Environmental Engineering Reference
In-Depth Information
REGULATORY AUTHORITIES IN HEALTH
Communicable and certain noninfectious diseases can usually be regulated or
brought under control. In the United States, the local or municipal (often at the
county level) health department is the fundamental unit of health intervention and
surveillance. A health department having a complete and competent staff to pre-
vent or control diseases that affect individuals and animals is usually established
for this purpose. The preventive and control measures conducted by a municipal
health department might include supervision of water supply, wastewater, and
solid wastes; housing and the residential environment; milk and food production
and distribution; stream pollution; recreational areas, including camps, swim-
ming pools, and beaches; occupational health and accident prevention; insects
and rodents; rural and resort sanitation; air pollution; noise; radiological hazards;
hospitals, nursing homes, jails, schools, and other institutions; medical clinics,
maternal and child health services, school health, dental clinics, nutrition, and
medical rehabilitation; medical care; disease control, including immunizations,
cancer, heart disease, tuberculosis, and venereal diseases; vital statistics; health
education; epidemiology; and nursing services. In practice however, many local
health departments are understaffed and not adequately funded.
The front line of emerging health concerns is often a private clinician's prac-
tice or hospital emergency department or poison centers. In the United States,
health care providers and biological testing laboratories have mandatory report-
ing obligations for specified lists of infectious diseases. These data are to be sent
to the state health department, usually within days of a presumptive diagnosis.
Mandatory reporting is a prime form of disease surveillance, and has been bol-
stered in reaction of fears about bioterrorism. Large health care facilities, such
as teaching hospitals, will have their own surveillance systems for infectious
disease, and epidemiologists monitoring infections.
State health departments are involved in disease surveillance, priority setting
for policy, and funding initiatives for alleviation of specific diseases. In some
states, certain environmental and medical activities are combined with the activi-
ties of other agencies and vice versa, making the achievement of a comprehensive
and coordinated preventive services program for environmental health more com-
plicated. State health departments must interact closely with legislatures. Funding
for disease prevention or health promotion programs can thus be tied to political
considerations and public opinion.
At the federal level, the Centers for Disease Control and Prevention (CDC)
has a broader mission, including but not limited to, setting national priorities,
providing technical assistance, conducting multistate or rare disease outbreak
investigations, and serving as an authority to policy makers and Congress. Par-
allel organizations fulfilling the same roles exist in all countries, with differing
levels of capacity and resources. In the United States, the National Institutes
of Health (NIH) fund research on diseases, the Food and Drug Administration
(FDA) regulates foods, drugs, and cosmetics, the U.S. Department of Agriculture
(USDA) sets standards for farming and animal husbandry, and the Environmen-
tal Protection Agency (EPA) sets standards for acceptable pollutant levels, funds
