Learning Objectives
1. Define the term community. State the relationship of community to that of the health of a community. Identify types of communities.
2. Identify the health-related functions of the WHO and UNICEF.
3. State the achievements attributed to improvements in public health that resulted in an increase of lifespan in the 20th century.
4. Define and differentiate between the USPHS and the HHS.
5. Identify and discuss functions of the HHS, the CDC, and the FDA.
6. Discuss the purpose of the NIH and state the role of the NINR.
7. Identify the functions of OSHA and of the Social Security Agency.
8. Identify the role and functions of the National Safety Council, the Red Cross, and the VNA.
9. Differentiate between organizations that are related to specific disorders and organizations promoting specific health goals.
10. Identify at least seven programs that are common to state healthcare services.
11. Discuss primary care and functions of the community health center.
12. Identify the causes and discuss the significance of the various types of pollution.
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IMPORTANT TERMINOLOGY |
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biohazardous |
primary healthcare |
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bionomics |
radiation |
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community |
radon |
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community health |
Standard Precautions |
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demography |
target population |
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ecology |
Transmission-Based |
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plumbism |
Precautions |
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pollution |
worker’s compensation |
Acronyms
(Note: Each government agency has its own acronym and not all acronyms in this chapter are listed below.)
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CDC |
HHS |
OSHA |
USPHS |
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DOA |
MUA |
SSA |
VNA |
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DOL |
NAHCC |
UN |
WHO |
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EPA |
NHIC |
UNICEF |
WIC |
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FDA |
NIH |
USDA |
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FQHC |
NINR |
A group of individuals who interact with each other for the mutual benefit of their common interests to support a sense of unity or belonging is a community. You are a member of many communities: your family, school, place of employment, town or city, state or province, nation, and the world. Community can also refer to a smaller organization, such as a retirement home or a health maintenance organization.
Communities are studied as a part of demography, which is the study of populations. Demography examines the dynamic balances among population size, racial and ethnic distribution, economic opportunities, growth potential, and other indicators. Health concerns are based on a community’s demographics as well as a nation’s overall health and economy. World and national events influence state and local communities. The welfare and priorities of the individual are balanced against the needs and resources of a community.
Community health is the aggregate health of a population: a town, state, nation, or planet.
Other factors influencing societal health include rates of crime, juvenile justice, and high school graduations. Poverty levels, population density, incidences of domestic violence, and adequate housing (rental and ownership) contribute to community health.
HEALTHCARE WORLDWIDE
Health promotion is a worldwide concern. The guidelines established by the World Health Organization (WHO) have become international standards for sanitation, chemical safety, water purification, immunizations, and infectious diseases. As a part of the United Nations (UN) in New York City, WHO’s objectives are to emphasize growth and development of significant internal, governmental changes in countries that currently have difficulty providing basic healthcare services to their citizens.
The WHO sends healthcare professionals to nations to combat diseases and disorders at both the community and the individual level. The infections of malaria, tuberculosis, HIV, and other diseases are major international health concerns. Women of childbearing age are of special concern. Globally, public health officials are increasing their nation’s efforts to decrease smoking. The diseases associated with the high-fat, high-salt, and high-calorie intake of Western industrialized countries—such as cardiac disease and hypertension—are noted. Mental health issues are also addressed.
Hundreds of international healthcare and nonhealthcare agencies are linked to the WHO. After events such as earthquakes, floods, or volcanic eruptions, a country may need extensive assistance to prevent starvation and widespread disease. The UN tailors specific programs to meet the needs that arise from natural disasters.
Another UN program, the United Nations Children’s Fund (UNICEF), helps children, especially those in developing countries. Some of its goals include nutrition instruction, development of low-cost food supplements, support of general education, childhood immunization programs, procedures for supplying safe water, and infant rehydration programs.
NCLEX Alert NCLEX scenarios may relate to changing, eliminating, or treating the effects of risk factors.
Read the scenario carefully and select the best option that is presented which may be different than what you might want to do in a similar situation.
