Disease

A disease is an abnormal condition affecting the body of an organism. It is often construed to be a

medical condition associated with specific symptoms and signs.[1][2][3] It may be caused by external
factors, such as infectious disease, or it may be caused by internal disfunctions, such as autoimmune
diseases. Ecologically, disease is defined as maladjustment of a body with environment.
In humans, "disease" is often used more broadly to refer to any condition that causes pain, dysfunction,
distress, social problems, and/or death to the person afflicted, or similar problems for those in contact with
the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes,
infections. Isolated symptoms, deviant behaviors, and atypical variations of structure and function, while
in other contexts and for other purposes these may be considered distinguishable categories. A diseased
body is quite often not only because of some dysfunction of a particular organ but can also be because of
a state of mind of the affected person who is not at ease with a particular state of its body.
Death due to disease is called death by natural causes. There are four main types of disease: infectious
disease, deficiency disease, hereditary disease, and physiological disease
Infectious Disease

An infectious disease is a clinically evident illness resulting from the presence of pathogenic microbial
agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multicellular parasites, and
aberrant proteins known as prions. These pathogens are able to cause disease in animals and/or plants.
Infectious pathologies are also called communicable diseases or transmissible diseases due to their
potential of transmission from one person or species to another by a replicating agent (as opposed to a
toxin).[1]
Transmission of an infectious disease may occur through one or more of diverse pathways including
physical contact with infected individuals. These infecting agents may also be transmitted through liquids,
food, body fluids, contaminated objects, airborne inhalation, or through vector-borne spread.[2]
Transmissible diseases which occur through contact with an ill person or their secretions, or objects
touched by them, are especially infective, and are sometimes referred to as contagious diseases.
Infectious (communicable) diseases which usually require a more specialized route of infection, such as
vector transmission, blood or needle transmission, or sexual transmission, are usually not regarded as
contagious, and thus not are not as amenable to medical quarantine of victims.
The term infectivity describes the ability of an organism to enter, survive and multiply in the host, while the
infectiousness of a disease indicates the comparative ease with which the disease is transmitted to other
hosts.[3] An infection however, is not synonymous with an infectious disease, as an infection may not
cause important clinical symptoms or impair host function
Transmission

An infectious disease is transmitted from some source. Defining the means of transmission plays an
important part in understanding the biology of an infectious agent, and in addressing the disease it
causes. Transmission may occur through several different mechanisms. Respiratory diseases and
meningitis are commonly acquired by contact with aerosolized droplets, spread by sneezing, coughing,
talking, kissing or even singing. Gastrointestinal diseases are often acquired by ingesting contaminated
food and water. Sexually transmitted diseases are acquired through contact with bodily fluids, generally
as a result of sexual activity. Some infectious agents may be spread as a result of contact with a
contaminated, inanimate object (known as a fomite), such as a coin passed from one person to another,
while other diseases penetrate the skin directly.[2]
Transmission of infectious diseases may also involve a vector. Vectors may be mechanical or biological.
A mechanical vector picks up an infectious agent on the outside of its body and transmits it in a passive
manner. An example of a mechanical vector is a housefly, which lands on cow dung, contaminating its
appendages with bacteria from the feces, and then lands on food prior to consumption. The pathogen
never enters the body of the fly.
In contrast, biological vectors harbor pathogens within their bodies and deliver pathogens to new hosts in
an active manner, usually a bite. Biological vectors are often responsible for serious blood-borne
diseases, such as malaria, viral encephalitis, Chagas disease, Lyme disease and African sleeping
sickness. Biological vectors are usually, though not exclusively, arthropods, such as mosquitoes, ticks,
fleas and lice. Vectors are often required in the life cycle of a pathogen. A common strategy used to
control vector borne infectious diseases is to interrupt the life cycle of a pathogen by killing the vector

Publicly Spread diseases

Malaria

Malaria is a mosquito-borne infectious disease caused by a eukaryotic protist of the genus

PlasmodiumMalaria is naturally transmitted by the bite of a female Anopheles mosquito. When a
mosquito bites an infected person, a small amount of blood is taken, which contains malaria parasites.
These develop within the mosquito, and about one week later, when the mosquito takes its next blood
meal, the parasites are injected with the mosquito's saliva into the person being bitten. After a period of
between two weeks and several months (occasionally years) spent in the liver, the malaria parasites start
to multiply within red blood cells, causing symptoms that include fever, and headache. In severe cases
the disease worsens leading to hallucinations, coma, and death. Malaria is commonly associated with
poverty, and can indeed be a cause of poverty[3] and a major hindrance to economic development.

