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In this module, we will examine the history and future of public health in the United States. Module 6 will highlight some of the public health issues in the United States, reviewing briefly the development of the public health system and identifying broad social, political, and technological forces that shape its future. The relationship between public health and private medicine will be explored.
This module presented the history of government efforts to prevent or control the problems of health and disease. Efforts to protect the public’s health, begun in early European history and transferred to Colonial America, were traced, with emphasis on their purpose, motivation, and success. The rise and decline of America’s once elaborate federal, state, and local partnerships in the delivery of public health services were described, as well as the efforts of private and voluntary agencies. Also discussed were the barriers to effective preventive services that resulted from the lack of a population perspective in the U.S. health care system.
The goal of public health is to secure health and promote wellness, for both individuals and communities, by addressing the social, environmental, and individual determinants of health. As defined by the World Health Organization, health is “A state of complete well-being, physical, social, and mental, and not merely the absence of disease or infirmity.”
Despite the merit of this intent, a lack of consensus on the public health mission, inadequate capacity in the field, disjointed decision-making, hobbled leadership, and organizational fragmentation led the Institute of Medicine (IOM) in 1988 to liken public health to a “shattered vision.” Two decades later, has that assessment borne out? What does the future of public health look like today, and what will it look like in the coming years?
Discussion Question:
It is unfortunate that it requires a threat, epidemic, or pandemic to halt the demise of organized public health and restore an effective public health structure. Why does public health have so much difficulty maintaining governmental support of its central role in maintaining the health and well-being of the American people?
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