Ken Watkins from USC

The South Carolina Public Health Consortium would like to acknowledge the following as sources of
information/content for this curriculum:
• History of Public Health, Dr. Max Learner, DHEC
• Introduction to Public Health. New York/New Jersey Public Health Training Center.
   http://www.nynj-phtc.org/intro/default.cfm
• Turnock, Bernard. Basic and Cross-Cutting Practice Competencies for Public Health Workforce
Development. Public Health Foundation.



Screen Title              Certificate in Public Health

The Continuing Education Certificate in Public Health Practice is being developed by the South Carolina
Public Health Consortium. The Certificate program consists of the following six courses.

Click on each course for more information.

Introduction to Public Health: This course provides a comprehensive overview of Public Health concepts and
practices by examining the philosophy, purpose, history, organization, functions and activities of Public
Health practice at the national, state and community levels. Case studies and a variety of practice-related
exercises serve as a basis for learner participation in real world Public Health problem-solving scenarios.
The course covers the history of Public Health; the core functions; 10 essential services; the ecological
model; and the national, state and local organization of Public Health and how the DHEC employee fits
within these systems.

Advocacy and Policy Workshop: This training provides participants with an overview of issues surrounding
advocacy and policy development, including applying advocacy and agenda setting principles in the
formulation of public policy and an overview of the legislative and regulatory processes.

EBPH Program Planning and Evaluation: This course provides training in developing and evaluating
evidence-based Public Health (EBPH) programs. Students will learn the steps of the planning process, be
exposed to the CDC Evaluation Framework and develop a logic model for a program through the course.

Public Health Data: This training provides an introduction to the data used in Public Health, including
definitions of common terms associated with data, the differences between qualitative and quantitative data,
data-gathering mechanisms and methodologies and analysis and presentation of data using charts and
graphs.

Financial Management: This training examines the financing of Public Health and the underlying issues that
influence resource availability on the federal, state and local levels, including an overview of the grant
application process.

Community Assessment: This course explores the components of community assessment and its
importance in the community health-improvement process. Its particular emphasis is placed on the
Mobilizing for Action through Planning and Partnerships (MAPP) process.



Screen Title              Pre-Test

Let’s assess your understanding of Public Health. The following screens consist of a 30 question Pre-Test.
After you have completed the Pre-Test you can exit this Overview course and proceed to the My Courses
section of the LMS to launch the “Introduction to Public Health”.
            Module 1: Overview and Historical Origins of Public Health
                                  Transcript


Screen Title             Intro Animation

Welcome to “Overview & Historical Origins of Public Health,” the first of the three modules in the course.
The mission of Public Health is "to fulfill society's interest in assuring conditions in which people can be
healthy" and "to promote health and quality of life by preventing and controlling disease, injury, and
disability."
This mission is accomplished through an organized set of activities that protect and promote people's health.



Screen Title         Learning Objectives


By the end of this module, you will be able to:
• Define Public Health
• Explain the origins and historical developments of Public Health
• Recall the contributions of Public Health
• Differentiate between medical care and Public Health
• Compare the three levels of prevention and recognize examples of each



Screen Title         Definition of Public Health

What is Public Health? Here are a couple of definitions from Public Health professionals.

• “Public Health is community health."
• “Public Health is concerned with people being able to make healthy choices in healthy communities."


Now let's see what someone in the general public might say that Public Health is.


• "In my town, Public Health takes care of septic tanks and dog bites."
• "When I think of Public Health, I think about the local health department and the free clinic."
• "Public Health? Doesn't Public Health regulate restaurants and swimming pools?"

Screen Title                  Definition of Public Health - Winslow

Charles-Edward Amory Winslow was a very important figure in Public Health, not only in his own country,
the United States, but in the wider Western world. From 1915 to 1945, Winslow was a professor of Public
Health at Yale University. Winslow began his career as a bacteriologist, but he soon broadened his focus to
embrace occupational and environmental health, housing conditions, epidemiology, Public Health
administration, nursing, mental health, and the organization of medical care. Winslow's legacy includes
several monographs that have become classics of Public Health and epidemiology.


In 1923, C.E.A. Winslow defined Public Health as the science and art of preventing disease; prolonging life;
and organizing community efforts for the sanitation of the environment, control of communicable diseases,
education of the individual in personal hygiene, organization of medical and nursing services for the early
diagnosis and preventive treatment of disease, and development of the social machinery to ensure everyone
a standard of living adequate for the maintenance of health.



Screen Title              Contemporary Definitions

Since Winslow, there has been more work done to better define Public Health.


Click on each date to see these more recent attempts to define our profession.


• "Public Health is the organized application of resources to achieve the greatest health for the greatest
number."
• "Public Health is the application of scientific and medical knowledge to the protection and improvement of
the health of the group."
• "Public Health is the effort organized by society to protect, promote and restore other people's health. The
programs, services and institutions involved emphasize the prevention of disease and the health needs of
the population as a whole. Public Health activities change with changing technology and social values, but
the goals remain the same: to reduce the amount of disease, premature death and disease-produced
discomfort and disability."
• "Public Health is the fulfillment of society's interest in assuring the conditions in which people can be
healthy" and "organized community efforts aimed at the prevention of disease and promotion of health. It
links many disciplines and rests upon the scientific core of epidemiology."
• "Public Health is the science and art of preventing disease, prolonging life and promoting health through
the organized efforts of society."



Screen Title          Contemporary Definitions

The discipline of Public Health is also known by its responsibilities.
• Prevent epidemics and the spread of disease
• Protect against environmental hazards
• Prevent injury
• Promote healthy behavior
• Respond to disasters and assist in recovery and
• Assure access to health services


Click on each of the Public Health responsibilities below to learn more about each one.




Screen Title               Why History Is Important

Now that we have explored some of the different definitions of Public Health, let's take a step
back and see where the roots of Public Health began. Why is history important? History helps us
understand how we got to where we are today. It is important to be better prepared to deal with present and
future challenges and to explain how and why our focus has changed and is changing. Also, we learn from
our mistakes and often today's solutions may be tomorrow's problems.
Screen Title               Brief Timeline of Public Health

To begin our Public Health history tour, let's look at a brief timeline of Public Health. Each one of
the major eras indicated below will be discussed in more detail in the following slides. What you
see here is a Brief Timeline of Public Health starting from pre-history to the modern age.


The awareness of the importance of sanitation in human society began in ancient times and
evolved in the Greek and Roman civilizations. In the Middle Ages, there was great decline in
hygiene and sanitation practices. The Renaissance began to shed the weight of the Middle Ages
and rediscover its Greek and Roman roots.


The Age of Enlightenment proved to be the foundation for the great discoveries of the 1800s.
During the 1900s, advances in the field of Public Health prompted a reduction in infant mortality
rate, the discovery of antibiotics and vaccines and the establishment of the World Health
Organization. The 20th and 21st century saw spectacular advances in the fields of family
planning, safety standards, control of infectious diseases and immunizations.


Let's assess your understanding of Public Health. The following screens consists of a ten
question Pre-Test. After you have completed a Pre-Test you have an opportunity to complete the
first module in this course, Module 1 - Overview & Historical Origins of Public Health.


Screen Title               Survive the Tribe


Public Health can be seen from pre-history through the times of Hammurabi in the most ancient
of human activities. From the beginning of our history, human beings have needed to ensure the
survival of the larger community or the tribe. Focus has been beyond the individual to the whole
population. Even the early tribes understood the need to protect mothers and infants. Ensuring
maternal and child health continues to be a major focus of Public Health today.


Screen Title            Requirements for Survival


All people have basic needs that must be met in order for them to survive. We all must protect the conditions
required for survival. All these requirements continue to be essential for group survival and success. These
requirements are:
• Air
• Water
• Food
• Shelter, and
• Care and Mutual Support


Click on each of the basic needs below to learn more about how these needs influence our health.


Screen Title               Public Health Codes


Societies that survive develop Public Health measures such as strong rules, regulations, taboos and powers
to protect the community's health. These are seen throughout time in hieroglyphs and artifacts, oral histories
and religious writings. Health codes are based on society's beliefs and understanding of health and disease.

Here are some examples of early Public Health Codes. Tribal Rules included concepts like restricting where
the tribe camped, what type of water to drink, where animals were allowed, what not to eat and making sure
that children were cared for.

Public Health codes are also imbedded in religious beliefs. In the Bible, the book of Leviticus spells out the
Rabbi's power to evict lepers and demolish their housing, which was based on the fear of the disease and
the misperception that leprosy was easily communicable. Also, both the Bible and Koran have detailed food
codes.

An example from governmental laws can be found from the Roman Senate: Salus populi: suprema lex esta
= "Let the welfare of the people be the supreme law."

Health codes have existed in multiple cultures in virtually all Eastern and Western civilizations and are
imposed by political forces.



Screen Title                Early History


Let's now review how Public Health progressed from historical times.


Click on each image to learn more about each period.


Modern-day Public Health stresses the importance of physical activity and good nutrition. This modern idea
was actually introduced by the ancient Greeks more than 2,000 years ago. Some of the fundamental
concepts used today in modern medicine—such as the Hippocratic Oath and applying science to disease
and illness for medical doctors—came right out of ancient Greece. Hippocrates is known as the Father of
Western Medicine (460 BC).


Like the Romans, we provide water and sewage systems to our citizens, not only for convenience, but more
importantly because these are Public Health programs that have dramatically reduced sickness and death
caused by "bad water." Roman society realized that the public benefited from water and sewage
infrastructure. They paid taxes for these services much as we do in modern society now.



Much of the good coming out of ancient Greece and Rome was lost during the Middle Ages. In this period,
hygiene and sanitation practices greatly declined. As a result, the rate of infectious diseases such as the
Black Death (the plague) and smallpox increased.

The Renaissance began to shed the weight of the Middle Ages and rediscover its Greek and Roman roots.
Fortunately, civilizations in the Middle East (from Iran to Egypt) kept up with the knowledge and science from
Greece and Rome and actually built on this legacy of information. As Europe began to leave the Middle
Ages, scholars throughout the continent were able to use this legacy from the Middle East, Greece and
Rome to develop the foundation of modern-day science and Public Health. Despite these advances,
epidemics continued to ravage Europe. With the beginning of the great explorations of the world (including
Europeans arriving in North America), many diseases such as smallpox, measles and typhoid were spread
far and wide. Galileo and Newton did begin to use the scientific method of discovery, key steps in the
progression to the modern Public Health system.



Screen Title                Recent History
Let's now look at more recent developments in Public Health, beginning with the Enlightenment
and the 19th century, also known as the Great Sanitary Awakening.


Click on each button below to learn more about each.


The Industrial Revolution was bringing about drastic changes in every aspect of human life in Europe and
parts of North America, and yet these societies continued to suffer greatly from rampant infectious diseases
such as smallpox and yellow fever. Life expectancy was still poor in Europe and North America, because of
very high rates of infant mortality. Knowledge of diseases and the human body was increasing, but still, by
our modern standards, it was quite limited. However, these limited advances did provide the foundation for
the great discoveries of the 1800s.