Tuberculosis

Tuberculosis or TB (short for tubercles bacillus) is a common and often deadly infectious disease
caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans.[1] Tuberculosis
usually attacks the lungs but can also affect other parts of the body. It is spread through the air when
people who have the disease cough, sneeze, or spit.[2] Most infections in humans result in an
asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active
disease which, if left untreated, kills more than 50% of its victims.

Polio
Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from
person to person, primarily via the fecal-oral route.[1] The term derives from the Greek poliós (πολιός),
meaning "grey", myelós (µυελός), referring to the "spinal cord", and the suffix -itis, which denotes
inflammation.[2]
Although around 90% of polio infections cause no symptoms at all, affected individuals can exhibit a
range of symptoms if the virus enters the blood stream.[3] In about 1% of cases the virus enters the central
nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and
acute flaccid paralysis. Different types of paralysis may occur, depending on the nerves involved. Spinal
polio is the most common form, characterized by asymmetric paralysis that most often involves the legs.
Bulbar polio leads to weakness of muscles innervated by cranial nerves. Bulbospinal polio is a
combination of bulbar and spinal paralysis
Wat is public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through
the organized efforts and informed choices of society, organizations, public and private, communities and
individuals." (1920, C.E.A. Winslow)[1] It is concerned with threats to the overall health of a community
based on population health analysis. The population in question can be as small as a handful of people or
as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health
is typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral,
and occupational health are other important subfields.

There are 2 distinct characteristics of public health:

1. It deals with preventive rather than curative aspects of health

2. It deals with population-level, rather than individual-level health issues

The focus of public health intervention is to prevent rather than treat a disease through surveillance of
cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a
disease may be vital to preventing it in others, such as during an outbreak of an infectious disease. Hand
washing, vaccination programs and distribution of condoms are examples of public health measures.

Objectives

The goal of public health is to improve lives through the prevention and treatment of disease. The United
Nations' World Health Organization defines health as "a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity."[2]

The focus of a public health intervention is to prevent rather than treat a disease through surveillance of
cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a
disease can be vital to preventing its spread to others, such as during an outbreak of infectious disease or
contamination of food or water supplies. Vaccination programs and distribution of condoms are examples
of public health measures.

Most countries have their own government public health agencies, sometimes known as ministries of
health, to respond to domestic health issues. In the United States, the front line of public health initiatives
are state and local health departments. The United States Public Health Service (PHS), led by the
Surgeon General of the United States, and the Centers for Disease Control and Prevention,
headquartered in Atlanta, are involved with several international health activities, in addition to their
national duties.

There is a vast discrepancy in access to health care and public health initiatives between developed
nations and developing nations. In the developing world, public health infrastructures are still forming.
There may not be enough trained health workers or monetary resources to provide even a basic level of
medical care and disease prevention. As a result, a large majority of disease and mortality in the
developing world results from and contributes to extreme poverty. For example, many African
governments spend less than USD$10 per person per year on health care, while, in the United States, the
federal government spent approximately USD$4,500 per capita in 2000.

Many diseases are preventable through simple, non-medical methods. For example, research has shown
that the simple act of hand washing can prevent many contagious diseases.[3]

Public health plays an important role in disease prevention efforts in both the developing world and in
developed countries, through local health systems and through international non-governmental
organizations.

The two major postgraduate professional degrees related to this field are the Master of Public Health
(MPH) or the (much rarer) Doctor of Public Health (DrPH). Many public health researchers hold PhDs in
their fields of speciality, while some public health programs confer the equivalent Doctor of Science
degree instead.
Public health programmes

Today, most governments recognize the importance of public health programs in reducing the incidence
of disease, disability, and the effects of aging, although public health generally receives significantly less
government funding compared with medicine. In recent years, public health programs providing
vaccinations have made incredible strides in promoting health, including the eradication of smallpox, a
disease that plagued humanity for thousands of years.

An important public health issue facing the world currently is HIV/AIDS.[14] Antibiotic resistance is another
major concern, leading to the reemergence of diseases such as Tuberculosis.