HEALTHCARE ON THE NATIONAL LEVEL
United States Public Health Service
The United States Public Health Service (USPHS) celebrated its 210th birthday in 2008. Since 1798, it has had many responsibilities, including investigation and control of communicable diseases, protection from disease carried by immigrants, control of sanitation, prevention of disease spread through interstate commerce, and control of the manufacture and sale of biologic products.
The achievements of the USPHS are truly impressive. Life expectancy in the early 1900s was about 45 years. In the last decade of the 20th century, the lifespan of Americans has been lengthened by 30 years, to more than 75 years. Advances in public health contribute to 25 of these additional 30 years, according to the Centers for Disease Control and Prevention (CDC). Eight of the most notable achievements include:
• Vaccinations
• Motor-vehicle safety
• Safer workplaces
• Control of infectious diseases
• Declines in deaths from coronary artery disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Recognition of tobacco use as a health hazard
The USPHS is the forerunner of the U.S. Department of Health and Human Services (HHS). HHS was created by Congress and is one of the executive agencies of the U.S. president.
Department of Health and Human Services
The Department of Health and Human Services is a highly versatile agency that has a myriad of responsibilities. The agencies that constitute the branches of HHS are listed below. Each of these programs provides a multitude of services. You may be familiar with some of the agencies below as they are often mentioned publicly and many individuals benefit from these resources. The day-to-day effects of these agencies on U.S. citizens as well as individuals in a global population cannot be overstated. You are encouraged to check the Website of each agency. Three of the branches of HHS that will be discussed here in further detail are the CDC, the Food and Drug Administration (FDA), and the National Institutes of Health (NIH).
• Administration for Children and Families (ACF): Provides services and assistance to needy children and families
• Administration on Aging (AOA): Provides services to the elderly, promoting independence and providing home-delivered meals
• Agency for Healthcare Research and Quality (AHRQ): Provides research designed to improve quality of healthcare, including information on costs and client safety
• Agency for Toxic Substances and Disease Registry (ATSDR): Provides information, assessments, and educational training related to the U.S. Environmental Protection Agency’s (EPA) national priorities list of hazardous substances and waste sites
• Centers for Medicare & Medicaid Services (CMS): Administers the Medicare and Medicaid programs and the Children’s Health Insurance Program
• Health Resources and Services Administration (HRSA): Provides health resources for medically underserved populations, such as migrant workers, the homeless, and residents of public housing; oversees the national organ transplantation system; provides services to decrease infant mortality and to improve the health of children and of people with AIDS
• Indian Health Service (IHS): Provides a network of hospitals and health centers and stations for American Indians and Alaska Natives of 557 federally recognized tribes
• Substance Abuse and Mental Health Services Administration (SAMHSA): Provides services to improve the quality and availability of substance abuse prevention, addiction treatment, and mental health services
• Centers for Disease Control and Prevention (CDC): Provides health surveillance to monitor and prevent outbreaks of disease; guards against international disease transmission; maintains national health statistics; provides for immunization services; and supports research into disease and injury prevention
• Food and Drug Administration (FDA): Provides for the safety of foods and cosmetics, and the safety and effectiveness of pharmaceuticals, biological products, and medical devices
• National Institutes of Health (NIH): Provides for research projects in 27 separate institutes for thousands of health-related subjects
Key Concept Health information is available from many sources. A referral service called the National Health Information Center (NHIC) provides health professionals and consumers with resource organizations. Visit the Center’s Website (see Web Resources on Point;·.).
Centers for Disease Control and Prevention
The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. This globally recognized agency is a major force in the protection of the health and safety of citizens of the United States. It also functions as an advocate for environmental health, health promotion, and education worldwide.
CDC national headquarters is located in Atlanta, Georgia, but it also has health departments in 47 states and employees in 45 countries. It works with nearly 200 public health disciplines throughout the world to monitor health, detect and investigate health problems, conduct research to enhance prevention, promote healthy behaviors, and foster safe and healthy environments.