The 1800s are known as the “Great Sanitary Awakening” and the birth of modern Public Health. Our
understanding of disease and prevention exploded in the 1800s in Europe and the United States. The basic
science of Public Health was founded at this time. There was a revival of sanitary measures, including clean
water, food inspection, use of soaps and disinfectants and personal hygiene. Also, the 1800s saw the
beginning of Public Health departments and regulations and public works departments, such as garbage
collection, landfills and street cleaning.




Screen Title               John Snow and the Broad Street Pump


Let's now learn about one of the great pioneers of Public Health, John Snow. John Snow is known
as the “George Washington” of Public Health. He was a man of many interests, a physician to Queen
Victoria and a mathematician. He is also known as the founder of epidemiology, the science of Public
Health. Dr. John Snow did his famous work in the middle of the 19th century.


Roll your mouse over epidemiology to read its definition.


Cholera is a terrible intestinal disease that is mainly spread through contaminated water. Although now
under control in the rich world, it continues to break out in parts of the world that do not have modern
sewage and water services.
In John Snow's day, cholera was a great concern, even in England. He became concerned about the
cholera outbreaks that were then devastating the London population. He made careful observations of the
disease, who caught it and where the deaths occurred.
Dr. Snow identified and stopped the source of the disease using epidemiological practices.
Based on his analysis of the cholera epidemic afflicting London at that time, he had the pump handle
removed from the Broad Street pump, to prevent more people getting infected with cholera water.
Dr. Snow developed a theory of the source of the outbreak, before people understood the role of bacteria in
causing disease and without any modern laboratory supports or computer analysis.



Screen Title               Giants of the 1800s


John Snow was in good company in the 1800s with other Public Health giants, such as Robert Koch, Louis
Pasteur and Florence Nightingale.
Click on the images of these giants to learn about their contributions to Public Health.


Robert Koch was a German physician and considered one of the founders of bacteriology. His great
contributions included determining and identifying the causes of anthrax, tuberculosis and cholera. He
received a Nobel Prize in 1905 for his discovery of the bacteria that causes tuberculosis.


Louis Pasteur changed the world with his elegant proofs for the germ theory of disease. He developed
practical applications including the pasteurization treatment of food products, vaccination to prevent anthrax
and the dramatically successful rabies vaccine. In 1878, he published “The Germ Theory and Its
Applications to Medicine and Surgery” bringing the science of bacteriology to bear on disease prevention.


Florence Nightingale was a pioneer of modern nursing and a noted statistician. She is best known for her
work in the Crimean War, where she introduced female nurses to field hospitals in the 1850s. She published
books on hospital-planning and organization that had a profound effect in England and across the world.
Miss Nightingale was the principal advocate of the 'pavilion' plan for hospitals in Great Britain.




Screen Title               Modern Public Health (1900s)


The 1900s were the beginning of the modern age in Public Health. Important changes during this time
included: death rate in children dropped, average life span increased from less than 40 years to 74 years,
the germ theory more accepted, antibiotics discovered, vaccines developed and World Health Organization
created.



Screen Title             Giants of the 1900s


Public Health progress in the 20th century was dramatic. Following are 10 great achievements of this
century, all of which continue to be very important to our current health and well-being.
• Immunizations
• Motor Vehicle Safety
• Workplace Safety
• Control of Infectious Diseases
• Decline in Heart Disease and Stroke
• Safer and Healthier Foods
• Fluoridation of Drinking Water
• Healthier Mothers and Babies
• Tobacco Recognized as a Health Hazard and
• Family Planning




Screen Title              10 Great Achievements


Three important Public Health giants of the 1900s era were Walter Reed, Rachel Carson and Sabin and
Salk.
Click on the images of these giants to learn about their contribution to Public Health.


Despite the great Public Health accomplishments of the 1800s, humanity was still facing great plagues of
infectious diseases, yellow fever being one of the more important problems. Dr. Walter Reed and others in
the United States Army Yellow Fever Commission, studied yellow fever in Cuba. The commission figured
out how yellow fever virus was spread and identified the type of mosquito that was the vector. With this new
knowledge, mosquito control measures were put in place throughout the southeastern United States. The
last yellow fever outbreak occurred in New Orleans in 1905.

In her 1963 classic, "Silent Spring", Rachel Carson brought the environmental problems the country was
beginning to face to the public's attention. Her linking pesticide use to the death of birds and other wildlife
caused a great stir in the country. This was the beginning of the modern-day environmental movement that
ultimately resulted in many beneficial actions including the passing of the Clean Air and Clean Water Acts
and the creation of the Environmental Protection Agency. She demonstrated dramatically the link between
health and the environment.

Through the use of the vaccines developed by Sabin and Salk, polio was eliminated from the United States
and in many other parts of the world.



Screen Title               The Late 1900s


Many advances in Public Health continued throughout the 20th century, and important programs were
developed. However, at the close of the century new challenges such as HIV/AIDS and the resurgence of
diseases like TB that we thought were eradicated, made us more humble going into the 21st century.




Screen Title                The 2000s


Among the many Public Health issues that confront us in the 21st century are two issues that you have
probably heard about. The first, pandemic flu, has been with us for hundreds of years. The second, obesity,
is a relatively new and modern Public Health issue, one that presents great challenges to our modern world.
In the 21st century, we have achieved dramatic gains in life expectancy by solving many challenges
especially in infectious diseases such as smallpox and yellow fever. From the history and the evolution of
Public Health, we can understand where we are today and how to prepare ourselves to deal with present
and future challenges. As we have always done, we will build on the Public Health legacy from our past.




Screen Title               South Carolina Public Health Events


To complement what you just learned about the history of Public Health, the following section describes the
history of Public Health in S.C. Just as the overall history section showed for the modern world, S.C. has
also overcome many challenges and continues to face important issues that affect the lives of our citizens.
Let us now have a look at a brief history of Public Health in S.C.


The recorded history of Public Health in S.C. begins with the earliest permanent European settlement.
Charleston, founded in 1670, was the largest population center of all the English settlements in S.C. The
historical records from Charleston are about death and misery from widespread contagious and vector-
spread diseases, including smallpox, diphtheria, malaria and yellow fever and the fight against these
diseases.


In 1692, as part of the initial attempts to control the plagues that were terrorizing the citizens, the provincial
legislature forbid swine from running free in the city of Charleston and instructed all property owners to
refrain from littering their land and to cut "stinking weed" in and about the lots and streets.


Although knowledge of germs and how diseases were spread were not understood in colonial S.C., there
was some understanding that diseases were spread from person to person. For example, in 1698 the
provincial legislature required incoming vessels to produce evidence that no persons on board were
suffering from any contagious disease before the ship could dock in the Charleston harbor.


You should be proud to know that S.C. and Charleston specifically was the site of the creation of the first
health officer in America. This took place in 1712, when the provincial legislature passed an act that created
the first provincial health officer in America. He was empowered to board and inspect all incoming ships
before passengers were allowed to come on shore.




Screen Title             Antebellum Public Health


Leading up to the Civil War, Public Health continued to take small but important steps on the path to the
modern-day science of Public Health. Now, let’s have a look at Public Health in the antebellum period.


In 1808, the City of Charleston establishes a board of health with 13 commissioners.


In 1814, the Ladies Benevolent Society of Charleston begins volunteer care of the sick and needy in
Charleston. This is the beginning of visiting nursing programs and Public Health nursing in S.C.


In 1824, the Medical College of S.C. (MUSC) is established by the state legislature.


In 1828, the Robert Mills Building opens as the sixth state-supported mental asylum in the United States.
Today the Mills Building serves as the headquarters for DHEC Health Services.




Screen Title                 Public Health After Civil War


The Civil War left South Carolina in ruins. Disease was the major killer in the Civil War. The camps brought
together people and their diseases, which flourished in the war conditions of poor sanitation and poor
nutrition. There were 204,000 combat deaths on both sides, and more than 471,000 wounded. Diseases and
non-combat injuries claimed more than 417,000 lives, twice as many as the number who died in battle. One
in 10 Northern men and one in four Southern men died or were incapacitated as a result of the war.




Screen Title           Creation of the State Board of Health - 1878


After the Civil War, in December 1878, the S.C. General Assembly created the state board of Health with a
budget of $2,000. The board had these powers and duties:
• It shall be the sole adviser of the state in all questions involving the protection of the Public Health
• It shall make an annual report to the legislature
• It shall have authority to divide the state into health districts
• It shall investigate the causes and means of preventing diseases
• It shall make inspections of the sanitary condition
• It shall supervise the quarantine system and
• It shall recommend law for a system of vital statistics




Screen Title                 Creation of the State Board of Health - 1878


In a report to the legislature in 1881, a special committee of the health board reported: “We declare that
three great scourges have afflicted this country with countless woes, namely: bad air, bad whiskey and bad
biscuits! Their baneful effects cannot be easily exaggerated. The first deteriorates the blood, out of which
are the issues of life and death, the second is the cause of frequent crimes and sufferings and the third
makes us pale, lean and miserable. Bad teaching, though it has no influence on health, from the magnitude
and importance of its evil results, namely the disastrous effects upon the education of youth, whereby the
intellectual standard of the State is lowered, might well constitute a fourth.” Although these words were
uttered over 125 years ago they neatly summarize what we in Public Health are still trying to work on today.


Click on each image to learn about the progress of the State Board of Health.


Francis Porcher was a valedictorian of the 1847 graduating class at the Medical College of the State of S.C.
He was a well-respected writer of several works on the medicinal properties of plants. He was among the
few physicians chosen to represent the United States at international medical conferences in Berlin and
Rome.

In 1908, the State Board of Health hired its first full-time State Health Officer, Dr. Charles Frederick Williams.
The hiring of the first State Health Officer was a major turning point in the history of the agency, as it had
been a voluntary association whose physicians served without pay. The board became a full-time
organization dedicated to protecting the public's health.

The Board of Health grew to include a tuberculosis sanatorium and the Bureau of Vital Statistics in 1915,
and then the Division of Venereal Disease Control in 1918.

Public Health nurse visits rural patients, 1920. In 1921, 358 women died in childbirth or from pregnancy-
related conditions. This was an improvement of 14% from the previous year.

Health education, 1920 style, National Library of Medicine.



Screen Title                 South Carolina Events - Rapid Changes in 1930s through the 1950s


1930 - 1950 brought a revolutionary change in the history of S.C.


Click on each image to learn about the progress in Public Health from the 1930s through 1950s.


Raw sewage was dumped in S.C.'s streams until the early 1970s. This was a marked improvement from
throwing it in the backyard, where it spread hookworm, typhoid fever and dysentery. Garbage was dumped
wherever people wanted to dump it, until the Board of Health began its efforts to control the spread of
typhus—a rat-borne disease carried to man by fleas and lice.
Restaurant sanitation experienced major improvements in the 1940s.

Venereal disease control was a particularly important Public Health function during the war years. There
were dramatic improvements in the treatment of venereal diseases at this time.

Over 25,000 tuberculosis patients were treated in 1945, with 48,000 clinic visits.

Malaria control and investigation was a major activity. The control program was largely one of larvicidal
control. 70,849 gallons of larvicidal oil used, 2,744 miles of ditches and 3,227 acres of ponds controlled by
larvicide. House spraying with DDT began in 11 counties.

Children’s health was an important area of activity. After the development of polio vaccine, major Public
Health immunization campaigns were implemented successfully.