Another major public health concern is diabetes.[15] In 2006, according to the World Health Organization,
at least 171 million people worldwide suffered from diabetes. Its incidence is increasing rapidly, and it is
estimated that by the year 2030, this number will double. However, in a June 2010 editorial in the medical
journal The Lancet, the authors opined that "The fact that type 2 diabetes, a largely preventable disorder,
has reached epidemic proportion is a public health humiliation."[16] (Type 1 diabetes mellitus is not
preventable, however.)

A controversial aspect of public health is the control of smoking.[17] Non-communicable diseases caused
by smoking have been threatening public health because it requires a long term strategy for improving
unlike the communicable diseases which take a shorter period to be improved. The reason for this is
because communicable diseases have been at the top as a global health priority while non communicable
diseases have been at the bottom as a global health priority. Simultaneously, global health policy making
is increasingly aligned with industrial and trade policies, and is being done hand in hand with business,
thus weakening the firewalls necessary for effective regulation and normative actions both at national and
global levels.[18] Many nations have implemented major initiatives to cut smoking, such as increased
taxation and bans on smoking in some or all public places. Proponents argue by presenting evidence that
smoking is one of the major killers in all developed countries, and that therefore governments have a duty
to reduce the death rate, both through limiting passive (second-hand) smoking and by providing fewer
opportunities for smokers to smoke. Opponents say that this undermines individual freedom and personal
responsibility (often using the phrase nanny state in the UK), and worry that the state may be emboldened
to remove more and more choice in the name of better population health overall. However, proponents
counter that inflicting disease on other people via passive smoking is not a human right, and in fact
smokers are still free to smoke in their own homes.

There is also a link between public health and veterinary public health which deals with zoonotic
diseases, diseases that can be transmitted from animals to humans. (See also Vector control).

Public Health Service

[For the Public Health Service statement of organization, see the Federal Register of December 2, 1977,
42 FR 61317]
The Public Health Service was established by act of July 16, 1798 (ch. 77, 1 Stat. 605), authorizing
marine hospitals for the care of American merchant seamen. Subsequent legislation has vastly
broadened the scope of its activities.
The Public Health Service Act of July 1, 1944 (42 U.S.C. 201), consolidated and revised substantially all
existing legislation relating to the Public Health Service. The basic Public Health Service legal
responsibilities have been broadened and expanded many times since 1944. Major organizational
changes have occurred within the Public Health Service to support its mission to promote the protection
and advancement of the Nation's physical and mental health. This is accomplished by:

• coordinating with the States to set and implement national health policy and pursue effective
intergovernmental relations;
• generating and upholding cooperative international health-related agreements, policies, and
programs;

• conducting medical and biomedical research;

• sponsoring and administering programs for the development of health resources, prevention and
control of diseases, and alcohol and drug abuse;

• providing resources and expertise to the States and other public and private institutions in the
planning, direction, and delivery of physical and mental health care services; and

• enforcing laws to assure the safety and efficacy of drugs and protection against impure and unsafe
foods, cosmetics, medical devices, and radiation-producing projects.
The Office of the Assistant Secretary for Health consists of general and special staff offices that support
the Assistant Secretary for Health and the Surgeon General plan and direct the activities of the Public
Health Service.
Agency for Health Care Policy and Research. The Agency was established by the Omnibus Budget
Reconciliation Act of 1989 (42 U.S.C. 299) as the successor to the National Center for Health Services
Research and Health Care Technology Assessment. The Agency is the Federal Government's focal point
for health services research. The Agency for Health Care Policy and Research is the only Federal agency
charged with producing and disseminating scientific and policy-relevant information about the quality,
medical effectiveness, and cost of health care. The Agency's programs focus on maximizing the value of
our national health care investment by analyzing the costs and improving the outcomes of health care. Its
priorities include:

• reducing health care costs, through studies on the interaction of cost, quality, and access;
microsimulation modeling, to understand the effect of proposed health care reform; and analyzing
health care costs effected by acute, ambulatory, and long-term care and AIDS;

• expanding clinical practice guideline activities by increasing production of important guidelines and
evaluating their effect on the cost and quality of health care; and

