PHS 2101 - Chapter 3

• Government

  • Federal
  • State
  • Local
  • International/Global organizations
  • Non-governmental organizations
• U.S. Federal Government

  • powers specifically delegated by the Constitution
  • “to promote and provide for the public welfare”
  • “to regulate commerce”
  • Taxation 16th amendment
  • 3 branches of federal government
  • Checks and Balances
• States' Responsibilities

  • “powers not delegated to the federal government by the Constitution... are reserved to the States respectively...”
  • Education
  • Police powers
  • Protection from communicable diseases
  • Protection from environmental hazards
  • Licensing of health professionals
• Local Municipalities

  • Enactment of specific programs addressing community needs
  • Local health department
  • Assessment
  • Assurance
  • Provision of basic services
  • Sanitation, water, public hospitals, labs
  • “Think globally, act locally”
• Laws

  • Legislative or statutory laws
  • Enacted by Congress or state/local legislatures
  • Administrative laws
  • Agencies are empowered to develop and enact specific rules and regulations
  • Judicial laws
  • courts
• Federal Government

  • Legislative: House of Representatives +Senate
  • Judicial: Courts, Supreme Court
  • Executive: President + VP + Cabinet
• Executive Branch

  • President
  • Vice President
  • Departments (Secretary of each forms the Cabinet)
  • Agriculture (USDA)
  • Interior
  • Commerce
  • Justice
  • Defense
  • Labor
  • Education
  • State
  • Energy
  • Transportation
  • Health & Human Services
  • Treasury
  • Housing & Urban Dev.
  • Veterans Affairs
  • Homeland Security
• Department of Health and Human Services (DHHS)

  • Part of executive branch of government
  • Secretary is Cabinet level position
  • the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
  • www.dhhs.gov
• U.S.PHS: Agencies

  • National Institutes of Health (NIH)
  • Food and Drug Administration (FDA)
  • Centers for Disease Control and Prevention (CDC)
  • Indian Health Service (HIS)
  • Health Services and Resources Administration (HRSA)
  • Agency Health Care Research and Quality (AHRQ)
  • Agency Toxic Substances and Disease Registry(ATSDR)
  • U.S. PHS Commissioned Corps
  • Surgeon general and health professionals
• FDA

  • Assures safety of foods, drugs and cosmetics

  • Safety and efficacy of pharmaceuticals, biologicals, medical devices

  • Est. 1906: first Food and Drug Act

  • 1938: Food, Drug & Cosmetic Act

  • 1962: Kefauver-Harris Amendments

  • 1984: Hatch-Waxman Act

  • 1987: Fast Track

  • 1997: FDA Modernization Act

  • 2016: 21st Century Cures Act
• CDC

  • Primary epidemiological agency in federal gov.

  • Health surveillance monitor and prevent disease outbreaks

  • Implement disease prevention strategies

  • Maintain national health statistics

  • Guards against international disease transmission

  • Est. 1946 as Communicable Disease Center
• Health Resources Services Administration (HRSA)


  • Provides access to essential health services for underserved

  • 3000 centers provide primary and preventative medical care

  • Partnerships with state and community organizations

  • Programs to support increase in number and diversity of healthcare professionals

  • Services to HIV/AIDS patients Ryan White Care Act

  • Est.1982
• HRSA study

  • The pharmacist workforce: a study of the supply

  and demand for pharmacists.

  • Study mandated by Congress

  • Conducted by HRSA

  • December 12, 2000 report predicts 10 year

  shortage of pharmacists. Why?
• HRSA: Workforce Projections for Pharmacists

  • Demand modelling to plan adequate workforce

  • Supply vs. demand for health care

  • Two models project different demand: Status Quo

  vs. Evolving Care

  • How do two models differ?

  • What do the numbers say about demands for

  pharmacists in future?

  • Is there an adequate supply of pharmacists to provide

  for needs in 2030?
• Substance Abuse and Mental Health Services Administration

  • Substance abuse prevention

  • Addiction treatment

  • Mental health services

  • Federal block grants to mayors, town and county officials

  • Est. 1992, formerly Alcohol, Drug Abuse and Mental Health Administration, 1974
• Agency for Healthcare Research and Quality

  • Supports research to improve quality of health

  care

  • Reduce cost of health care

  • Improve patient safety; address medical errors

  • Broaden access to essential services

  • Develop measures of quality

  • Evidence based information on quality, cost, use,

  access inform policy

  • Est. 1989

  • Will discuss in our study of U.S. healthcare system
• Indian Health Service

  • Assistance to tribes running hospitals, health

  centers, health stations, North Alaska village clinics

  • Assists urban Indian Health Centers

  • Serves 1.5 million American Indians and Alaska natives

  • Est. 1924; transferred from Dept. Interior, 1955

  • www.ihs.gov
• Department of Interior

  • Oversees uses of land mass of U.S.

  • Secretary of Interior

  • Debra Haalland

  • First Native American to serve in this positon

  • Strong advocate for protections of public lands
• Human Services Agencies

  • Center for Medicare and Medicaid Services

  (formerly HCFA)

  • Administration of Children and Family Services

  • Administration on Aging

  • Older Americans Act

  • Social Security Administration: independent

  agency since 1995.
• Center for Medicare and Medicaid Services (CMS)

  • Health care to one in four Americans

  • Medicare - health insurance for elderly and

  disabled Americans

  • Medicaid – joint federal-state program

  • 34 million low income Americans

  • Children’s Health Insurance Program (CHIP) >

  state plans 2.2 million children

  • Est. 1977

  • 2003: Medicare Prescription Drug Improvement

  and Modernization Act
• Administration for Children and Families

  • Promote economic well being of families

  • Administers state-federal welfare programs

  • Temporary assistance to needy families

  • National child support enforcement system

  • Head Start Program

  • Supports state programs for foster care and

  adoption assistance

  • Programs to prevent child abuse and domestic

  violence
• Administration of Aging

  • Advocate agency for older persons

  • Older Americans Act 1965

  • Nutrition programs e.g. Meals on Wheels

  • Area Agencies on Aging

  • Regional and state offices
• Health-related Agencies (non-DHHS)

  • EPA

  • Administrator in President’s cabinet

  • OSHA (Department of Labor)

  • FEMA

  • Director in President’s cabinet

  • Office of Homeland Security

  • Director in President’s cabinet

  • Department of Agriculture

  • Drug Enforcement Agency (DEA)

  • Social Security Administration (SSA)
• EPA

  • Michael Regan

  • Top North Carolina Environmental Protection

  regulator