In conjunction with state and local health departments, the public is protected in numerous ways by the efforts of the CDC. A few roles of the CDC include:
• Investigating disease outbreaks at a local, national, or international level, such as avian flu or influenza (e.g., viral) outbreaks or occurrences of bioterrorism (e.g., anthrax)
• Providing current and accurate health-related information to the public
• Fostering cooperative relationships with national, state, and local organizations to combat dangerous environmental exposures, such as might occur in the air, the water, and the workplace
Box 7-1 describes the various organizational components of the CDC and their specific functions.
Food and Drug Administration
The FDA’s mission is to promote and protect public health by helping safe and effective products reach the market in a timely way and by monitoring products for continued safety after they are in use. The FDA blends science and law to protect consumers.
The headquarters for the FDA is in Washington, D.C., but it also has nearly 200 field offices. Employees perform inspections, surveillance, laboratory studies, and education in industrial and public sectors. The FDA does not develop or test products itself; it reviews the results of laboratory and clinical testing done by individual companies.
The FDA regulates food ingredients, complex medical and surgical devices, medications, and radiation-emitting products. FDA accomplishments include:
• Requiring that new drugs and complex medical devices (e.g., cardiac pacemakers) be proved safe before they are put into a consumer market
• Establishing performance standards for products, such as x-ray machines, mammography equipment, and microwave ovens
• Requiring safety practices in blood banking
• Requiring accurate, truthful, and useful labeling for prescription drugs, over-the-counter medications, foods, and dietary supplements
• Conducting scientific research and providing standards and guidelines to make regulatory decisions
• Requesting or requiring that manufacturers recall unsafe products
National Institutes of Health
The mission of the NIH is to uncover new knowledge that will lead to better health for everyone. As listed in Box 7-2, there are 27 separate institutes or centers plus offices for the directors. These individual institutes are located in 75 buildings on more than 300 acres in Bethesda, Maryland. Each institute works in its specific field to accomplish the following goals:
• Conducting research on site or through universities, medical schools, hospitals, or other research institutions
• Training research investigators
• Promoting improved sharing of medical information
The NIH formally recognized nursing as a unique and important component of the healthcare system in 1993 when the National Institute for Nursing Research (NINR) was established. The NINR separates the funding for nursing research from other Institute research funding, such as medicine.
The NINR supports research and establishes a scientific basis for the care of individuals across the lifespan. The focus of nursing research is to discover ways to benefit clients. These areas include:
• Managing clients during illness and recovery
• Reducing risks for disease and disability
• Promoting needs for underserved, high-risk clients, such as those with chronic illness and healthcare disparities
• Caring for individuals at the end of life
• Promoting the care of families within a community
Other Federal Agencies
Occupational Safety and Health Administration
Along with the HHS, the U.S. Department of Labor (DOL) is an Executive Agency of the federal government. Several subdivisions of the DOL gather information related to working conditions, occupational hazards, international child labor, and numerous other work-related issues.
BOX 7-1.
Subdivisions of the Centers for Disease Control and Prevention (CDC)
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The CDC is one of the major operating components of the Department of Health and Human Services (HHS). These agencies have numerous Websites that would be of interest to the student nurse, practicing health professionals, and the general public. |
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Major Agencies of the CDC |
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Environmental Health and Injury Prevention |
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♦ National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH-ATSDR) provides national leadership in preventing and controlling disease and death resulting from the interactions between people and their environment. |
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♦ National Center for Injury Prevention and Control (NCIPC) works to prevent death and disability from nonoccupational injuries, including those that are unintentional and those that result from violence. |
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Health Information and Services |
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♦ National Center for Health Statistics (NCHS) provides statistical information that guides actions and policies to improve the health of the American people. |
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♦ National Center for Public Health Informatics (NCPHI) provides national leadership in the application of information technology in the pursuit of public health. |
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♦ National Center for Health Marketing (NCHM) provides national leadership in health marketing science and in its application to affect public health. |
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Health Promotion |
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♦ National Center on Birth Defects and Developmental Disabilities (NCBDDD) provides national leadership for preventing birth defects and developmental disabilities and for improving the health and wellness of people with disabilities. |
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♦ National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) works to prevent premature death and disability associated with chronic diseases and promotes healthy personal behaviors. |
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♦ Office of Genomics and Disease Prevention provides national leadership in fostering understanding of human genomic discoveries and how they can be used to improve health and prevent disease. |
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Infectious Diseases |
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♦ National Center for Infectious Diseases (NCID) works to prevent illness, disability, and death caused by infectious diseases in the United States and around the world. |
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♦ National Immunization Program (NIP) works to prevent disease, disability and death from vaccine-preventable diseases in children and adults. |
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♦ National Center for HIV, STIs, and TB Prevention (NCHSTP) provides national leadership in preventing and controlling human immunodeficiency virus infection, sexually transmitted infections, and tuberculosis. |
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♦ Coordinating Office for Global Health provides national leadership, coordination, and support for CDC’s global health activities in collaboration with CDC’s global health partners. |
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♦ Coordinating Office for Terrorism Preparedness & Emergency Response provides strategic direction for the Agency to support terrorism preparedness and emergency response efforts. |
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♦ National Institute for Occupational Safety and Health (NIOSH) ensures safety and health for all people in the workplace through research and prevention. |
BOX 7-2.
