public health(redirected from Public health system)
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public health,field of medicine and hygiene dealing with the prevention of disease and the promotion of health by government agencies. In the United States, public health authorities are engaged in many activities, including inspection of persons and goods entering the country to determine that they are free of contagious disease. They are empowered to isolate persons with certain diseases and to quarantine such individuals, if necessary, for the public good. Public health officials are responsible for supervising the purity of the water, milk, and food supply as well as the persons who handle these items and the public eating places that dispense them. They are responsible for the good health of animals that supply food and for the extermination of wildlife, rodents, and insects that contribute to disease. Public health authorities are also concerned with the pollution levels in air and water, and must assure the safety of water used for drinking, for swimming, and as a source of sea food. In addition, they collect vital statistics on death rates, birth rates, communicable and chronic diseases, and other indicators of the state of public health.
The duties of carrying out the many services required to keep the population healthy and to prevent serious outbreaks of disease are divided among local, state, and federal government agencies. They provide health officers and nurses for the schools and visiting nurses for the home. They oversee the water supply, the disposal of sewage, the production and distribution of milk, and the proper handling of food in restaurants. Public health agencies impose standards of public health on local communities when needed; they give financial and technical assistance to local communities in time of crisis, such as that caused by epidemics, hurricanes, and floods.
The principal federal health agency in the U.S. today is the Public Health Services division of the Department of Health and Human Services. It consists of five agencies including the National Institutes of HealthNational Institutes of Health
(NIH), agency of the U.S. Public Health Service, with headquarters in Bethesda, Md. It was established initially in 1887 as a laboratory in the U.S. Marine Hospital on Staten Island in New York City, and was given its present name in 1948.
..... Click the link for more information. , its research arm, which conducts extensive research into neurology, blindness, AIDS, immunology, and heart disease. The Centers for Disease Control and PreventionCenters for Disease Control and Prevention
(CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center.
..... Click the link for more information. , another agency under the Public Health Service, maintains statistical data on all diseases; it was instrumental in showing the relationship between tampons and toxic shock syndrome, as well as pinpointing the source of Legionnaire's disease to a new water-borne organism. The Food and Drug AdministrationFood and Drug Administration
(FDA), agency of the Public Health Service division of the U.S. Department of Health and Human Services. It is charged with protecting public health by ensuring that foods are safe and pure, cosmetics and other chemical substances harmless, and
..... Click the link for more information. is the arm charged with assuring the effectiveness and purity of food, drugs, and cosmetics. The Alcohol, Drug Abuse and Mental Health Administration was established by Congress more recently to address substance abuse and mental health problems. To carry out all these activities the public health services employ large numbers of physicians, dentists, veterinarians, laboratory technicians, nurses, sanitary engineers, health educators, psychologists, and social workers (see also Surgeon General, United StatesSurgeon General, United States,
former head of the U.S. Public Health Service, which is responsible for protecting the people's health (see public health). Since a 1986 reorganization, the surgeon general has largely served as a national spokesperson and watchdog on health
..... Click the link for more information. ).
Because of the frequent and rapid transportation of people and disease vectors by air there has been a growing need for the monitoring of public health on a global level. This is done by the UN's World Health OrganizationWorld Health Organization
(WHO), specialized agency of the United Nations, established in 1948, with its headquarters at Geneva. WHO admits all sovereign states (including those not belonging to the United Nations) to full membership, and it admits territories that are not
..... Click the link for more information. .
See studies by J. Leavitt and R. Numbers, ed. (1978), R. Bayer et al., ed. (1983), and O. Anderson (1985).
the state, social, economic, medical, and other measures undertaken by a society for the protection and improvement of the health of its members. The character of public health services is determined above all by the social structure of the society and of the state. Hence, the principles and character of public health services in capitalist and socialist societies are different, although the goal of public health is the same—the study of health and diseases, the prevention and treatment of diseases, and the preservation of health and of fitness for work. Methods of public health, measures of individual and group prophylaxis, methods of inspection and supervision of the biosphere, and methods of diagnosis and treatment of diseases are international. But the public health services of each state differ according to national characteristics and traditions.