• enhancing the scientific evidence base for cost-effective clinical practices, by expanding research to
improve clinical decisionmaking and strengthening clinical information systems for effectiveness
research.
The Agency supports and conducts research integral to understanding the design and performance of the
health care delivery system, and undertakes widespread dissemination of the results of its research and
clinical guidelines it supports. The emphasis on widespread and rapid dissemination and research on
more effective dissemination methods reflects the goal of the Agency to enhance the value of our national
investment in health care.
The Agency plays an important role in increasing possibilities for future health services research,
including medical effectiveness research through its support for methodological studies; data
development and research training particularly, related to primary care; and minority and rural health. The
Agency also has an active program in medical liability.
The goals of our nation’s public health system are to prevent disease and disability, promote healthy
lifestyles, and prevent and mitigate the results of both unintentional and intentional public health threats,
including biological, chemical, and nuclear terrorism as well as natural disasters. These goals are
facilitated through implementation of the following ten essential public health services.
 • Monitor health status to identify community health problems.
• Diagnose and investigate health problems and health hazards in the community.
• Inform, educate, and empower people about health issues.
• Mobilize community partnerships to identify and solve health problems.
• Develop policies and plans that support individual and community health efforts.
• Enforce laws and regulations that protect health and ensure safety.
• Link people to needed personal health services and assure the provision of health care when
otherwise unavailable.
• Assure a competent public health and personal health care workforce.
• Evaluate effectiveness, accessibility, and quality of personal and population-based health
services.
• Research for new insights and innovative solutions to health problems.
Governors encourage federal support for these essential public health services that are routinely carried
out by public health agencies to improve the health of our citizens and prevent illness. These essential
services generally result in a higher quality of life and a lower cost of medical services for all Americans.
An adequate public health infrastructure leads to increased savings and prevents substantial economic
loss.
4.2 Public Health Infrastructure
The governmental public health infrastructure provides the backbone necessary to carry out the ten
essential public health services. Three areas are vital to a strong public health system: public health
workforce; information, data, and communication systems; and organizational and systems capacity.
Public health infrastructure is comprised of a complex network of people, systems, and organizations
working in all levels of government and in the private sector. As such, the strength of the public health
system depends on sustained, consistent investment and cooperation among all levels of government.
Governors urge the federal government to fully integrate efforts to enhance the public health information,
data, and communication systems into the ongoing development and nationwide implementation of an
interoperable health information technology infrastructure.
4.3 Public Health Standards, Accreditation, and Licensure
The essential services of public health are the primary responsibility of both local and state public health
agencies across this nation. Each public health entity differs in its capabilities, responsibilities, and
authorities. It is critical for these agencies to demonstrate their readiness and capacity to act across a
wide variety of circumstances. Governors believe that given the diffuse structure and variation in capacity
of state public health systems, accreditation status should not determine grant competitiveness or
eligibility. Governors also urge that public health service initiatives programs be created from state-
developed best practices and should be supported by the federal government through assistance in the
form of technical support and incentive grants, not penalties.
Governors support the voluntary use of performance standards that facilitate continuous performance and
infrastructure improvement in public health systems. A uniform set of national standards, such as the
voluntary national accreditation program being developed by the Public Health Accreditation Board, could
serve to illustrate what all residents, policymakers, and partnering organizations should be able to expect
from public health agencies and provide greater assurances to all policymakers of the capacity and
quality of public health agencies. Furthermore, utilization of these national standards would lead to the
building of a more cohesive and robust system and demonstrate the effectiveness of investments in
public health. States should be recognized for having taken the initiative to develop state specific
standards for public health when national standards are adopted.
Additionally, governors urge the federal government to recognize the reciprocal licensure, certification,
and/or accreditation agreements developed by states to ensure medical and public health personnel are
able to respond to emergency situations inside the borders of another state. Specifically, governors urge
the federal government to continue its recognition of the Emergency Management Assistance Compact
(EMAC) program. The reciprocity within the EMAC system ensures licenses, certifications, or
accreditations transfer and is recognized by the receiving state or locality during an emergency. Federal
recognition of EMAC will guarantee that responding personnel can care for the citizens of the affected
area immediately upon arrival, no matter if they are located on public, private, or government property.
The liability for any care rendered by these individuals would be covered through the state-to-state EMAC