In 1950, S.C. legislature created the Water Pollution Control Authority Board.

Malaria does not occur in S.C. currently. The state board has continued an insect control program. In 1955,
the health departments sprayed 110,487 gallons of chlordane; dusted 40,421 acres with 134,610 pounds of
chemicals; and fogged 694,301 acres with 61,672 gallons of insecticide.

These highly effective pesticides were used to kill the mosquitoes that spread malaria and the rats that
spread typhus. Their use, however, was partly responsible for creating new environmental problems.



Screen Title                1960s-1970s


Public Health in the 1960s and 1970s. The 1960s brought significant change in Public Health programs.
Medicare and Medicaid were created to provide health insurance coverage for the elderly and low-income
populations. The Board of Health developed a home-health nursing service in the mid-1960s to provide care
to homebound patients in need of skilled nursing services. The county health departments were organized
into multi-county Public Health districts.


In 1973 the Board of Health was merged with the Pollution Control Authority to form the Department of
Health and Environmental Control (DHEC).


Since 1973 DHEC has continued to address the Public Health issues facing our state, building on the
pioneering work and legacy of all those who came before us. From the early Roman and Greek scientists to
the initial quarantine efforts in Charleston, to the great pioneering works of Snow, Pasteur, Koch, Nightingale
and Reed, DHEC continues to use science to protect the health of the environment and citizens of our state.




Screen Title              The Face of Public Health


Moving from the historical overview, we are now going to look at modern-day Public Health. Let's look at the
video to recognize the value and contributions of Public Health. Based on the video, please answer the
questions on the following page.

Click the Play button on the video controller to view the video.


Screen Title               Selected Unique Features of Public Health


Let's now have a look at selected unique features of Public Health. While Public Health is a vast and
complicated operation that is challenging to define, it does have several unique features that make it
different from other health-related disciplines and activities. One feature is that it has the core of social
justice. Another is its basic political nature. Next, Public Health is linked with government. Public Health has
an ever-changing agenda with new problems and issues. Public Health is grounded in sciences, including
biological, physical, quantitative, social and behavioral sciences. It has an uncommon culture and bond.
Lastly, Public Health uses prevention as its prime strategy.



Screen Title               The Public Health Perspective


An important concept to understand is the difference between Public Health and medicine. While in the
public's mind Public Health and medicine may be interchangeable concepts, they are in fact very different.
They complement each other well, but each has an important and unique role to play in order to maintain
and improve the health of the public. How is Public Health different from traditional medicine?


Though Public Health and medical practice work together to create a healthy world community, they are
quite different from each other in many ways. We are more familiar with the medical model. You get sick.
You go to the doctor. You’re diagnosed for a condition or illness. You receive treatment either through a
drug or some other course of action.


Let’s have a look at this table to get a better understanding of how the Public Health focus is different. Public
Health is societal; it works for the good of whole, while the medical model focuses on individuals. Public
Health uses epidemiology and medicine concentrates on medical diagnostics. Public Health emphasizes
primary prevention, while medicine emphasizes secondary and tertiary prevention. Public Health provides
education through media, schools, communities and also individuals, but medicine concentrates on
individuals. Public Health uses the tools such as statistics and research; on the other hand, medicine uses
tools such as thermometer and stethoscope. Public Health focuses on the policy and legislation to ensure
healthy environments; medicine focuses on personal responsibility for one's health. Public Health is
dependent on public funds, while medicine charges a fee for services.




Screen Title               Levels of Prevention


Now let's look at the concept of Prevention. Prevention describes the actions taken to keep something from
happening and to minimize damage after something occurs. Within Public Health, prevention aims to reduce
or eliminate the occurrence of disease or its impact. Prevention can also be further broken down into three
different levels, which are primary, secondary and tertiary prevention. All three levels of prevention are
important and play an important role in improving the people's health.

Primary prevention focuses on diseases before they occur, when people may be susceptible. It reduces both
the incidence and prevalence of a disease. An example of primary prevention is smoking-prevention
programs.

Secondary prevention lessens the impact of a disease and refers to early detection when people are
asymptomatic and stopping or modifying behavior. An example of secondary prevention is smoking-
cessation programs.

Tertiary prevention targets the person who already has symptoms of the disease. It keeps those who are
disabled from experiencing more severe effects. The goals of tertiary prevention are to prevent damage and
pain from the disease, to slow down the disease, to prevent the disease from causing other problems, to
give better care to people with the disease and to make people with the disease healthy again and able to
do what they used to do. An example of tertiary prevention is pulmonary rehabilitation programs.
Screen Title              Primary Prevention


Let us now look more closely at these three levels of prevention, starting with primary prevention. Primary
prevention strategies try to keep a disease or injury from occurring in the first place. DHEC programs that
provide primary prevention services include:
• Risk reduction to prevent chronic diseases which addresses issues around physical activity, proper
nutrition and tobacco
• Immunizations for children to prevent the occurrence of vaccine-preventable diseases and for adults to
prevent the occurrence of the flu
• Food service inspections of permitted food service facilities, like restaurants, to make sure that food
preparation techniques are safe so the foods they serve are free from contamination that can cause
illnesses




Screen Title             Secondary Prevention


Secondary prevention strategies seek to identify and control disease processes in their early stages before
signs and symptoms develop. DHEC programs that provide secondary prevention services include:

• Metabolic screening of infants to determine if they suffer from a metabolic condition and take the necessary
steps to prevent further complications from the condition

• Testing for STDs and HIV infection with follow-up treatment, if necessary



Screen Title               Tertiary Prevention


Tertiary prevention strategies prevent disability by restoring individuals to their optimal level of functioning
after a disease or injury has been established and damage is done. The DHEC programs that provide
tertiary prevention include the Home Health program and programs in Maternal and Child Health, such as
the Children with Special Health Care Needs programs.



Screen Title               Tension between Individual and Community Rights


A final concept that you should take away from Module 1 is that there is tension between the rights of an
individual and the rights of the community. Some examples from Public Health are:

Environmental laws that are passed to protect the environment are often in conflict with development and
industry. A landowner does not have the "right" to build anywhere on his or her property. These laws protect
the environment and may keep surrounding properties from flooding.

Immunization requirements for children to attend school protect the children from infectious diseases such
as measles and mumps. However, a family may be against immunizing their children because of religious or
moral convictions. Others may fear that the immunizations will harm their children.

Another area of tension between the rights of an individual and the rights of the community concerns limiting
tobacco use. Many smokers believe that they should have the right to smoke wherever they please. Non-
smokers feel that the smokers are infringing on their right to breathe smoke-free air. Laws currently restrict
smoking in federal buildings and other locations. There is a recent push to restrict smoking in bars and
restaurants. Smokers believe this inhibits their rights. Bars owners are concerned that they will lose
business.
Public Health works to promote the healthiest environment for the most people.



Screen Title               Summary


We have come to the end of the module on overview & historical origins of Public Health. Let us quickly
summarize what we have learned in this module.

This module provided an overview of Public Health from its early history into the 21st century. You also
learned about the current definitions and activities of Public Health today. We compared Public Health and
medical care and highlighted the value and contributions of Public Health to our society. Finally, you learned
about the three levels of prevention and some of the DHEC programs that provide these preventive
services.

Let’s now assess your understanding of Module 1: Overview & Historical Origins of Public Health. The
following screens consist of 10 questions related to the module. Each question is worth 10 points. You have
to score equal or above 50% to proceed to the next module. If you score below 50%, you are advised to
take the module again.

All the best!
                    Module 2: Purpose and Practice of Public Health
                                     Transcript


Screen Title              Introduction

In Module 1, we defined the term Public Health. We also took a walk through the history of Public Health.
We then looked at Public Health versus the Medical Model and the three types of prevention. In Module 2,
we will look at current Public Health issues, the determinants of health, the Ecological Model and the core
functions and essential services of Public Health.



Screen Title         Learning Objectives


By the end of this module, you will be able to:

• Identify determinants of health
• Recognize the levels of the Ecological Model
• Discuss the core functions and essential services of Public Health
• Recognize real-world applications of the core functions and essential services in Public Health practice



Screen Title                Determinants of Health

By the end of the 20th century, researchers found that individual behaviors and environmental factors were
responsible for about half of all premature deaths in the United States. They also found that the many
complex links among these factors determined the health of individuals and communities.

Roll the mouse over each determinant to learn about its scope.



Screen Title                  Leading and Actual Causes of Death

Look at these two tables carefully. You may be familiar with Table 1, or at least have seen references to it in
your work or on television or in the newspaper. Table 2 describes some of the underlying causes of death
that are listed in Table 1.

Heart disease was the most common cause, leading to 710,760 deaths, followed by cancer with 553,091.
167,661 people died of stroke, making it the third leading cause of death. Chronic lower respiratory diseases
accounted for 122,009 deaths.

The table “Actual Causes of Death in United States” describes the 10 non genetic, changeable factors that
contributed to death, or underlying causes of death in the United States for the year 2000. Tobacco was the
leading killer with 435,000 deaths. The next actual cause was poor diet and physical inactivity, which led to
nearly 365,000 deaths, followed by alcohol with 85,000 deaths.

Over the years, the causes of death have changed. There has been a shift from infectious diseases to
behavior-related deaths and chronic diseases.

In summary, these tables indicate that a total of 38% of deaths were caused from a combination of poor diet
and exercise and the use of tobacco and alcohol, all behavior-related factors.

Screen Title               Leading and Actual Causes of Death

The following two examples and table explain this idea of Leading and Actual Causes of Death.
Click here to view a table showing selected behavioral risk factors related to leading causes of deaths in the
United States.

For example, there is no doubt that if No One smoked in the United States as of today, the number deaths
that are caused by heart disease, cancer and stroke would begin to decrease, even if the number of people
who had access to doctors and prescription drugs did not change.

If, all of a sudden, everyone in the United States started exercising and eating the recommended
diet, heart disease, stroke, cancer and diabetes as causes of deaths would begin to decrease as
well. We know this because epidemiology has taught us that people who smoke, eat high-fat
diets or don't exercise very much have a greater chance of dying from the leading causes of
death.

Public Health aims to understand the underlying causes of death and whether some of these deaths could
have been prevented. By looking at the underlying causes of death, Public Health can figure out where it
should put its program efforts. Medicine can work to reduce the suffering of those with heart conditions or
cancer, while Public Health can focus its work on preventing these health problems.



Screen Title               Epidemiology

Before we further discuss the leading and actual causes of death, it is important for you to become more
familiar with the science of Public Health called epidemiology. Epidemiology is the one science unique to
Public Health.

The word "Epidemiology" comes from two Greek words: “Epis," meaning "On" or "Akin " to and "Demos,"
meaning "people."

Epidemiology is the study of the distribution and determinants of disease in populations, seeking the causes
of both health and disease. Epidemiology is the basic scientific tool that Public Health professionals use to
study disease.

The goals of the epidemiological investigation are to identify the source of the infection, the mode of
transmission, the pattern of spread, the responsible agent and effective treatments to prevent further illness.


An Epidemiologist is a medical detective whose work links observed problems with potential causes to arrive
at a diagnosis that assists in design and implementation of a successful response.