National Institutes of Health
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The National Institutes of Health (NIH) is composed of 27 separate research institutes and centers. Throughout your nursing education and your nursing career; you will find these sites helpful. The NIH Website has detailed information on the functions of each institute. |
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Office of the Director (OD) |
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National Cancer Institute (NCI) |
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National Eye Institute (NEI) |
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National Heart, Lung, and Blood Institute (NHLBI) |
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National Human Genome Research Institute (NHGRI) |
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National Institute on Aging (NIA) |
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National Institute on Alcohol Abuse and Alcoholism (NIAAA) |
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National Institute of Allergy and Infectious Diseases (NIAID) |
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) |
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National Institute of Child Health and Human Development (NICHD) |
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National Institute on Deafness and Other Communication Disorders (NIDCD) |
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National Institute of Dental and Craniofacial Research (NIDCR) |
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♦ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |
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♦ National Institute on Drug Abuse (NIDA) |
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♦ National Institute of Environmental Health Sciences (NIEHS) |
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♦ National Institute of General Medical Sciences (NIGMS) |
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♦ National Institute of Mental Health (NIMH) |
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♦ National Institute of Neurological Disorders and Stroke (NINDS) |
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♦ National Institute of Nursing Research (NINR) |
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♦ National Library of Medicine (NLM) |
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♦ National Institute for Biomedical Imaging and Bioengineering (NIBIB) |
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♦ National Institutes of Health Clinical Center (CC) |
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♦ Center for Information Technology (CIT) |
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♦ National Center for Complementary and Alternative |
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Medicine (NCCAM) |
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♦ National Center for Research Resources (NCRR) |
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♦ National Center on Minority Health and Health Disparities (NCMHD) |
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♦ John E. Fogarty International Center (FIC) |
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♦ Center for Scientific Review (CSR) |
The Occupational Safety and Health Administration (OSHA) is the subdivision of the DOL that works to prevent occupational injury and illness. OSHA’s mission is to send every worker home whole and healthy every day. OSHA has affiliations with individual state agencies that focus on occupational health and safety. OSHA accomplishments include:
• Standards for safety and health protection in the workplace
• Standards for occupational exposure to blood-borne pathogens
• Standards published to protect construction workers
• Ergonomic standards to prevent musculoskeletal disorders
Healthcare workers are directly affected every day by the criteria set forth in Standard Precautions and its supplement, Transmission-Based Precautions (airborne, droplet, and contact). This Standard ensures the education and protection of all levels of healthcare workers, in all settings, regarding blood-borne pathogens, particularly hepatitis B and HIV. OSHA’s standards mandate that all healthcare agencies and facilities develop policies and procedures, as well as staff education programs. It also encourages immunization of healthcare workers against hepatitis B. Ultimately, this standard serves to protect consumers as well.
Another subdivision of the DOL is the Bureau of Labor Statistics, which assists with worker’s compensation. Worker’s compensation provides financial compensation to a person who has been injured at work or who has contracted a disease that can be directly related to his or her job. The federal government supervises the program, and employers are required to contribute funds, based on the hazards of the particular occupation and the place of employment.