In the USSR and other socialist countries, the social structure has determined the development of a new type of public health system, which consists in the state’s socioeconomic, medical, and public measures directed toward the prevention and treatment of disease and the ensuring of healthful working conditions and of work fitness and longevity. The basic principles of socialist public health are a scientific character, free qualified medical care, available to all, an emphasis on prevention, and participation of the community in public health. In the USSR the principles of public health are deter-mined by the policy of the CPSU and of the Soviet state. The Program of the CPSU adopted by the Twenty-second Congress of the CPSU declares that “the socialist state is the only state that concerns itself with the protection and continuous improvement of the health of the whole population. This is ensured by a system of socioeconomic and medical measures” (1971, p. 96). In the USSR the basic provisions concerning public health are regulated by legislation and are most completely and systematically set forth in the Basic Principles of Legislation on Public Health of the USSR and of the Union Republics, adopted by the Supreme Soviet of the USSR on Dec. 19, 1969. The synthesis of advanced medicine and modern organizational forms is the basis of the unity of the theory and practice of medical science, and this unity determines the scientific character of public health in the USSR, one of the basic principles of socialist public health.
On July 11, 1918, V. I. Lenin signed a decree of the Council of People’s Commissars of the RSFSR concerning the establishment of the People’s Commissariat of Public Health of the RSFSR, the first state agency in the world for the administration of public health. By the decree, all medical and sanitary institutions, which had previously been under the control of various government departments, institutions, organizations, and private persons, were transferred to the state budget and placed under the direction of the People’s Commissariat of Public Health of the RSFSR. In 1918 the Scientific Medical Council of the People’s Commissariat of Public Health was organized for the purpose of bringing together the country’s scientific resources, making use of the achievements of advanced medical science, determining the directions of medical research, and solving scientific and practical problems.
In 1936 a central agency of public health administration was established, the Union-republic People’s Commissariat of Public Health of the USSR (since 1946 the Ministry of Public Health of the USSR). Ministries of public health were also set up in the Union and autonomous republics. The executive committees of krai, oblast, municipal, and raion soviets of workers’ deputies have public health sections.
Medical and sanitary departments have been organized under a number of ministries to provide medical services to workers in particular industries, and some ministries have sanitary inspectorates; their activities are coordinated by the Ministry of Public Health of the USSR.
A firm material and technical base has permitted the realization of one of the most important principles of socialist public health—free qualified and specialized medical care available to the entire population. In the USSR the public health budget is part of the state budget; state, cooperative, trade union, and other public enterprises and organizations, as well as kolkhozes, also make use of their own resources. Concerned with the health of its workers, the Soviet state is continually increasing its expenditures for public health, including physical education and sports: in 1950 expenditures totaled 2.1 billion rubles, in 1960, 4.8 billion rubles, and in 1970, 9.9 billion rubles.
The plan for the development of public health is an integral part of the plan for the development of the national economy as a whole, which takes into account prospects and prognoses for economic development in various parts of the country, as well as the basic demographic and morbidity indexes of these regions. The public health plan is all-inclusive. Along with public health agencies, other government departments and various organizations also participate in solving public health problems, particularly by taking preventive measures. This ensures the united action of these departments and organizations together with the central state agencies and permits the coordination and centralized administration of public health services on all levels according to common principles, while taking into account the specific nature of local conditions and of national traditions and characteristics.
The emphasis on prevention is carried out in practice through a state system of social and medical measures designed to prevent diseases, as well as of measures for safe-guarding health, fitness for work, and longevity. Of great significance in safeguarding the health of workers and in the treatment and prevention of various diseases is the treatment provided in sanatoriums and health resorts. The Academy of Medical Sciences of the USSR and its committees for dealing with special problems and the scientific medical councils of the Ministries of Public Health develop medicine on both its theoretical and practical planes. Since 1965 permanent committees on public health and social security have been functioning in both houses of the Supreme Soviet of the USSR; there are also permanent committees on public health under the local soviets of workers’ deputies, which supervise and assist public health agencies. Much work is being done by representatives of trade unions, by members of the Union of Societies of the Red Cross and of the Red Crescent of the USSR, and by public organizations. In other socialist countries, public health is based primarily on principles analogous to those of Soviet public health.