Screen Title              Epidemiology Triangle

When investigating disease and injury, epidemiologists identify the agent, host and environment in order to
understand how a disease or injury is caused and how it might be stopped or prevented. The Epidemiology
Triangle is a model that scientists have developed for studying health problems. It helps them understand
infectious diseases and how they spread. It is also used to apply a scientific model to a variety of
circumstances and facts. The model includes Agent, Host and Environment.

Roll the mouse over each component for details.

The Agent, or the microbe that causes the disease, the "what" of the Triangle.

The Host, or the organism that harbors the disease, the "who" of the Triangle.

The Environment, or the external factors that cause or allow transmission of disease, the "where" of the
Triangle.
Screen Title               Public Health Expenditure Management

Now that you know a bit more about epidemiology, think about the leading and actual causes tables we saw
before. Determining the causes of premature death and illness in our society is important because Public
Health resources available to work on prevention are limited. Since we have fewer resources to work with,
we must prioritize our efforts so that we can get the biggest bang for our buck. Note the amount of resources
going towards Public Health compared to non-Public Health activities described below.

Why is it important to know what causes illness and premature death?

For instance, in 2001 the total National Health Expenditure was $1,424.5 billion, of which expenses towards
Public Health Activities amounted to only $46.4 billion.

86.8% of the national health dollars were distributed to personal health services/supplies, whereas only
3.3% were left for government Public Health activities, which included personal care services, delivered by
government Public Health agencies.



Screen Title              Ecological Model


The Ecological Model was developed to better understand the actual causes of death and the factors that
influence health. The Ecological Model helps describe the different levels of influence that result in a
person's healthy or unhealthy habits and behaviors.

An ecological model looks at the following six levels:
• Individual
• Interpersonal
• Institutional/Organizational
• Community, Environment
• Policy, Systems

Roll the mouse over each level to learn about its influence.

The Individual level refers to knowledge, attitudes, beliefs, personality and genetics/biology.

The Interpersonal level refers to processes & primary groups that provide social identity and role definition.

The Institutional or Organizational level refers to rules, regulations, policies and informal structures in
settings such as worksites, schools and religious groups, etc.

The Community, Environment level refers to partnerships, norms and standards, such as public agendas,
media, the built environment and green spaces.

The Policy, Systems level refers to policies and laws at the local, state and federal levels that regulate or
impact health behaviors for the benefit of the citizens.


Screen Title              Applying the Ecological Model


To better explain how the Ecological Model can help us understand a Public Health problem, let us look at
the following example.

According to the World Health Organization (WHO), the Centers for Disease Control (CDC), and the
Surgeon General, smoking remains the leading cause of preventable death, disease and disability in the
United States.

Smoking is the probable cause of 25 diseases and negatively impacts people at all stages of life, from the
unborn fetus, to infants, children, adolescents, adults and seniors. Over 400,000 adults die from tobacco-
related diseases each year, which translates into nearly one in every five deaths.

Since the Surgeon General’s Report on risks of smoking in 1964, there has been a decline in smoking, yet
each year more than one million people continue to become smokers.

Let’s look at the Ecological Model and identify factors that influence the risk behavior of smoking and
tobacco use.



Screen Title             Individual Level


The first level in the Ecological Model is the Individual Level. Look at the text in the blue box for further
explanation. The orange box looks at the Individual Level using smoking as an example.

• Individual characteristics such as knowledge, attitudes, beliefs, personality, biology and genetics influence
a person’s health and health practices
• Genetics influence disease resistance and disease susceptibility
• Individual behavior and lifestyle choices can mediate the effects of genes

Individual behavior is the key in preventing disease, disability and death from tobacco use. The decision to
start smoking, the decision to continue smoking or the decision to stop smoking is the result of a lifestyle
choice.

Let's proceed through the model and identify other contributing factors that influence the use of tobacco.



Screen Title             Interpersonal Level

The second level in the Ecological Model is the Interpersonal Level. Look at the text in the blue box for
further explanation. The orange box looks at the Interpersonal Level using smoking as an example.

• Lifestyle choices are influenced by an individual’s family, peers, and social networks
• It is within the family and social environment that habits are formed and reinforced
• The influence of role models is important in developing habits and making lifestyle choices

If the use of tobacco is accepted as normal in the family and if role models and authority figures use
tobacco, then the influence to smoke can be high, especially on a teenager.

For a teenager, the use of tobacco and smoking may be a part of their social identity. The use of smokeless
tobacco is highest in high school males and is thought by them to be an acceptable practice that does not
have the same risks as smoking does.

Cultural, ethnic, religious and social differences are important in understanding patterns of tobacco use. In
certain cultures, smoking is accepted. Some religions ban smoking.

Let's proceed through the model and identify other contributing factors that influence the use of tobacco.



Screen Title          Institutional/Organizational Level


The third level in the Ecological Model is the Institutional and Organizational Level. Look at the text in the
blue box for further explanation. The orange box looks at the Institutional and Organizational Level using
smoking as an example.

• The conditions of living and working environments—schools, religious groups, worksites, recreational
facilities—strongly influence the behavior patterns of children
• Rules, regulations, policies and informal structures can be made to support non-smoking behaviors
There should be a smoke-free environment. An environment where tobacco is not allowed is a healthier
environment that supports the individual in changing his or her behavior.

School-based programs can prevent or postpone smoking onset 20% to 40%, but less than 5% of schools
have implemented such programs.



Screen Title            Community, Environmental Level


The fourth level in the Ecological Model is the Community, Environment Level. Look at the text in the blue
box for further explanation. The orange box looks at the Community, Environment Level using smoking as
an example.

• The norms of the community, such as the public agenda of a community
• Community coalitions and partnerships
• Availability and accessibility to community education and intervention programs
• Community support for existing laws and regulations
• The physical environment including the built environment, green spaces, etc.

• The strategies for getting smokers to quit, preventing young people from starting and protecting non-
smokers from second-hand smoke are most effective when done as community-based efforts
• The community and its public agenda on smoking and tobacco use are critical influences on smoking
behavior. Anti-smoking coalitions and community partnerships are effective in addressing tobacco use.
For example, some communities have eliminated smoking in indoor spaces and banned smoking in public
places.
• The community supports enforcement of existing laws and regulations concerning smoking, such as
access to minors
• The availability and accessibility of community-based education and intervention programs for tobacco
users in all segments of the population are important




Screen Title             Policy, Systems Level


The last level in the Ecological Model is the Policy, Systems Level. Look at the text in the blue box for further
explanation. The orange box looks at the Policy, Systems Level using smoking as an example.

• Policies and laws at the local, state and federal (national) levels that regulate or impact health behaviors for
the benefit of all citizens

• Increased restrictions on tobacco advertising started with the ban of tobacco advertising in the broadcast
industry in 1971
• Raising tobacco taxes result in fewer people smoking
• Warning labels are put on smoking products to alert people of the harmful effects of smoking
• Clean indoor air regulations have resulted in a decline in environmental exposure to smoke
• Educational initiatives and state tobacco control programs funded by excise taxes, sale of tobacco
products and tobacco settlements with the tobacco companies support a comprehensive approach to
reducing tobacco use
• Measures in reducing minors’ access to tobacco that are successful. Some of these measures include:
restricting distribution, regulating sales, enforcing minimum age laws and providing merchant education and
training.
Screen Title            Core Functions of Public Health


Another aspect of Public Health that we need to become familiar with is how Public Health carries out its
mission of "fulfill society's interest in assuring conditions in which people can be healthy."

Public Health carries out its mission using organized, interdisciplinary efforts through three core functions:

Assurance that all people have access to needed and cost-effective educational, environmental and
personal health services. Included is evaluation of the effectiveness of that care.

Assessment and monitoring of the health of communities and populations to identify health problems and
priorities.

Policy Development to prioritize and solve local and national health problems.

Let's look at the Core Functions using the example of childhood (pediatric) immunization services.



Screen Title              Childhood Immunization Services


The progress made in the vaccination coverage of children in S.C. can be looked at through the core
functions of Public Health. DHEC has played a key role in assessing the vaccine needs of children in the
state. DHEC helped develop the required regulations to meet those needs and also provided the required
resources and services to assure that the vaccine needs were and are being met. Let's take a look at how
DHEC accomplished this.

DHEC gathered data that showed that many school-aged children were not immunized and had very high
rates of vaccine preventable diseases. To protect children and to control the spread of the infectious
diseases, DHEC worked with multiple partners to pass and enforce "No shots/no school" regulation. At that
time, DHEC provided the majority of immunizations in the state.

These efforts paid off and DHEC assessed that the immunization rates have gone up, while the vaccine
preventable disease rates have gone down throughout the state. Data also showed that children would
benefit from having all of their health care needs managed by one provider, which DHEC could not do. So,
DHEC worked with its partners, including the private medical community, the state legislature, S.C. Medicaid
and the CDC and established policies which made it feasible to have immunizations done by private medical
providers. Today, the private sector provides the majority of immunizations to our children. DHEC assures
that quality immunization services are provided by monitoring the private sector vaccine practices. DHEC
also continues to provide some immunization services where there are gaps in services.

In the future, DHEC will continue to assess the infectious diseases impacting children. It will continue to
work to have the new vaccines added to the "must have" list for children and continue to assure that the
immunization system meets the needs of all children throughout the state. When necessary, DHEC will
provide some gap-filling vaccination services.



Screen Title               10 Essential Services


To better understand what Public Health does the Public Health profession in the mid-1990s expanded on
the three core functions by describing what are now called the 10 Essential Public Health Services. All of
these services are linked to the three core functions. This expansion helped to better define Public Health.
The wheel below shows the 10 essential services. The next slides will cover the essential services in more
detail.
The essential services that constitute Assessment are:

• Monitor Health Status
• Diagnose and Investigate

The essential services that constitute Policy Development are:
• Inform, Educate and Empower
• Mobilize Community Partnerships
• Develop Policies

The essential services that constitute Assurance are:
• Enforce Laws
• Link to & Provide Care
• Assure Competent Workforce
• Evaluate

Finally, research is an essential service that looks for new and innovative solutions to health problems and
can involve all of the other essential services.



Screen Title                 Monitor Health Status


Let's look at the activities that fall under each of the 10 essential services. We will start with the essential
services that fall under the core function of Assessment. Under Assessment, the first service is Monitor
Health. Let's learn what this means. Public Health monitors health status to identify and solve community
health problems. Examples of how DHEC and others in the Public Health system monitor health status
include the following activities:
• Diagnose community’s health status
• Identify threats to health and assess needs
• Collect, analyze and publish information about access, utilization, costs and outcomes of personal health
services
• Collect and analyze vital statistics and health status of higher-risk groups (birth and death certificates,
immunization registries)
• Integrate information systems with private providers and health benefit plans




Screen Title               Diagnose and Investigate


The second essential service under Assessment is Diagnose and Investigate. Let's understand what this
means. Public Health diagnoses and investigates health problems and health hazards in the community.
Examples of how DHEC and others in the Public Health system diagnose and investigate health problems
include the following activities:
• Identify emerging health threats to discover, for example, the source of a food-borne illness outbreak
• Use modern laboratory technology to conduct rapid screening and high-volume testing
• Use active surveillance programs to address infectious diseases epidemiologically
• Maintain technical capacities to undertake epidemiologic investigations of disease outbreaks and to
examine patterns of chronic disease and injury




Screen Title                Inform, Educate and Empower
Let's look at Policy Development. The first essential service under Policy Development is Inform, Educate
and Empower. Let's understand what this means. Public Health informs, educates and empowers people
about health issues. Examples of how DHEC and others in the Public Health system inform, educate and
empower the citizens include the following activities:

• Market community health issues; communicate to targeted media
• Provide access to health information resources at community levels
• Collaborate with personal health care providers to reinforce health promotion messages and programs
• Participate in joint health education programs; collaborate with schools, churches and work sites



Screen Title            Mobilize Community Partnerships


The second essential service under Policy Development is Mobilize Community Partnerships. Let's
understand what this means.

