The Future of Public Health -- Copyright -- Preface -- Acknowledgements -- Contents -- Summary and Recommendations -- WHY STUDY PUBLIC HEALTH -- THE APPROACH -- THE STATE OF U.S. PUBLIC HEALTH -- The Public Health Mission -- Professional Expertise and the Political Process -- Public Health and the Medical Profession -- The Knowledge Base and its Application -- THE FUTURE OF PUBLIC HEALTH: RECOMMENDATIONS -- THE PUBLIC HEALTH MISSION, GOVERNMENTAL ROLE, AND LEVELS OF RESPONSIBILITY -- Mission -- The Governmental Role in Public Health -- Assessment -- Policy Development -- Assurance -- Levels of Responsibility -- States -- Federal -- Localities -- FULFILLING THE GOVERNMENT ROLE: IMPLEMENTING RECOMMENDATIONS -- Statutes -- Organizational Structure -- States -- Localities -- Federal -- Special Linkages -- Environmental Health -- Mental Health -- Social Services -- Care of the Indigent -- Strategies for Capacity Building -- Technical -- Political -- Managerial -- Programmatic -- Fiscal -- Education for Public Health -- CONCLUDING REMARKS -- 1 The Disarray of Public Health: A Threat to the Health of the Public -- IMMEDIATE CRISES -- AIDS (Acquired Immune Deficiency Syndrome) -- Access to Health Care for the Indigent -- ENDURING PUBLIC HEALTH PROBLEMS -- Injuries -- Teen Pregnancy -- Control of High Blood Pressure -- Smoking and Substance Abuse -- GROWING CHALLENGES AND IMPENDING CRISES -- Toxic Substances -- Alzheimer's Disease or Dementia of the Alzheimer Type -- Revitalization of Public Health Capacities -- REFERENCES -- 2 A Vision of Public Health in America: An Attainable Ideal -- A DEFINITION OF PUBLIC HEALTH -- The Mission of Public Health -- The Substance of Public Health -- The Organizational Framework of Public Health -- The Role of Government in Public Health -- The Functions of Government in Public Health -- Assessment -- Policy Development.

Assurance -- State, Local, and Federal Roles in Public Health -- State Governments -- Federal Government -- Local Governments -- The Public and Private Sectors in Public Health -- THE BASIC SERVICES OF PUBLIC HEALTH -- REFERENCES -- 3 A History of the Public Health System -- HISTORY -- Before the Eighteenth Century -- The Eighteenth Century -- The Nineteenth Century: The Great Sanitary Awakening -- The Sanitary Problem -- The Development of Public Activities in Health -- Late Nineteenth Century: Enter Bacteriology -- The Development of State and Local Health Department Laboratories -- The Successes of Bacteriology -- Early Twentieth Century: The Move Toward Personal Care -- Further Development of State and Local Health Agencies -- The Growth of Federal Activities in Health -- Mid-Twentieth Century: Further Expansion of the Governmental Role in Personal Health -- Federal Activities -- State and Local Activities -- The Late Twentieth Century: A Crisis in Care and Financing -- CONCLUSION -- REFERENCES -- 4 An Assessment of the Current Public Health System: A Shattered Vision -- VIEWING THE SYSTEM -- THE PUBLIC HEALTH SYSTEM -- Summary of the National Public Health System -- State -- Local -- Federal -- Resources -- Other Actors -- The Public Health System as Observed by the Committee -- Organization of Health Agencies -- Leadership -- Range of Activities -- Assessment -- Policy Development -- Assurance of Health Services -- Intergovernmental and Interorganizational Relationships -- Resources -- CONCLUSION -- REFERENCES -- 5 Public Health as a Problem-Solving Activity: Barriers to Effective Action -- THE LACK OF CONSENSUS ON MISSION AND CONTENT OF PUBLIC HEALTH -- Public Health Responsibility for Indigent Care -- Relationship of Public Health to Environmental Health -- Relationship of Public Health to Mental Health.

The Public Health Role in Encouraging Healthful Behaviors Through Education and Through Modification in Social Environment -- IMPEDIMENTS TO THE ESSENTIAL WORK OF PUBLIC HEALTH -- Assessment and Surveillance -- Policy Development -- Assurance of Access to the Benefits of Public Health -- LEADERSHIP FOR PUBLIC HEALTH -- The Interaction of Technical Expertise and Political Accountability -- Continuity of Leadership -- National Leadership for Public Health -- Poor Relationships with the Medical Profession -- Community Organization for Public Health Action -- STRUCTURE AND ORGANIZATION OF PUBLIC HEALTH -- Organizational Separation of Environmental Health Programs, Mental Health Programs, and Indigent Care Programs -- Creation of Health and Human Services Superagencies -- Lack of a Clear Delineation of Responsibilities Between Levels of Government -- DEFICITS IN THE CAPACITY TO CONDUCT PROGRAMS -- Knowledge and its Application -- The Need for Well-Trained Public Health Personnel -- Distribution of Technical Expertise -- Building Constituencies for Public Health -- Managerial Capacity -- The Lack of Fiscal Support -- HOW THE PUBLIC HEALTH SYSTEM WORKS-AIDS AS AN EXAMPLE -- Statutory Base -- Assessment -- Policy Development -- Assurance -- THE STATE OF PUBLIC HEALTH -- REFERENCES -- 6 Conclusions and Recommendations -- THE PUBLIC HEALTH MISSION, GOVERNMENTAL ROLE, AND LEVELS OF RESPONSIBILITY -- Mission -- The Governmental Role in Public Health -- Assessment -- Policy Development -- Assurance -- Federal, State, and Local Responsibilities -- States -- The Federal Government -- Localities -- FULFILLING THE GOVERNMENT ROLE: RECOMMENDATIONS -- Statutory Base -- Structural/Organizational Steps -- States -- Federal -- Special Linkages -- Environmental Health -- Mental Health -- Social Services -- Care of the Medically Indigent -- Strategies for Capacity Building.

Technical -- Political -- Managerial -- Programmatic -- Fiscal -- Education for Public Health -- CONCLUDING REMARKS -- REFERENCES -- Supplementary Statements -- HARVEY I. SLOANE -- ROBERT J. RUBIN -- Appendixes -- Appendix A Summary of the Public Health System in the United States -- Public Health Agencies -- Federal -- Leadership -- Organization -- Activities -- Resources -- State -- Leadership -- Organization -- Activities -- Resources -- Local -- Leadership -- Organization -- Activities -- Resources -- Other Participants in the Public Health System -- National -- Governmental -- Nongovernmental -- State -- Governmental -- Nongovernmental -- Local -- Governmental -- Nongovernmental -- Conclusion -- References -- Appendix B Biographies of Committee Members -- Appendix C Model Standards -- Program Areas -- Promoting Health/Preventing Disease: Objectives for the Nation-1990 -- Appendix D Site Visits: Site Selection and Methodology -- Objectives for the Site Visits -- Site Selection -- Methodology -- References -- Index.