RESEARCH program of the U.S. Public Health Service.
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BACKGROUND: Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII) offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach. DISCUSSION: A national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries). The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security) framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges. SUMMARY: A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors.
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Public Health Services in Bavaria are presently undergoing basic and complete reorganisation. A working group of the Bavarian Ministry of Labour, Social Problems, Family, Women and Health is compiling a report and working out a far-reaching concept of the tasks to be handled by Public Health Offices. The purpose of this work is to develop a profile of an update and efficient Public Health organisation. This entails not only description and definition of the jobs to be handled but also a delineation against other medical disciplines. Closer ties to research institutions and intensifying the exchange of expert knowledge with universities and other expert institutions is highly essential. Only if all professional groups represented in the Public Health organisation are called upon to cooperate, will it be possible to translate into reality a profile of tasks encompassing both the classical areas of activity such as infection hygiene and update requirements of the quality of management and research abilities such as a thorough knowledge of epidemiology. The interdisciplinary approach that can be realised in Public Health Offices enables teamwork in the development of approaches to solving a multitude of problems of a medical but mainly also of a social or environmental nature. This potential must be exploited and expanded. 2.9.99/D1.
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The US Public Health Service recently completed and published Healthy People 2000: National Health Promotion and Disease Prevention Objectives. The report is the culmination of a national effort, representing the work of citizens, professionals, organizations, and communities, and the cooperation of numerous federal agencies. The overall goal of the report and its objectives are to prevent unnecessary disease and disability and to achieve a better quality of life for all Americans.
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Essential public health services are activities that public health departments and other partners undertake to protect and ensure the health of the public. To characterize expenditures for those services and to distinguish within them expenditures for personal health-care services from community-based health services directed toward populations, the Public Health Service (PHS) and the Public Health Foundation surveyed senior health officials in eight states (Arizona, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas and Washington [combined 1995 population: 57.8 million]). This report summarizes the results of that survey, which indicate that spending on community-based health services is a small proportion of spending on essential services and an even smaller proportion of total health-care expenditures.
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The status of pharmaceutical services in the United States Public Health Service (PHS) is described. The PHS has been the principal health agency of the United States for nearly 200 years, directing its resources to meeting the nation's changing health needs. Pharmacists are assigned to all eight operating divisions of the PHS (a major component of the Department of Health and Human Services), as well as other federal agencies and programs. Pharmacists assigned to the Indian Health Service, the National Institutes of Health, the United States Coast Guard, the Immigration and Naturalization Service, the Federal Bureau of Prisons, and Saint Elizabeths Hospital provide pharmaceutical services to a broad range of patients and settings. Some PHS pharmacists are involved in bringing new drugs to market in the Food and Drug Administration, participating in research protocols at the National Institutes of Health, and helping the underserved populations through the programs of the Health Resources and Services Administration. Still other PHS pharmacists provide leadership and program management at the Agency for Health Care Policy and Research, the Agency for Toxic Substances and Disease Registry, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and the Health Care Financing Administration. Pharmacists in the PHS work in a broad array of settings, in many cases providing care for the underserved.
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Today's emergency and first-aid systems are a challenge to Public Health offices which they must meet diligently and competently within the framework of health care and defence against health hazards. Close cooperation with fire brigades and first-aid and emergency service organizations is mandatory especially in case of threatening major disasters (for example, accidents involving large amounts of toxic matter). There are gaps in the immediate care and service systems in case of emergencies. Public Health offices are called upon to close these gaps by active participation, if required, at the site of the disaster, in the management and supervision of first-aid and other measures in the fight against the sequels of major disasters or catastrophes. Innovative concepts regarding the future development of public emergency and first-aid services have been worked out.
This article proposes a framework for the delivery of public health services by the health care system. Considering the many factors associated with a population's health status and well-being, health care systems must provide public health services in addition to clinical preventive health care services. Public health services are distinctive in that they are supplied in response to community as opposed to individual needs. The delivery of public health services is carried out, in partnership with groups and organizations, through the use of strategies that enable, advocate and educate. These strategies, taking place at the earliest possible moment in the natural history of problems, act as catalysts in the process of change towards health and well-being.
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