Public Health mobilizes community partnerships to identify and solve health problems. Examples of how
DHEC and others in the Public Health system mobilize community partnerships include the following
activities:
• Convene and facilitate community groups and associations—including those not typically considered to be
health-related—to define preventive, screening, rehabilitative and support programs
• Build community health coalitions, drawing upon the full range of human and financial resources available




Screen Title              Develop Policies


The third essential service under Policy Development is Develop Policies. Let's understand what this means.
Public Health develops policies and plans that support individual and community health efforts. Examples of
how DHEC and others in the Public Health system develop policies include the following activities:

• Develop leadership at all levels of Public Health
• Plan community-level and state-level health improvement in all jurisdictions
• Develop and track health objectives to measure quality improvements
• Collaborate with medical communities to create policies on prevention and treatment services
• Develop codes, regulations and legislation to guide the practice of Public Health



Screen Title            Enforce Laws


Let's take a look at the core function - Assurance. The first essential service under Assurance is to Enforce
Laws. Let's understand what this means.

Public Health enforces laws and regulations that protect health and ensure safety. Examples of how DHEC
and others in the Public Health system enforce the law include the following activities:
• Enforce sanitary codes
• Protect drinking water supplies
• Enforce clean air standards
• Provide rabies control
• Follow-up hazard investigations
• Monitor medical care quality
• Review new drugs, biologics, & devices
Screen Title                 Link to & Provide Care


The second essential service under Assurance is Link to & Provide Care. Let's understand what this means.
Public Health links people to needed personal health services and provides health care. Examples of how
DHEC and others in the Public Health system link people to services and provide care include the following
activities:

•   Assure clinical care for disadvantaged people
•   Link populations with services by ensuring culturally/linguistically appropriate materials/staff
•   Provide ongoing “care management” and transportation services
•   Target information to high risk population groups
•   Provide technical assistance for work site health promotion/disease prevention programs



Screen Title                Assure Competent Workforce


The third essential service under Assurance is Assure Competent Workforce. Let's understand what this
means. Public Health assures a competent Public Health and personal health care workforce. Examples of
how DHEC and others in the Public Health system assure a competent workforce include the following
activities:

•   Provide education and training for personnel
•   Verify credentials
•   Continue quality improvement and life-long learning within all licensure/certification programs
•   Partner with professional training programs to assure community-relevant learning experiences
•   Assure continuing education in management and leadership for administrators and executives



Screen Title                 Evaluate


The fourth and final essential service under Assurance is Evaluate. Let's understand what this means. Public
Health evaluates effectiveness, accessibility, and quality of personal and population-based health services.
Examples of how DHEC and others in the Public Health system evaluate include the following activity:

Evaluate health programs based on analysis of health status and service utilization data; assess program
effectiveness and provide information necessary for allocating resources and reshaping programs.



Screen Title                 Research


The last essential service in the center of the wheel is Research. Let's look at how Research is important in
linking with all the essential services. Public Health does research for new insights and innovative solutions
to health problems. Examples of how DHEC and others in the Public Health system conduct research
include the following activities:

• Link with appropriate institutions of higher learning and research
• Maintain internal capacity to mount timely epidemiologic and economic analyses
• Conduct needed health services research



Screen Title                  Employee Tasks Linked to the 10 Essential Services


Now that you have had a chance to go over the 10 essential services, it is time to make them more
meaningful to you by linking the essential services to what you do on a daily basis. First look at the diagram
below. Notice that the Health Services workforce has been divided into four broad categories. Below each
category are the types of employees in DHEC that fall within each category. After reviewing this diagram,
select the category that most applies to you.

Roll the mouse over the category to view examples of jobs in each category.
Click on the category for details on the essential services mapped to its tasks.

Starting with the Support category, we will now, over the next few slides, link specific tasks and activities that
each general category of employee does, to the essential services. While you will be asked to do the activity
described on each of the next slides, pay particular attention to the category of staff to which you belong. On
that specific slide, really think through the activity and see if you can get all the correct responses. The
Employee Tasks Linked to the 10 Essential Services is organized under the four Broad Categories of
Employees as taken from the 2003 Workforce Assessment Survey.

The four Broad Categories are:
• Support Occupation classification
• Technical classification
• Professional/Supervisory/Managerial classification
• Senior Management classification

The Support Occupation classification describes employees who perform structured work in support of
office, business, or fiscal operations. Examples of employees who fit in that category are Administrative
Specialist, Human Resource Specialist, Information Resource Coordinator, Computer Programmer, Data
Coordinator and Data Entry.

The Technical classification describes staff who perform non-routine work typically associated with and in
support of a professional or administrative field.

The Professional/Supervisory/Managerial classification refers to employees who have acquired knowledge
in their field through an associate’s or higher degree with major study in or pertinent to a specialized field.
Examples of job titles included in this classification are: Nurse, Social Worker, Dentist, Nutritionist,
Physician, Training Coordinator, Program Manager, Library Specialist, Health Educator and Physical
Therapist.

The Senior Management classification describes employees who have oversight responsibilities with
knowledge in administration or management. Job titles of S.C. DHEC employees who fit this category are:
Deputy Director, Associate Director, Division/ Bureau Director, Office Director and Regional Health Director.




Screen Title               Employee Tasks - Support Occupation


The Support Occupation classification describes employees who perform structured work in support of
office, business, or fiscal operations. Let's now link specific tasks with the 10 essential services.

Click each title to read some sample tasks and the essential services related to those tasks. Once done,
click here to return to the Employees Tasks main page.

Click the Print icon to print the job tables.

The Admin Specialist processes personal transactions and compiles and maintains personnel records,
which map to essential service #8. Some jobs performed by the Admin Specialist can fall under any one of
the essential services depending on the specific job.

Depending on activity, jobs performed by the Information Resource Coordinator can also address any of the
other essential services. Without the needed skills to operate computer technology our employees would not
be effective public health employees.

Jobs performed by the Human Resource Specialist also linked to essential service #8.
Jobs performed by the Data Entry Clerk can link to any one of the essential services. Public health uses
data extensively to monitor health status, to determine what the health problems are, to educate, to
mobilize, to determine plans of action and to evaluate.



Screen Title            Employee Tasks - Technical


The Technical classification describes staff that performs non-routine work typically associated with, and
supportive of a professional or administrative field. Let's now link specific tasks with the 10 essential
services.

Click each title to read some sample tasks and the essential services related to those tasks. Once done,
click here to return to the Employees Tasks main page.

Jobs performed by the Lab Technician can link to either essential service #2 or essential service #7.

The Chemist analyzes and experiments with known and unknown substances using chemical and physical
analytical procedures, which is linked to essential service # 2.



Screen Title        Employee Tasks - Professional/Supervisory/Managerial


The Professional/Supervisory/Managerial classification refers to employees who have acquired knowledge
in their field through an associate or higher degree with major study in or pertinent to a specialized field.
Let's now link specific tasks with the 10 essential services.

Click each title to read some sample tasks and the essential services related to those tasks. Once done,
click here to return to the Employees Tasks main page.

Jobs performed by the Nurse are related to either essential service #3 or essential service #7 or essential
service #5. Some jobs are also linked to essential services 8 and 9.

Jobs performed by the Social Worker are related to either essential service #3 or essential service #5 or
essential service #7.

Jobs performed by the Nutritionist link to essential services 3 and 7.

Jobs performed by the Health Educator link to nearly all essential services.

Jobs performed by the Environmental Manager link to essential services 2, 3, 4 and 6.



Screen Title            Employee Tasks - Senior Management


The Senior Management classification describes employees who have oversight responsibilities with
knowledge in administration or management. Let's now link specific tasks with the 10 essential services.

Click each title to read some sample tasks and the essential services related to those tasks. Once done,
click here to return to the Employees Tasks main page.

Jobs performed by the Senior Management can be linked to any one of the essential services.
Screen Title               Summary


We have come to the end of the module on Purpose and Practice of Public Health. Let us quickly
summarize what we have learned in this module.

This Module provided an overview of various aspects of Public Health, including the determinants of health
and the leading and actual causes of death. The impact of behavioral risk factors in today’s leading causes
of death were also stressed. Other covered topics included epidemiology, the epidemiology triangle, and its
use in Public Health. The module also explained the Ecological Model and its application.

The three core functions of Public Health were covered and the 10 essential services of Public Health.
Explanation was provided on how the core functions and essential services link up together.

From this Module we can define factors that influence health and make an ecological model necessary.
Finally, real-world applications of the core functions and essential services in Public Health were provided.

The following screens consist of 10 questions related to the module. Each question is worth 10 points. You
have to score equal or above 50% to proceed to the next module. If you score below 50% you are advised
to take the module again.

All the best!
                          Module 3: Organization of Public Health
                                       Transcript


Screen Title              Introduction

In Module 2, we looked at current Public Health issues, the determinants of health, the ecological model, the
core functions and the essential services of Public Health. In this module you will learn how Public Health is
organized, especially how governmental Public Health services are delivered at the federal, state and local
levels. You will learn the roles and functions of each level of government and how the three levels work
together.

This module will help you understand how the governmental system functions, with descriptions of areas of
strength and areas that need improvement. More importantly, we hope that your increased understanding of
the governmental Public Health system will help you better coordinate, network and partner inside and
outside the agency.



Screen Title         Learning Objectives


By the end of this module, you will be able to:
• Identify the general organization of Public Health at the federal, state and local levels
• Explain how the individual Public Health professional fits within the Public Health system



Screen Title                 Effective Public Health System

In Module 2, we have learned about the purposes and practices of Public Health. These purposes are
addressed by a group of agencies and organizations that together form the Public Health system. To
understand how Public Health services are provided, it is important to understand this system and how
agencies and organizations work together within it.

What are the necessary components of an effective Public Health system?

The first component is collaboration. The system requires a collaborative network of people working
together, in both the private and public sectors.

The second component is alignment. The system requires an alignment of governmental Public Health
agencies with each other at the federal, state and local levels.

With this understanding, let us check how well our current reality in DHEC compares to these standards.

While there are many entities in the Public Health system, governmental agencies play a key role in funding
and coordinating programs that no one else can do.




Screen Title                 Public Health System Network

The Public Health system is a complex network of agencies and organizations with the governmental Public
Health agency in the center. Let's see how these other entities contribute to Public Health.

Click on each category to learn about these organizations and the type of work they do.

• Healthcare providers are organizations such as hospitals, physicians, community health centers, mental
  health service providers, laboratories, nursing homes and others that provide preventive, curative and
  rehabilitative care.
• Public Safety Providers are organizations such as police, fire and EMS. Their work is focused on
  preventing and coping with injury and other emergency health situations.