agreements.
4.4 Federal-State Partnership
While state and local public health agencies have the primary responsibility for implementing the essential
public health services, the federal government plays a critical role in supporting efforts by these agencies
to protect the health of our nation’s citizens. In each case, coordination between the federal government
and states to work towards the same goals is essential to the success of public health activities. This is
particularly true when providing funding. Funding provided to local public health projects should be
consistent with state plans.
Public policy coordination is also key to establishing nationwide public health programs and workforce
development. Governors support the establishment of nationwide health promotion and disease
prevention efforts necessary for modifying unhealthy practices and reducing the incidence of disease.
4.5 Public Health Workforce
An adequate and well-trained workforce is necessary for carrying out the essential public health services.
Currently, this is critical due to the increasing retirement rate of public health officials and workers and
insufficient education incentives. Governors support coordination between the federal government and
states to develop mechanisms to recruit and retain individuals to the field, including a federal loan
repayment or scholarship program that supports master of public health graduates who choose to work in
local, state, or federal public health agencies.
4.6 Immunizations and Vaccines
Protecting the nation’s citizens from vaccine-preventable diseases is a critical goal of the public health
system. Both states and the federal government should maintain and enhance effective partnerships to
conduct reliable research, ensure vaccine safety, provide for the availability of critical vaccines, and
strengthen immunization delivery systems.
States play a key role in achieving and maintaining high immunization coverage rates. The federal
government also has a key role in ensuring an effective vaccine shipping and distribution program for the
nation. Governors urge the federal government and Congress to create incentives for advanced vaccine
manufacturing to ensure an adequate and timely supply of all vaccines, including childhood
immunizations and flu vaccines as well as any vaccine to prevent a future pandemic or bioterrorism
threat. Similarly, both the states and the federal government play a role in vaccine distribution. States,
working collaboratively with the local health departments, are best suited to guide allocation of vaccines
within their jurisdictions; however, the federal government must give states timely access to vaccines and
vaccine distribution data for the allocation process.
Adequate funding for immunization programs is critical to their success. Governors urge increased federal
funding for immunization programs, including funding for vaccine purchase, vaccine
operations/infrastructure, and federal requirements on states for immunization programs.
4.7 Public Health Threats and Response
Developing and maintaining a strong integrated public health infrastructure and health care system in
every state and territory is critical to quickly respond to bioterrorism, catastrophic natural disasters, and
emerging infectious diseases. Since 2001, state public health agencies have prepared for and responded
to an increasing number of natural and manmade threats by spending millions of dollars in unbudgeted
funds and expanding the duties and work schedules of many public health employees. Public health
preparedness and response must be coordinated among all levels of government and integrated into an
all-hazards emergency preparedness and response system that includes nationwide planning and federal
resources.
The federal government developed national plans aimed at reducing vulnerability to terrorism, major
disasters, and other emergencies, including public health emergencies. Governors support these efforts
and encourage the federal government to work with the state public health system to ensure that states
are well integrated into these plans, as well as the development and implementation of any future national
plan, including those to address pandemic influenza. In order to successfully prepare for and respond to
public health threats and to implement national emergency response plans, the federal government
should acknowledge the fiscal situation states already face and refrain from imposing maintenance-of-
effort requirements, state-funded matches, or any other unfunded mandates. The federal government
should acknowledge the importance of—and commit to the continuation of federal funding through the
U.S. Department of Health and Human Services (HHS) for the Hospital Preparedness Programs and the
Centers for Disease Control and Prevention (CDC) for the Public Health Preparedness Programs. The
continuation of technical assistance currently being provided for improving the public health infrastructure
and public health emergency preparedness is essential.
The sharing of information is critical to the success of public health preparedness and response. Critical
information must be communicated to states in a timely fashion. States and territories need to know what
resources are available to them in a public health emergency, including how to access the strategic
national stockpile or call for federal assistance. When responding to a public health emergency, state and
federal health, law enforcement, and emergency management agencies should operate as a well-
coordinated team.
4.7.1 Mental Health and Substance Abuse Response to Emergencies, Natural Disasters, and
Terrorist Attacks. The terrorist attacks and other recent crises underscore the vital importance of state
mental health and substance abuse systems in helping individuals cope with and recover from
emergencies, natural disasters, and terrorist attacks. Faced with growing budget shortfalls, states already
are struggling to meet the basic, day-to-day mental health and substance abuse prevention and treatment
needs of their citizens. When a crisis occurs, the strain on this safety net is dramatically increased,
