Discuss the public health power of the federal, state, and local governments. Explain the differences at each level and use this information to develop and justify your position regarding which level of government has the greatest power.
The United States of America is a pristine nation that prioritizes the safety and health of its people above all the other welfare parameters. The U.S health care has three tiers/levels: local, state, and federal health care systems (Hyde & Shortell, 2012). The local agencies are established in a city, neighborhood or county, the establishments depend upon the population of the locality and the state laws (McMillan v. Monroe County, 1997). Local health departments can be structured as a “a health department administrated locally, a state health department branch, a district arising from a state, a multicounty area-administrated department” (Nat’l Ass’n of County & City Health Officials, 2005).”
The ultimate responsibility to protect the health of the nation lies in the hands of the U.S Department of Health and Human Services, which was initially established in the year 1980. The HHS being the main agency that overlooks the health care system of the nation, works closely with the local and state governments and monitors their performance so as to ensure the services are rendered rightly to the local population (Public Health Law Center, 2014).
The U.S Public Health Service which was one of the oldest federal services that focused on public health is now a part of the HHS. The USPHS has about 6,000 health providers from varying sectors who work tirelessly to form a rigid health care system and also volunteer during the natural calamities. Most of the workers of USPHS are pharmacists while the rest are advisors and consultants.
Some of the agencies that comprise HHS are Food and Drug Administration and Centers for Disease Control and Prevention. The FDA mainly works with the manufacturers and is involved in the process of development of drugs. The Department is keen on ensuring the safety to consume or use products such as cosmetics, food and products that emit radiation.
The CDC, on the other hand, works with researchers and practitioners to prevent the prevalent diseases from being transmitted. The CDC web site serves as the ultimate source for general practitioners and pharmacists to refer to symptoms and cures for various diseases. Pharmacists can use the site for obtaining information regarding the prevalent diseases and to advise patients about important vaccinations, symptoms for likely diseases, and treatment options for the appropriate diseases.
Each of the tiers of the system of public health contributes significantly to public health care system of the nation. However, the state and local tiers form the ‘backbone’ of the health care (Salinsky, 2010). The health system varies drastically in different localities, due to the extent of flexibility offered to the state governments in defining their public health role.
With the power to self-govern (Medtronic, Inc., 1996), state governments protect and promote health care by adopting the six prime responsibilities. The main duties are to develop policies, ensure compliance with the laws, assure the availability of resources, build a cohesive community by forming partnership through education and by collaborating with various stakeholders, continuously strive to improve the health status and policies, and to provide wholehearted support to the public health agencies seeking to improve.
The state health department acts as the ‘umbrella’ agency which comprises several other departments that performs a slew of other roles such as providing mental healthcare services, palliative care, and public assistance.
More than half of the state public health departments are governed by the elected officials who act as the board members. The board advises other elected officials, forms health policies, and adopts health care legislative agendas. The members of the board are citizens, teachers, business men and women, educators, and health professionals. As most of the policies are formed by the elected officials and the legislature passes the public health laws, the state health agencies are strongly influenced by the board’s decision.
The authority is delivered down to the localities by the state public health care system. The decisions undertaken by the local government, roles, responsibilities and the extent to which the local health care systems can exercise their policies depends largely on the laws adopted by the state health care system. The effectiveness of the functioning of the local health departments depends upon the how well the local and state health departments are associated (Ass’n of State and Territorial Health Officials, 2012).
The most common relationships between the local and state health care departments are centralized, local, mixed, or hybrid systems. The functions performed by the local health care department vary according to size of populations served. Each state basically has counties and metropolitans; the size of each of these sectors forms the basis of the functioning of the local healthcare departments. Huge metropolitans require advanced and developed health care agencies while the smaller ones require health agencies that offer a minimal series of services in health.
Discussion
Both the local and state health departments play a vital role in caring for the health of the population. The state government manages more than 90% vaccine order management for both children and adult immunizations.
The state government forms the policies and the health agencies usually possess more powers than the local health care systems. However in some cases, when the municipalities comprise of a large area, the local health care system is more advanced than the state level. The local health care department plays a bigger part in implementing the health care policies and coordinating jurisdiction of health care services.
Most of their activities involve in ensuring that the community is provided effective and efficient health services. The local department works closely with the members of community to prevent diseases, develop public health policies, protect people from the potential health hazards, keep close tabs on the health status of the public, train the workforce appropriately and provide other such community health services.
Generally the state governments have complete authority over the local governments. But as specified earlier, in some states the norms may vary and if the policies and laws of state governments are not established clearly, the Dillon’s Rule is followed by the local health care departments (Nat’l League of Cities, Local Government Authority, 2013). Under this rule, the local governments have a narrow authority and it is imperative for them to implement only those policies that are specified by the state government.
Conclusion
Reading about the powers and authority that is bestowed upon the three levels of system of health care of the USA, we realize that each tier has its own set of responsibilities and the contribution of each one is highly critical. It can be said that the three tiers co-exist and the nation’s overall health status cannot be maintained well without the significant contribution of any one of the departments.
However, it seems that the most of the critical responsibilities are undertaken by the state healthcare systems. The state health care system acts as the connector between the national and local health care departments. Apart from being the connector, the state governments provide most of the health care services such as disease prevention, state laboratory services, environmental health, prevention of sexually transmitted diseases such as HIV/AIDS and offer mental health services such as counseling and partner notification.
Moreover, the local governments are generally under the supervision of state health care systems. Although, the association between the local and state health care departments will vary from one state to the other, local governments are instructed by the state government by-the-rule.
It can be inferred that the roles played in all the three levels are critical. To conclude, it is firmly believed that the state level of government has the highest power in forming policies, implementing them and supervising the local counties and municipalities.
References
Ass’n of State and Territorial Health Officials (2012), State Public Health Agency: Understanding the Relationship between State and Local Public Health, Retrieved from https://www.norc.org/PDFs/Projects/Classification%20of%20State%20Health%20Agencies/ASTHO%20
Hyde, J. K., & Shortell, S. M. (2012), The structure and organization of local and state public health agencies in the U.S.: a systematic review, Am.J. Preventive Medicine, Retrieved from https://www.rwjf.org/content/dam/farm/articles/journal_articles/2012/rwjf72639.
McMillan v. Monroe County (1997), Ala., 520 U.S. 781, 780 Retrieved from https://supreme.justia.com/cases/federal/us/520/781/case.html.
Medtronic, Inc. v. Lohr (1996), 518 U.S. 470, 475 (1996)
Nat’l Ass’n of County & City Health Officials (2005), Operational Definition of a Functional Local Health Department 9, Retrieved from https://www.naccho.org/topics/infrastructure/accreditation/OpDef.cfm.
Nat’l League of Cities (2013), Local Government Authority, Retrieved from https://www.nlc.org/buildskills-and-networks/resources/cities-101/city-powers/local-government-authority.
Public Health Law Center (2014). State & Local Public Health: An Overview of Regulatory Authority, William Mitchell College of Law, Retrieved from https://publichealthlawcenter.org/sites/default/files/resources/phlc-fs-state-local-reg-authority-publichealth-2015_0.pdf
Salinsky, E., (2010), Governmental Public Health: An Overview of State and Local Public Health Agencies National Health Policy Forum Background Paper No. 77 8, Retrieved from https://www.nhpf.org/library/background-papers/BP77_GovPublicHealth_08-18-2010.pd
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