•   Human service and charity organizations assist people with access to health care and receipt of other
    health-enhancing services.

• Education and youth development organizations are those such as schools, faith institutions, youth
  centers and other groups that assist with informing, educating and preparing children to make informed
  decisions and act responsibly regarding health and other life choices and to be productive contributors in
  the community.

• Recreation and arts-related organizations are organizations that contribute to the physical and mental
  well-being of the community and those that live, work and play in it.

•    Economic and philanthropic organizations provide resources necessary for individuals and organizations
    to survive and thrive in the community. Some of these organizations are employers, community
    development and zoning boards, United Way and community and business foundations.



Screen Title                Public Health System Network

As you can well imagine in such a large and complicated system, Public Health services at times can be
fragmented and disjointed.

Click the buttons below for two ideas regarding how well our system is meeting the needs of those we serve.

On the positive side, the system is flexible and no one person or organization can stop the system from
working

On the less positive side, fragmentation can result in the system not working well. Often, agencies and
organizations are not even aware that they are part of the Public Health system. Without a good
understanding of the roles and responsibilities of each of the different pieces, a system like ours will not be
fully integrated. This will hurt the quality of services the system is providing.

Think back to the anthrax scare of 2001. How would you describe the initial Public Health response to the
situations in Florida and Washington DC?

For those who work in program coordination with other units within DHEC or outside the agency, such as
preparedness efforts, medical home partnerships, tobacco coalitions and others, think about how important
it is to communicate and to clarify roles and how difficult it is to do that.



Screen Title                  Government Role and Public Health

The government plays an important role in the Public Health system. It serves as the glue that holds the
system together. In the Public Health system, the role of government in terms of its responsibility and the
public’s health stems from democracy itself. Public Health officials are either elected or appointed to their
positions by elected officials.

The extent to which citizens view Public Health as a priority can influence elected officials. If people do not
raise Public Health issues with their elected officials, these officials often do not think about Public Health as
a priority. This can result in less attention being paid to Public Health by our elected officials.

Click on the high priority and low priority icons to learn how the citizens' view of Public Health influences
elected officials.

During the anthrax scare of 2001, the media and the general public were understandably concerned about
bioterrorism. The public wanted answers and action. Elected and public officials responded quickly. The
result was a greatly expanded Bioterrorism grant, now called Preparedness. DHEC benefited directly from
this financial expansion resulting in the agency being much better prepared to deal with future events.

If the public does not think about Public Health as a priority, less attention will be paid to Public Health by
our elected officials. Public Health programs such as STDs, TB and Environmental Sanitation have been
chronically under funded, partly because they are not viewed as a priority.

With this in mind, let’s understand the roles of the three levels of government in providing Public Health
services. Let’s start with the highest level – the federal government.




Screen Title              The Federal Government and Public Health

Before we look into the role of the state and local governments, let us first understand the role of the federal
government within the governmental Public Health system.

The federal government has a limited role in the direct delivery of essential services. It does, however, play
a key role by providing leadership for setting goals; developing policies and standards, especially regulatory;
and providing operational resources, especially financial resources.



Screen Title            Specific Functions of the Federal Government

Let us now look at the role and functions of the federal government in more detail.

Roll the mouse over each function to read an example.

Transportation funding given to states based on whether they raise the drinking age is an example of policy
making.

Medicare health insurance for people who are 65 years of age and older is an example of financing.

Bioterrorism (Preparedness) and all the efforts around Homeland Security that pertain to Public Health is an
example of Public Health protection.

National Vital Records system for all the states is an example of collection and dissemination of information.

Funds for certain schools/scholarships to improve the skills of the Public Health workforce and increase the
number of people working in Public Health is an example of capacity building.

Indian health services providing federal health services to American Indians and Alaska Natives is an
example of direct management of services.

Now that you know about the Public Health system and the role of the federal government, let’s see if you
can remember the concepts you’ve learned so far.



Screen Title              Department of Health and Human Services


Within the federal government, one of the most important (in terms of budget and size) agencies for Public
Health is the Department of Health and Human Services (DHHS). Most of the federal funding that DHEC
Health Services receives comes from the DHHS. Its functions include:

    •    Policy Making
    •    Financing
    •    PH Protection
    •    Services

Roll the mouse over each function to learn its scope.

Policy Making: DHHS implements presidential and legislative decisions through the budgetary process. It
also implements non-legislative policies such as HP2010 (Public Health goals for the country).

Financing: DHHS provides funding for entitlements including Medicare and Medicaid.

Public Health Protection: DHHS provides coordination and funding of hospital preparedness efforts,
assurance of food and drug safety and surveillance.

Services: DHHS and its subsidiaries provide medical care to Native Americans and Alaska Natives.

To better understand the DHHS, go to the next slide and answer the questions.




Screen Title               Other Federal Agencies


Two other important federal agencies for DHEC Health Services are the Department of Education and the
Department of Agriculture.

The Department of Education, formed in 1980, administers the BabyNet program. The Office of Special
Education and Rehabilitative Services administers the IDEA program which includes Part C of the BabyNet
program, concerning children from birth through two years of age. The Department of Education's total
budget in 2006 was $57.5 billion.

The Department of Agriculture, founded in 1862 by Abraham Lincoln, is the lead federal agency that deals
with food and food security. The total budget in 2006 was $94.6 billion. Funding for the WIC program, the
Food Stamp program and the School Breakfast and Lunch programs come from the Department of
Agriculture. Nationwide, the WIC program serves 8.5 million people; the Food Stamp program serves 29.1
million; and the School Lunch program serves 29.8 million.



Screen Title             State Governmental Public Health Agencies


We have looked at the role of the federal government and other federal agencies. Let us now look at the role
of state government in the governmental Public Health system.

The state government has the legal authority and the responsibility to protect the public. This authority is
given the general title of Police Powers. Public Health is considered one of the police powers that
governments throughout the world have.

The 10th Amendment of the United States Constitution reserves all powers for the states not explicitly
provided to the federal government. Since Public Health is not explicitly mentioned in the constitution, the
authority for Public Health in the United States rests with the states.

It's said that the federal government has the money, the state has the authority and the local government
has the problem.
Screen Title               How States Deliver the Essential Services

Although there is great variability in how Public Health is carried out in the various states, there are some
common elements that all states have. For example, all fifty states have a state or territorial health agency.
They also have a Health Commissioner or a Secretary of Health who directs each state health agency. Each
state also has a Chief State Health Officer, who is the Public Health authority in the state.

But, how do the states deliver the essential services? Study the chart carefully. The chart indicates the
percentages of states following a particular mode for delivering Public Health services.

Roll the mouse over each colored section of the chart to learn about four modes for delivering Public Health
services.

11 percent of the states provide essential services through shared responsibility of state and local
government. The states following this mode of delivery include Florida, Idaho and Ohio.

21 percent of the states provide essential services through units and staff of the State Health Department.
The states following this mode of delivery include S.C., Louisiana and Mississippi. Ours is an integrated
system. The Central Office, the Regions and the County Health Departments are all part of the same state
system.

23 percent of the states provide Public Health services in some cases through the state, while in others
through local government. The states following this mode of delivery include Tennessee and Alabama.
States such as Tennessee provide local Public Health services through the state in some areas, while local
government provides services in other locales.

45 percent of the states provide Public Health services through units of local government. The states
following this mode of delivery include North Carolina, Georgia and West Virginia. Some states, such as
North Carolina, are decentralized. Each county health department is run by county government, totally
independent of state government.



Screen Title             Legal Authorities


The governmental level with the highest authority has the ultimate power. Let's take the example of the
Tuberculosis (TB) Control program to understand the government roles better.

Click on the governmental levels to learn about their functions in the TB Control program.

The federal regulation, in this case, the CDC, provides funding to states to control TB and also performs
research on strategies for testing and treatment of TB.

The state regulation provides funding to local communities to control TB and trains health care
professionals.

The local implementation receives reports of new cases from hospitals, physicians and labs, tracks the care
of TB patients and finds individuals who have had contact with identified TB patients and provides treatment
to the contacts before they become ill.

Now that we have reviewed how the federal government and the states deliver Public Health services, let’s
test your knowledge of the material by completing the exercise on the next slide.
Screen Title              DHEC Structure


Now that we understand the governmental roles, let's understand our organization and its setup.

Roll the mouse over the red highlighted boxes to learn about each component of the organization.

DHEC has a Board of Health with seven members appointed by the Governor with the advice and consent
of the Senate.

The Board members select the Commissioner after consultation and approval of the Governor with the
advice and consent of the Senate. C. Earl Hunter is the current Commissioner.

Under the Commissioner are the Chief of Staff, the four Deputy Commissioners: Environmental Quality
Control (EQC), Health Regulations (HR), Ocean and Costal Resource Management (OCRM) and Health
Services (HS) and the Assistant to the Commissioner for External Affairs. All of the above, combined with
the General Counsel, make up the Executive Management Team (EMT) of the agency.



Screen Title         Functions of DHEC Board


The main functions of the DHEC Board include: provide agency oversight, guide policy, set direction for the
Agency, hear appeals and publish regulations.



Screen Title           DHEC Executive Management Team


The DHEC Executive Management Team (EMT) is responsible for the performance of the Department of
Health and Environmental Control across all the Deputy areas and the Commissioner's Office.

Click the labels to learn about the EMT's composition and functions.

The EMT is comprised of the Commissioner, four Deputy Commissioners, the Chief of Staff, the General
Counsel and the Assistant to the Commissioner for External Affairs.

The EMT provides senior leadership to advise and support the Commissioner and the Board and to follow
the Board's guidance and directives.

Let us now learn more about the areas of responsibility of each EMT member, EXCEPT for the Health
Services Deputy area. We will cover Health Services in more detail after we finish the DHEC overview
section.



Screen Title            Commissioner’s Offices' Responsibilities


Here are the responsibilities of two areas represented on the Executive Management Team (EMT): the
Assistant to the Commissioner and the General Counsel.

The Assistant to the Commissioner for External Affairs manages all communications resources, media
relations, the DHEC internet and serves as liaison with the state legislature. The Assistant to the
Commissioner’s Office also heads up the Art Department and the TV studio.

The General Counsel gives legal advice to the Commissioner’s Office as well as the Deputy areas.
Screen Title      Responsibilities of the Chief of Staff’s Office


The Office of the Chief of Staff is responsible for:

        Affirmative action/ EEO
        Financial management
        Region & program support
        Drug control
        HIPAA privacy
        Information systems
        Internal audits
        Personnel
        Planning
        Public Health information & PH statistics
        Public Health preparedness and
        Quality management



Screen Title              Responsibilities of Environmental Quality Control


The Environmental Quality Control (EQC) Deputy area is responsible for implementing and enforcing
environmental standards and policies for the state and providing effective and quick response to
environmental emergencies. EQC oversees implementation and enforcement of Environmental Protection
Agency Standards for Air Quality, Water, and Land and Waste Management through eight regional offices.
Other EQC responsibilities include emergency response, monitoring, facility inspections and evaluations,
shellfish safety and sanitation and environmental planning.