particularly to the most vulnerable populations, such as children, the elderly, individuals with disabilities,
and those with pre-existing mental health disorders and/or histories of substance abuse. Governors
believe the federal government has an obligation to help states support a strong community mental health
core to enable them to address the behavioral health needs of its citizens during those particularly difficult
times which have been exacerbated by emergencies, natural disasters, or terrorist attacks.
Governors, therefore, are encouraged by the federal government’s interest in promoting planning,
training, coordination, and communication activities related to mental health and substance abuse
treatment and prevention in response to emergencies, natural disasters, and terrorist attacks. Governors
believe that federal funding for such activities should be in the form of a state-based block grant. The
grant should be structured to build on existing mental health and substance abuse emergency response
plans in the states and should allow state mental health and substance abuse services delivery systems
to be expanded to serve all who are impacted by disasters, emergencies, and terrorist attacks. All funds,
whether directed to public or private entities, should be distributed through the states and their
appropriate agencies.
4.8 Chronic Disease Prevention and Health Promotion
Chronic diseases—such as heart disease, cancer, and diabetes—are the leading causes of death and
disability in the United States. These diseases account for seven of every ten deaths, and over 130
million Americans live with chronic disease. Although chronic diseases are among the most common and
costly health problems, they are also among the most preventable. Adopting healthy behaviors such as
eating nutritious foods, being physically active, avoiding tobacco use and promoting the importance of
chronic disease screening can prevent or control the devastating effects of chronic diseases. Nearly 80
percent of our nations’ health care dollars are spent on chronic illness.
Obesity is an epidemic in the United States with approximately two-thirds of the nation’s population being
classified as overweight or obese. These classifications are risk factors for several other chronic
diseases. Significant progress in preventing these chronic diseases cannot be made until leadership is
provided by both the federal government and states to curb this underlying risk factor. A coordinated
approach is required for outreach and education, policy and environmental changes, and determination of
best practices.
Mental illness also is a chronic disease and a leading cause of disability. Four of the ten leading causes of
disability for persons over age five are mental disorders. Major depression is the leading cause of
disability, with manic-depressive illness, schizophrenia, and obsessive-compulsive disorder ranking near
the top of the list. Mental disorders also contribute to mortality; suicide is one of the leading preventable
causes of death. Individuals with mental illnesses need to access community-based supports and
services.
Likewise, substance abuse is a primary chronic disease. Addiction can result in long-term irreversible
changes to the brain and its composition. As such, addiction requires a full continuum of care from
prevention through treatment, including the use of U.S. Food and Drug Administration (FDA) approved
medication assisted treatment. Therefore, prevention and treatment need to be evidence-based and
adequate funding is needed to provide for continued care in managing addictions and supporting the
remission of symptoms.
In 2009, Congress established a prevention and wellness fund, thereby recognizing the need to transform
and strengthen the nation’s approach to public health. Governors support a strong coordinated effort by
and between the federal government and states and territories to ensure the fund prioritizes evidence-
based prevention and wellness strategies and best practices to prevent and control chronic diseases.
Governors urge that prevention and wellness fund resources be used to fund infrastructure gaps, at the
states’ discretion, since addressing these gaps is critical to the success of public health programs and
services. Governors also call on Congress and the federal government to support programs and provide
flexible funding that allows states to maximize the impact of integrated public health programs that
effectively promote healthy behaviors as well as the avoidance of known risk factors. These actions will
result in better management of chronic diseases.
4.9 Block Grants for Public Health Services and Nutrition
Block grants for Preventive Health Services, Substance Abuse Prevention and Treatment, Community
Mental Health Services, and Maternal and Child Health continue to be important sources of funding for
many critical public health programs. In addition, the Special Supplemental Food Program for Women,
Infants, and Children provides vital supplemental food, nutrition, education, and health care referral
services to millions of women, children, and infants.
At a minimum, these block grants should be continued at current funding levels, adjusted for inflation, to
meet public health and nutrition needs. Ideally, the block grants should be increased to address the
increased need for and benefit of prevention and health promotion. Within each block grant, states and
territories should be given the autonomy to set their own goals, to target resources, and to tailor programs
based on their individual performance objectives. Providing for more state flexibility in existing health
service block grants, specifically by removing complex allocation and set-aside requirements and by
allowing for transfers among public health programs, is essential.
4.10 Community Mental Health Services and Substance Abuse Prevention and Treatment Block
Grants
Mental health and substance abuse prevention, education, and treatment are critical elements of public
health. Providing mental health and substance abuse services not only improves the quality of life for