Public health systems in capitalist countries are founded on different principles. Among the activities of state public health agencies in capitalist countries are public health legislation, border protection, military medicine, the organization of medical care for certain categories of the population (for example, war invalids and sometimes the mentally ill), the regulation of the rights and duties of physicians, higher medical education, and the sale of drugs. The functions of organs of self-government (such as those of municipalities) include the organization of hospitals and, to a lesser degree, of outpatient institutions for the protection of mothers and children and for combating tuberculosis and other social diseases, as well as the organization of sanitary inspection. The maintenance of municipal medical institutions (hospitals) is based on the fee-for-service principle, that is, treatment is provided only upon payment by the patient. Along with municipal and charitable hospitals there are a large number of private hospitals that are purely commercial enterprises.
However, healing by magic and charlatanry exist side by side with highly developed scientific medicine, for example, thousands of quacks, osteopaths, and chiropractors practice legally in the USA, fleecing gullible patients. Shameless advertisements of various miraculous “medicines” contribute to the profiteering from illness.
Even the wealthiest capitalist countries have not developed a system of medical care for the rural population. In contemporary capitalist countries there are three main systems for organizing medical care for the population: private-enterprise medicine, insurance medicine, and state public health service.
Private-enterprise medicine is most strikingly represented in the USA, Spain, Portugal, and several other states. For example, in the USA there is no compulsory medical insurance. The cost of hospital treatment is rising steadily: according to the New York Times the cost of a ten-day stay in private New York hospitals increased from $560 in 1960 to $842 in 1966.
“Voluntary” insurance on the basis of so-called pre-paid group insurance is justifiably called “poverty by installments,” in progressive circles. It reimburses, at the worker’s expense, only a small part of the cost of medical care (about 40 percent).
A characteristic of American public health is the large amount of hospital funds allocated for psychiatric hospitals, necessitated by the extremely large incidence of mental illness in the country.
Insurance medicine has become widespread in most European capitalist countries and in some countries of Asia and Latin America. Characteristic of this system are (1) obliga-tory state insurance for part or all the population, (2) the participation of the insured, of the owners of enterprises, and of government and municipal agencies in the financing of medical expenditures, (3) partial reimbursement of the medical expenses of the insured, and (4) emphasis on treatment. In some countries obligatory state insurance covers only the workers and employees of industrial enterprises (for example, the Federal Republic of Germany), while in others the entire population of the country is insured (Norway, Austria). The principal source for the creation of social-insurance funds are premiums paid by the insured (for example, in Norway about 55 percent). Average expenses for medical care total 1.5–3 percent of wages. Hospital care is provided by state, municipal, private, and philanthropic hospitals since the insurance agencies do not have their own hospitals; payment for treatment (partial or entire) is made by the insurance office. Under insurance medicine the budget does not include funds for preventive measures.
Among the capitalist countries, the system of state public health service in its most complete form has been introduced in Great Britain since 1948. This progressive system of public health, arising out of a prolonged class struggle, is justifiably considered by English workers to be one of their most important achievements. The state service system includes outpatient and hospital care, consultation with specialists, and some types of preventive care. All types of medical care with the exception of medication are provided, for the most part, free of charge. Outpatient care in the physician’s office or at home is provided by general practitioners. These physicians accept all patients assigned to them regardless of the type of disease (internal medicine, pediatrics, obstetrics, dermatology). Only a general practitioner may refer a patient to a specialist for consultation. The physician himself bears the expense of maintaining and equipping his office and of paying auxiliary medical personnel. Certain preventive measures are carried out by local public health agencies (for example, county public health committees), including nursing services for the home care of patients, care of mental patients, transporting patients, and preventive immunization. There are no sanatoriums, health resorts, or houses of rest.
In countries that have freed themselves from colonialism, democratic transformations are being carried out in various spheres of social life, including public health. The onerous legacy of the past and the insufficiency of medical personnel and material resources make it impossible to realize these important beginnings on a broad scale. Nevertheless, there is evidence of considerable progress in public health: measures are being taken to prevent the spread of such diseases as smallpox, malaria, and helminthiasis.
Contacts among various countries have resulted in more extensive international cooperation in public health. The World Health Organization is broadening its activities. The USSR and other socialist countries are playing an important role in the WHO, fostering in every way possible the development of international cooperation in public health. The problems of public health and of social hygiene as an inte-grated science have been transformed from internal problems of specific countries into international ones.
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