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Pharmacy in Public Health: Public Health Systems Course, date, etc. info Learning Outcomes • Explain why public health issues in one country often become an issue in another country • List key functions or duties of a public health organization • Describe the structure of the U.S. public health system • Describe the international public health system • Explain ways that pharmacists can be involved in the various levels of the U.S. or international systems Introduction • Disease and other public health problems often cross borders • Need to share information and coordinate responses • Most interventions are local, but impact can be global • The public health system has grown as its functions have expanded • Public and private organizations are involved at all levels Case: Spread of Infectious Disease • SARS case shows how a novel infectious disease can go from local to global quickly Functions of the U.S. System • Functions and system have grown over time • Original focus on reducing spread of disease • Health improvement, social justice, and environment protection added as needs arose • Can summarize major areas with the “Ten Essential Public Health Services” list 10 Essential U.S. Public Health Services General Area Specifics Monitor Health status to identify and solve community health problems Diagnose and investigate Health problems and health hazards in the community Inform, educate and empower People about health issues Mobilize Community partnerships and action to identify and solve health problems Develop policies and plans That support individual and community health efforts Enforce Laws and requirements that protect health and ensure safety Link People to needed personal health services and assure the provision of healthcare when otherwise unavailable Assure Competent public and personal health care workforce Evaluate Effectiveness, accessibility, and quality of personal and population-based health services Research For new insights and innovative solutions to health-problems (Table 3.1, pg 47. Source CDC. National Public Health Performance Standards Program.) U.S. Public Health System Figure 3.7, pg 59 U.S. Public Health • Source of authority • Authority to act on behalf of all U.S. citizens • The is no Constitutionally established role for federal government in matters of health or public health unless • Federal tax laws and oversight of how public funds are used • Interstate commerce laws that allow federal intervention if state or national borders are crossed • Treaties with the American Indian tribes to establish and limit federal role • Each state retains “police power” in most matters of public health • These powers can be delegated to local governments Federal Divisions and Agencies • HHS (Department of Health and Human Services) • Primary federal agency for public health • 11 divisions within it • U.S. Public Health Service is now found within the HHS • Roles – – – – Sets national priorities for health and public health Supports and funds programs and research Monitors health of the nation Interacts with international partners to promote health Major Divisions of HHS Agency AHRQ HHS agencies for health (public health) services Agency for Healthcare Research and Quality ATSDR Agency for Toxic Substances and Disease Registry CDC Centers for Disease Control and Prevention FDA Food and Drug Administration HRSA Health Resources and Services Administration IHS Indian Health Service NIH National Institutes of Health SAMHSA Substance Abuse and Mental Health Services Administration CMS HHS Agencies for human (welfare) services Centers for Medicare & Medicaid Services ACF Administration for Children and Families AoA Administration on Aging (Table 3.4, pg 61. Source: HHS.) State & Tribal Organizations • State Health Departments • • • • Structure and function vary by state Usually multiple divisions within the department Services as connection between local and federal groups Has police power that it can delegate to local departments • State Health Boards (Boards of Health) • Provide oversight of state-level departments • Hires and advises the director (Health Officer) • Usually appointed to the position by the Governor • Tribal Health Departments • Similar functions as state health departments but usually smaller in size • Advisory functions may be provided by mechanisms other than a health board Local Public Health Organizations • Local health department • Derives its police power from the local government which was delegated from the state • Level where one-on-one interactions occur as well as community interventions • May consist of a single health officer or a multidepartmental organization • Many cities and counties form combined departments through inter-governmental agreements • Local health boards • Hires and advises the director of the local health department • Appointed to the position by mayor or local government Global Public Health System Figure 3.5, pg 56 Functions of WHO Provide leadership on important health matters Partner with other public or private organizations as needed Shape the research agenda and ensure new knowledge is disseminated Develop standards and set norms and monitor implementation Promote policy options that are ethical and evidence-based. Provide technical support and expertise Monitor and assess the trends in health Promote change and support the development of its own sustainable institutional capacity (Table 3.2, pg 53. Source WHO, International. The Role of WHO in Public Health.) Pharmacy Roles in Public Health At the local or state level Be aware of health boards and task forces Become involved in education and awareness programs Report unusual sales volumes for medications or patient complaints Be an advocate for local citizens and keep eyes open for issues At the federal level Participate on task forces within professional organizations Serve on review panels or government committees Use national voluntary reporting systems At the international level Participate in voluntary medical and humanitarian aid Raise awareness for international travelers of risks and prevention Donate money or supplies Summary • Because disease can cross borders, public health systems need to collaborate across borders • Public health systems exist at local, state, tribal, national, and international levels • Both private and public organizations included • Within the U.S., states have most of the authority related to public health • International organizations must rely on voluntary cooperation to achieve solutions • Pharmacy can be involved at all levels Back to the SARS Case • What did you notice about where and when local, state, national, and international public health agencies became involved? • What happened at the local level in the different countries? • How did voluntary versus mandatory reporting affect the spread of SARS? • How did the U.S. respond to the threat? • Federal actions • State or local actions • Pharmacy actions Lai’s List from SARS case Prepare for: Patient surge (increased number of patients) Sicker patients Worried Well Poor communication or information Cause If local hospitals are closed or put under quarantine, patients will seek other sources of care and information. These patients may be sicker than usual but barred from hospital Patron who have respiratory symptoms but no history of exposure Health officials may change information frequently to adjust to evolving situation. Issues Increase staffing to handle increased traffic Prepare information for patients Pharmacists need to review info and help triage patients Provide information and reassurance Seek reliable information sources Seek local info for current quarantine/treatment info Protecting workforce from Healthcare workers are highly likely to become Use standard and respiratory precautions. exposure infected if they work closely with a SARS Handle items for potentially exposed SARS patient patients while wearing gloves. Need to limit exposure time and closeness Frequent handwashing Face masks if counseling coughing or feverish patients. Use telephone for counseling Drop off prescriptions at homes Bill via credit card numbers to avoid handling checks or money Monitor pharmacy staff Fever is an early sign of SARS. Take temperature of workers once a shift. If a family member is sick, put employee on sick If fever is present, send worker to leave designated SARS clinic site. Requests to dispose of potentially Family members of potential SARS cases may Determine local health department contaminated medications have unused medications they want to throw recommendations for disposing of unused away. medication products that had been dispensed to a SARS patient. Requests for ineffective Remedies for self-treating SARS may be Provide patients with most current prevention and treatment options requested by patients even though they are not treatment and prevention information effective Map 1 Map 2 Map 3 Map 4