individuals and families, but captures savings across many levels of government by increasing worker
productivity and reducing costs across other systems, including the criminal justice system. Mental health
and substance abuse services are funded almost exclusively by state and local governments.
States are working in partnership with the federal government to improve data reporting in the Community
Mental Health Services (CMHS) and Substance Abuse Prevention and Treatment (SAPT) block grants.
States have agreed to finalize and report a core set of measures. The goal of this initiative is to improve
service efficiency and effectiveness through the use of indicators of accountability and performance. The
core principle driving this process is continuous quality improvement (CQI). In exchange for improved
data, the federal government agreed to increase state flexibility in the use of the CMHS and SAPT block
grant funds and to reduce paperwork burden.
While supportive of the goals of the initiative, governors stress the need for CQI to drive this process
rather than any penalty structure that could threaten service delivery. Governors are also concerned with
the costs and other burdens associated with additional data collection and the impact of such
requirements on other services. In addition, no changes should be made to the performance reporting
requirements without a formal and transparent consultation with states and territories.
States and the federal government share the public health goal of the 1992 federal Synar statute for
reducing youth smoking and restricting underage access to tobacco products. For over two decades
governors have committed substantial state financial resources and serious strategic planning to the
enforcement of the Synar statute. In recent years, Congress has taken steps to prevent states that
commit substantial financial resources to the goals of Synar from suffering severe penalties to their SAPT
block grant. Governors believe these have proven to be important first steps and that Congress must
permanently revise the penalty structure and process provisions of the Synar law. Congress, in
collaboration with states, must establish a long-term Synar enforcement structure that does not threaten,
interrupt, or eliminate critical substance abuse treatment and prevention programs including for vulnerable
populations.
4.11 Rural Health Care
Governors agree access to quality, affordable health care is an important building block of rural
development. Rural America poses unique challenges to the traditional economic models of health care
delivery, which includes centralized hospital centers and employer-sponsored health insurance. States
and the federal government must work in partnership to develop innovative solutions to improve the
quality, affordability, and access to health care and health insurance in rural communities across this
nation. In moving forward with this important initiative, the federal government must recognize a one-size-
fits-all strategy for health care in rural areas will not meet the unique needs of individual communities.
Therefore, federal, state, and local governments should work collaboratively on identifying issues and
proposing solutions to improve access to quality health care in rural areas.
4.12 Drug Safety and Access
Safety and affordability of prescription drugs are important public health issues to the nation’s governors.
In order to ensure consumer protection and accessibility to the medications consumers need, the federal
government, in partnership with the states, should continue efforts to improve prescription drug safety,
innovation, reliability, and security, including law enforcement activities that address the increase in
counterfeiting activities.
4.13 Public Health Surveillance
Governors support the need for tracking both human health and environmental indicators using
epidemiologic methods. Epidemiological surveillance is defined by the CDC as “the ongoing systematic
collection, analysis, and interpretation of outcome-specific data for use in assessment, planning,
implementation, and evaluation of human health and environment.” Applying epidemiological methods
when gathering data ensures a critical examination of the data, and incorporates information not only on
health outcomes, but also on the environmental hazards and exposures to which these outcomes may be
related. Tracking conditions in the environment and the public health status of populations provides an
opportunity to compare this information through time and across geographic areas. Governors support the
efforts by the CDC and the Substance Abuse and Mental Health Services Administration to increase the
prevalence of public health surveillance to help identify and understand local, state and national needs,
data gaps and research the needs of human and animal populations and the environment.
4.14 Public Health Laboratories
Public health laboratories provide the basic and confirmatory laboratory testing data and consulting
information for a vast number of public health programs. This includes confirmatory testing during disease
outbreaks for known diseases and/or new emerging conditions affecting human health. Participation in
acute disease laboratory testing and public health epidemiology processes; verification of therapeutic or
vaccination compliance for disease intervention and prevention programs; monitoring of the environment
for harmful contaminants; testing and consulting on potential biological or chemical threats in
preparedness planning and response; toxicology testing in support of both human health and law
enforcement; and congenital disease detection and referral for immediate medical intervention in newborn
screening programs. Public health laboratories rely on a competent and technically trained workforce;
availability of state of the art scientific equipment; and up-to-date facilities. States and the multitude of
federal agencies (with laboratory functions or oversight responsibility) need to work together to coordinate
the efforts, resources, and communications that will ensure coordinated, high quality public health
laboratory resources throughout the nation.