Screen Title        Responsibilities of Health Regulations


The Health Regulations (HR) Deputy area assures that health facilities are adequate and safe by performing
the following activities:

        Certification of need for new and expanding facilities
        Health facilities planning
        Licensure & certification of facilities
        Regulation & licensures of all x-ray equipment and facility, and
        Development & enforcement of standards and regulations to improve EMS/trauma services



Screen Title             Responsibilities of Ocean and Coastal Resource Management

The Ocean and Coastal Resource Management (OCRM) Deputy area protects the quality of the coastal
environment and promotes coastal zone economic and social improvement through coastal planning,
regulatory affairs and policy and program development.



Screen Title                DHEC Budget Fiscal Year 2007 (FY07)

The DHEC budget is very complex. This graph shows where the funding comes from. In that year, the
overall budget was $643,491,935.

Study the pie chart carefully.
Of that total, 45% or about $290 million came from federal funds, about 22% or approximately $143 million
came from State funds, and 24% or about $151 million came from other funds. A restricted pot of money of
$59 million is kept as reserve. Note that the agency relies greatly on federal dollars, and that other really
means earned revenue. The state portion of the overall budget has been decreasing, while the federal part
has been increasing.

This overall budget pays the salaries of approximately 4,700 full time staff and 500 hourly/temporary
employees agency-wide.



Screen Title           DHEC Budget by Deputy Area


Let us now look at the size of the budget for each Deputy area by comparing funding they received in 2005.
Note the size of Health Services compared to the other parts of DHEC.

73% went to HS, 6% to the Commissioner’s Office, 16% to EQC, 3% to HR and 2% to OCRM.

Now that we understand the functions and responsibilities of the EMT members, it's time to don your
thinking caps and attempt this exercise.



Screen Title         Health Services Deputy Area


Now that we have studied the responsibilities of the other deputy areas, let us look at the largest deputy
area within DHEC, Health Services.

The Health Services Deputy Area is responsible for promoting, protecting and improving Public Health of the
citizens of S.C.



Screen Title           Health Services - Vision and Mission


Before we look at the structure and roles of Health Services, let us first understand its vision and mission.

Health Services aims to become the highest performing Public Health organization in the United States.

In order to achieve its vision, Health Services is committed to promoting, protecting and improving the health
of our clients by providing high quality Public Health services through:
• Successfully implementing the core functions and essential services of Public Health
• Collaborative leadership
• Working together as a team of committed, competent Public Health professionals



Screen Title           Fiscal Year 2007 (FY07)


Health Services is the largest deputy area within DHEC. In FY 2007, the total budget was approximately
$400 million.
Of that total, about a quarter came from state funds, a little more than half came from federal funds and
about 20% came from other sources, mainly billing for services provided.



Screen Title              Health Services Funding Breakdown


Here are two charts further explaining the Health Services budget over the years. On the left, you can see
that the Health Services budget has increased some since 2003. The chart on the right shows that while the
budget has increased slightly, we are more dependent than ever on federal and state monies while our
earned revenue has decreased.

The annual budget for the year 2003 was $374 million, while that of 2005 was $390 million. In 2007, the
annual budget was about $400 million.

Our reliance on federal funds has increased over time. In 2003, 19% of the funds came from the state, while
53% came from federal funds and 26% came from other sources. In 2007, there was a slight shift with 23%
of the funds coming from the state, 56% coming from federal funds and 21% coming from other sources.



Screen Title               Health Services Staff


Look at the chart below. It shows the number of full time employees and temporary/hourly employees
working in various capacities in Health Services. Note how our DHEC workforce has decreased dramatically
over the past six years, for both FTE and hourly employees. We are having to do as much if not more, with
fewer employees!

Health Services structure has also changed during this time of shrinking staff. The 13 local Public Health
districts have been constructed into eight local Public Health regions, causing the number of clinic sites to
decrease.



Screen Title                A Year in the Life of Public Health

Health Services is a very large organization that provides thousands of services to South
Carolinians. In 2003, for example, Health Services provided the following services:

WIC served 109,079 clients. More than 116,748 family planning visits and around 15,976 Post-
Partum Newborn Home Visits took place. 44,690 lead screenings were conducted on children
aged between 0-5 years. 268,361 Medicaid certified Home Health Visits were conducted. 11,535
pet or non-pet rabies investigations were conducted. Around 153,606 flu immunizations were
provided. 45 grants written and 459,087 vital records were provided.

Also, 32,561 surprise inspections were conducted by the food inspectors on retail food
establishments, and 56 School District partnerships were executed.

Food-borne outbreaks, flu vaccine shortage and chemical exposures were controlled and
managed with great efficiency, and during ice storms, hurricanes and floods, Health Services
professionals worked tirelessly to provide help and relief to the public.


Screen Title               Health Services - Regions

The State of S.C. is divided into eight (8) Public Health regions. These regions are created for the purpose
of delivering quality Public Health Services.

There are local health departments in approximately 95 sites in all 46 counties, along with five Major Central
Office Bureaus and six Professional Practice Offices.

A diverse team of health and environmental professionals forms the basis of the structure. These
professionals include nurses, administrators, physicians, epidemiologists, nutritionists, sanitarians,
pharmacists, administrative support, laboratory specialists and health educators. There are approximately
3,600 full time, hourly and temporary employees in Health Services.

Roll your mouse over the map to enlarge the view for each area.
Screen Title             General Role of Central Office and Role of Regions


To better understand how Health Services works, it is important to look at the complementary roles that the
central office and the regions play in delivering Public Health services.

Click the buttons to learn about the Health Services roles on the two levels.

On the Central Office or State Level, Health Services is responsible for:

•   State level health improvement
•   Acquisition of resources
•   Development of policies and regulations
•   Program guidance and oversight
•   Subject matter expertise – consultations, both public and private sectors, and
•   State, federal and national relationships and partnership

On the Regional or Local Level, Health Services is responsible for:

•   Community level health improvement
•   Direct service delivery
•   Implementation of policies, and
•   Regional and local relationships and partnerships



Screen Title               Health Services Organizational Chart


Let us now look at how Health Services is organized to do the types of work that we saw in the earlier
screens.

Click on the image for an enlarged view of the organizational chart.

Health Services is divided into five units:

Heath Services Operations
Office of Minority Health
State and Region Public Health Services
Public Health Services, and
Clinical Services

Health Services Operations is responsible for Administration and Performance and Information Systems.
The Office of Minority Health is responsible for assuring health services to minorities. State and Region
Public Health Services is responsible for the Public Health Regions, the Professional Offices, such as Health
Education, Social Work and Human Resources and also for the Public Health Laboratories. Public Health
Services is responsible for the Bureau of Maternal and Child Health, the Bureau of Disease Control, the
Bureau of Environmental Health and the Bureau of Community Health & Chronic Disease Prevention.
Clinical Services is responsible for the Offices of Nursing, Pharmacy, Primary Care and Public Health
Preparedness.

Let us learn more about each unit in detail.
Screen Title         Health Services Operations


The two major areas under Health Services Operations are Administration and the Office of Performance
and Information Systems.

Click on the red highlighted area to learn about the various functions of Health Services Operations.

Administration is responsible for all administrative activities, such as:
• Budgets
• Personnel
• Contracts
• Patient Billing
• Procurement
• Finance
• Business Management
• Third Party or Revenue Enhancement, and
• Information Resource Consultants

Performance and Information Systems is responsible for:
• Planning
• Performance Management
• CARES, and
• Communication



Screen Title           Employee Tasks - Senior Management


The Office of Minority Health is responsible for providing leadership and serving as a focal point to address
health disparities and other minority health issues in S.C.

Click on the red highlighted area to learn about the various programs supported by the Office of
Minority Health.

Programs Supported:

•   Closing the Gap - Elimination of Health Disparities
•   Minority HIV/AIDS Demonstration project
•   Limited English Proficiency (LEP) Services
•   "Real Men Checkin’ It Out”
•   Faith-Based Health Initiative


Screen Title             Office of Minority Health


Now let's look at State and Region Public Health Services. This unit is responsible for managing
all eight Public Health regions, as well as most of the professional offices and the laboratories.

Click the red highlighted area to learn about the various offices managed by State and Region
Public Health Services.

State and Region Public Health Services provides leadership, capacity building, professional
standards development and monitoring in the areas of:
• Health Education
• Nutrition
• Social Work, and
• HS Human Resources
The Public Health Laboratories supported by State and Region Public Health Services are:
• Chemistry laboratories for blood chemistry analysis
• Pathology laboratories for rabies detection
• Diagnostic Division, such as Milk Labs and Food Labs



Screen Title     Public Health Services


Public Health Services is responsible for providing essential services through its four Bureaus.

Click on the red highlighted area to learn about the Bureaus under Public Health Services.

•   Bureau of Maternal and Child Health
•   Bureau of Disease Control
•   Bureau of Environmental Health, and
•   Bureau of Community Health and Chronic Disease Prevention

The following pages will discuss these in detail.



Screen Title             Public Health Services - Bureau of Maternal and Child Health


The first Bureau under Public Health Services is the Bureau of Maternal and Child Health (MCH). MCH is
responsible for managing several important programs focused on promoting and improving the health of
mothers and children.

Click on the red highlighted area to learn about the programs supported by the Bureau of Maternal and Child
Health.

To deliver its services, MCH has five Divisions: Children with Special Health Care Needs (CSHCN),
Women's and Children's Services (WCS), Oral Health, Women, Infants and Children (WIC) and Perinatal
Systems.

Important programs in this Bureau include Children's Rehabilitative Services (CRS), BabyNet, Family
Planning, Newborn Metabolic and Hearing Screening, Newborn Home Visits, WIC and Perinatal
Regionalization.

Most of the funding for these programs comes from federal sources


Screen Title              Public Health Services - Bureau of Disease Control


The Bureau of Disease Control is responsible for all programs focused on monitoring, treating and
preventing infectious, viral and bacterial diseases. Many of the traditional health department services related
to communicable diseases are led by this Bureau.

Click on the red highlighted area to learn about the services supported by the Bureau of Disease Control.

•   Acute epidemiology
•   Region epidemiology teams
•   Tuberculosis control
•   STD/HIV
•   Immunization, and
•   Preparedness
The region epidemiology teams are responsible for surveillance of infectious diseases and measures to
control them.
All these programs have some funding from the state with many additional resources coming from CDC and
HRSA.



Screen Title           Public Health Services - Bureau of Environmental Health


The Bureau of Environmental Health is charged with protecting the health of the people of S.C. and the
environment through the application of scientific principles and sound management practices in several
areas.

Click on the red highlighted area to learn about the services supported by the Bureau of Environmental
Health.

•   General Sanitation
•   Onsite Wastewater Management
•   Region Support, and
•   Food Protection

Food Protection is handled by the Bureau along with the Division of Acute Epidemiology, the Lab and the
Region Epidemiology teams - the front-line effort that addresses food-borne disease and outbreaks.

Most of the funding for the Bureau comes from state appropriations.



                          Public Health Services - Bureau of Community Health & Chronic Disease
Screen Title
                          Prevention


The mission of the Bureau of Community Health and Chronic Disease Prevention is to improve the health
status of local citizens. It seeks to be community-focused, proactively responsive and team-oriented in
providing culturally appropriate leadership, technical assistance and resource-sharing to South Carolina's
communities. It works with district staff, community advocates, and others to improve current levels of
communication, collaboration, and consultation among DHEC's Health Services, other state agencies, and
local community partners.

The Bureau is composed of eight divisions that address a wide variety of program areas.

Click on the red highlighted area to learn about the services supported by the Bureau of Community Health
and Chronic Disease Prevention.

The Bureau designs programs for:
• Diabetes Prevention & Control
• Injury Prevention
• Cardiovascular Health
• Cancer Prevention & Control
• Risk Reduction and Health Promotion (Physical Activity & Nutrition)
• Obesity Prevention
• Tobacco Prevention
• Home Health Program
• School Health
• All-Health Team

Much of its federal direction and funding comes from the CDC. The Bureau has very strong external
partnership efforts with many organizations, agencies and community organizations.
Screen Title               Clinical Services


Now let us look at the last area under Health Services, Clinical Services. The Clinical Services area
oversees the offices of Nursing, Pharmacy, Primary Care and Preparedness.

Click on the red highlighted area to learn about the services supported by Clinical Services.

Clinical Services supports four offices - Nursing, Pharmacy, Primary Care and Public Health Preparedness.

For the Office of Nursing, Clinical Services provides leadership, building capacity, professional standards
development and monitoring, recruiting, mentoring, developing, professional retention and evaluation.

For the Office of Pharmacy, Clinical Services provides overall coordination, planning, directing, and
evaluation of pharmacy services in DHEC clinics and programs and oversight of regional pharmacists and
DHEC sites that store, distribute and/or dispense drugs

For the Office of Primary Care, Clinical Services helps link underserved populations with primary health care
providers. Primary care includes medical, dental and mental health services.

For the Office of Public Health Preparedness, Clinical Services assures a coordinated Health Services
approach to Public Health Preparedness and Emergency Management through: assessing Health Services
readiness for emergency response; assuring emergency plans are in place; assessing Health Services
training needs and coordinating health and medical services responses.



Screen Title               Public Health Regions


Now that we have learned about the central office DHEC structure, let us understand how the regions fit into
this structure. Look at the organizational chart below. The Public Health Regions fall under the State and
Region Public Health Services unit. Most of the work described in the "A Year in the Life of Public Health"
screen is done at the regional level. These regions are part of Health Services and fit into the Health
Services organizational chart and structure in the manner described.

Click the Local Public Health box on the image to view the Public Health Regions and to learn more about
them.

The state of S.C. is divided into eight Public Health Regions to provide Public Health services to the public.

• Leadership that each Region has in common includes a Regional Health Director (RHD), Regional
Administrator (RA) and
  Regional Environmental Health Director (REHD).
• Regions can be organized differently from each other. Some appear to be organized more by Discipline,
while others are more
  organized by Function.

Let us explore these differences on the next slides.

Roll your mouse over the map to enlarge the view for each area.



Screen Title         Generic Regional Organizational Chart - Discipline Model


Some of the Regions are organized more by Discipline. The Regional Leadership Team in these Regions
looks similar to this organizational chart.

In this model, the following Directors usually sit on the Regional Leadership Team:

    •    Regional Medical Director
    •    Region Nursing Director
    •    Region Nutrition Director
    •    Region Administrator
    •    Administrative Support Director
    •    Region PH Preparedness Director
    •    Region Environmental Health Director, and
    •    Region Social Work Director



Screen Title            Generic Regional Organizational Chart - Functional Model


Some Regions are organized as seen in this chart. People sitting on the Regional Leadership Team
represent different functional areas within the Regions, not the Professional Disciplines as in the other
model. Take a look at the chart below.

In this model, the following Directors usually sit on the Regional Leadership Team:

    •    Regional Medical Director
    •    Region Director for Clinical or PH or Preventive Services
    •    Region Director for Community or Integrated Services
    •    Region Administrator
    •    Region Director of Professional Offices
    •    Region PH Preparedness Director
    •    Region Environmental Health Director, and
    •    Regional Director of Community Services



Screen Title            Organization of the Regions


Now that you have seen two major ways that the regions are organized, find out how your region is
structured. Ask your supervisor, and if they don't know, ask them to pose the question to their supervisor.

Roll your mouse over the map to enlarge the view for each area.



Screen Title       Services Provided by the Regions


Services Provided by the Regions:

• Food Service Inspections, which includes all types of food service facilities
• Septic Tank Permitting, which includes inspections, permitting activities and subdivision work
• General Sanitation, which includes vector control, rabies, nuisance investigations and control
• Environmental Health investigations, which include daycares, foster homes and lead investigations
• CRS. Clinical and care coordination services for Children with Special Health Care Needs
• BabyNet services including all aspects of the program
• Newborn Home Visits for Medicaid infants just released from the hospital
• Family Planning, which includes clinical services, marketing and education
• Metabolic and Newborn Hearing Screening follow-up as necessary for infants in the region requiring these
services
• WIC and all aspects of this program to include risk assessment, nutrition education and food voucher
disbursement
• Immunizations both pediatric and adult, which include providing immunizations, education and work with
physician partners

Click on the Continue link to read the other major services provided by the Regions.
• STD treatment and prevention, both clinical and outreach services
• HIV/AIDS prevention, both testing and counseling services
• TB treatment and prevention, both clinical and outreach services
• PH Preparedness, which includes Planning, coordination and partnership
• Risk Reduction for chronic disease prevention
• Home Health, which includes services to home bound clients/patients
• Laboratory. Specific laboratory functions to support DHEC clinical services
• School Health. Varies by region - partnerships, providing of school health and social work services and
health education
• Epidemiology, which includes surveillance, outbreak investigations and report generation
• Vital Records, which includes provision of birth, death, marriage and any other required certificates


Click on the Back link to read the major services provided by the Regions.



Screen Title           Resource Links from Federal to State to Local


Many of the resources used by DHEC at the local level come from a federal office or program. Following are
three examples to show the link from federal to state to local:

    •    WIC
    •    Family Planning
    •    Preparedness

Click next to read examples on the following pages.



Screen Title                 WIC


WIC is a supplemental nutrition program for pregnant or post-partum Women, Infants and Children. Its
mission is to provide federal grants to states for supplemental foods, health care referrals and nutrition
education for low-income pregnant, breastfeeding and non-breastfeeding post-partum women and to infants
and children up to age five who are found to be at nutritional risk.

WIC was piloted in 1972 by the United States Department of Agriculture's Food and Nutrition Services by an
amendment to the Child Nutrition Act of 1966. It was made permanent in 1975.
Eligibility is based on annual gross income and the beneficiaries must fall at or below 185% of poverty level.
More than seven million people in the United States receive benefits each month.



Screen Title                WIC FY 2008


Where do the funds for managing WIC come from?
The national budget for WIC is nearly $6 billion. Of this, nearly $1.6 billion goes to the Nutrition Services and
Administrative costs (NSA) and the rest goes to food grants. From this composite, S.C. gets $61.9 million as
food grants and $18.6 million as NSA grants. Each of the eight Regions receives separate grants for its WIC
program.

Region 1 gets $1.7 million, Region 2 gets $3 million, Region 3 gets $2.9 million, Region 4 gets $3.1 million,
Region 5 gets $1.5 million, Region 6 gets $1.4 million, Region 7 gets $2.1 million and Region 8 gets $700
thousand.
Screen Title            Family Planning Program


The second example is the Family Planning Program, which is a program of Women and Children Services.

• In 1970, President Nixon signed it into a law as a part of the Public Health Services Act. It is the ONLY
federal program dedicated solely to family planning and related reproductive health care services.

• The amount paid for services depends on the income % of poverty level

• The program serves more than 4 million people a year in the United States



Screen Title               Family Planning Program Funding FY 2008


Where do the funds for managing the Family Planning Program come from?
For the entire United States, federal funding for Family Planning Programs is $299 million. S.C. receives
about $5.7 million of these dollars. S.C. also received $2.2 million from State funds and has been earning
about $4.9 million from Family Planning Program activities. Each of the eight Regions receives separate
grants for its Family Planning program from the federal and state dollars that the state receives.

There is variability in the total amount of federal and state resources each region receives for their Family
Planning program.



Screen Title              Preparedness


The last example we will discuss is the Preparedness Program, which is managed by the Office of Public
Health Preparedness (OPHP) at the agency level.

In 1999, approximately $40,980,000 was made available to the entire country by the CDC under the
Bioterrorism Preparedness Program. In Feb 2002, the CDC expanded the Preparedness program to the
Public Health Preparedness and Response for Bioterrorism Program and in 2002, the Health Resources and
Services Administration (HRSA) began supporting hospital preparedness programs too.



Screen Title              Preparedness Funding FY 2008 (Sep 1, 07-Aug 8, 08)


Where do the funds for the Preparedness Programs in the country come from? Total federal funding for the
program in the United States is a little over one billion dollars. The CDC gets a little over $600 million, while
the Assistant Secretary of Preparedness and Response (ASPR) gets about $430 million. The State of South
Carolina gets around $9.2 million from CDC and about $6 million from ASPR to manage its Preparedness
program. The CDC dollars come to DHEC. From these resources, each Region receives separate grants for
its local programs. The ASPR dollars go to hospitals to fund their preparedness programs.

As you can see, there is variability in the amount of resources each DHEC region gets for their
preparedness efforts. Region 7 receives the most and Region 8 the least.

The chart reflects only about 11 months, and some of the central office funds are also spent in the Regions,
but are not reflected in what is disbursed.
Screen Title               DHEC Exercises


For Region Staff:
Identify which central office organizational unit your program or unit primarily works with. If you work with
multiple central office units, just pick one. Describe which of the 10 essential services the central office unit
provides. Describe which of the 10 essential services your program or unit provides (based on which central
office unit you selected).
Determine the amount of funds your program or unit gets to perform, from central office and from any
earned revenue.

For Central Office Staff:
Describe which of the 10 essential services your program or unit provides. If the regions provide any
services related to your program or unit, describe which of the 10 essential services they provide.
Determine the amount of funds your program or unit gets from external sources (federal, state or grant). If
any funds are allocated out to the regions, determine these.


Click on the Activity 1 icon to download the template for Region Staff.

Click on the Activity 2 icon to download the template for Central Office Staff.

After completing the activity sheet, please share with your supervisor for his or her comments.



Screen Title               Summary


To deliver quality Public Health services, the government at the federal, state and local levels has
a key role to play. Most consumers probably think of Public Health services as those services provided by
their local health department since that is where they actually get many services. We hope that you now see
that the federal and state levels of government, by providing resources, direction, policy and technical
support, directly affect the quality and number of Public Health services provided at the local level.

We also hope that it is clear that government alone cannot address all the Public Health needs of our
communities and state. The Government (DHEC) has to work in collaboration and partnership with many
other organizations, agencies and persons to improve the public's health. Government has a key leadership
role to play, but we need to work with others in the Public Health system in order to get the positive results
that we are working towards.

Let's now assess your understanding of Module 3: Organization of Public Health. The following screens
consist of 10 questions related to the module. Each question has a score of 10. You have to score at least
50% to proceed to complete the module. If you score below 50% you are advised to take the module again.

All the best!



Screen Title          Congratulations


Congratulations!

You have successfully completed the Introduction to Public Health course.

								
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