PUBLIC HEALTH: Lecture Objectives
#1: Intro
Know the many different definitions of public health and the 2 main components of public health
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Comprehensive science with broad spectrum coverage
American Public Health Association definition:
o “Public Health is prevention.” Public health is the practice of preventing disease and
promoting good health within groups of people, from small communities to entire
countries.
o “Public Health is policy development and population health surveillance.” Public health
professionals rely on policy and research strategies to understand issues such as infant
mortality and chronic disease in particular populations
From What is Public Health .org:
o Public Health is the science of protecting and improving the health of communities
through education, promotion of healthy lifestyles, and research for disease and injury
prevention
o Public health professionals analyze the effect on health of genetics, personal choice, and
the environment in order to develop programs that protect the health of your family
and community
2 main components of PH
o Disease prevention through surveillance and healthy behaviors
o Deals with populations of people, not individuals
Understand the foundation of public health
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Foundation of public health is based on 6 pillars categorized into 3 categories (A,B,C)
Category A: Tools and science of public health
o Epidemiology
o Statistics
Category B: Health science research and investigation
o Biomedical sciences
o Environmental health sciences
Category C: Social and medical care system
o Social and behavioral science
o Health care administration, medical care system
Discuss the difference between early and modern focuses of public health and give examples of each
EARLY focuses of PH:
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Chinese developed variolation around 1000 BC
o Inhaling dried crusts from smallpox lesions (first example of immunization)
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1820s, Edward Jenner and cowpox vaccine--protected against smallpox
14th century, Black Death in Europe
o Burning parts of cities destroyed rodent infestations; Quarantine helped mitigate spread
Epidemiology
o John Snow and cholera epidemics in London; Identified source of outbreak as
contaminated water well
MODERN focuses of PH:
By 20th century, focused more on chronic diseases
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Cancer and heart disease
o Smoking and lung cancer; Diabetes and obesity
Still focus on infectious diseases in developing countries
o Malaria, TB, cholera in Haiti
Recent return to new and emerging infections in U.S.
o AIDS epidemic in 1980s; SARS, H1N1, Antibiotic resistance (MRSA), Food-borne
outbreaks (Salmonella, Listeriosis)
Know the 5 key focus areas included in the CDC’s strategic plan, and what the CDC’s main role is in each
area
1. Preparedness and prevention
a. Develop public health guidelines, support, technical assistance, provide self-assessment
tools
2. Detection and surveillance
a. Integrated surveillance for reporting of illnesses from biological and chemical terrorism;
ERs, medical personnel, poison control centers
3. Diagnosis and characterization of biological and chemical agents
a. Creation of multilevel laboratory response network for bioterrorism (LRNB)**
i. 4 levels, links clinical labs to public health agencies, capability of testing for
biowarfare agents, rapid-response and advanced technology laboratory,
provides 24-7 diagnostic confirmation and reference support
4. Response
a. Epidemiologic investigation, medical treatment, prophylaxis; Initiation of prevention or
environmental decontamination
5. Communication
a. State-of-the-art communication system that will support disease surveillance
i. Rapid notification and information exchange, dissemination of diagnostic results
and information, coordination of emergency response activities
**
Differentiate between covert and overt terrorist attacks based on most likely agents involved and the
most likely first responders
OVERT attacks:
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Quick effect of terrorism
o 9/11, bombings, chemical attacks--Chemical agents absorbed via inhalation or skin,
symptoms usually immediate and obvious
Historically more concern for these (Plans in place)
Such attacks elicit immediate response from police, fire, EMS personnel
COVERT attacks:
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Delay between exposure and onset of illness (incubation)--No immediate impact
o Release of smallpox, pts appear in Drs' offices, clinics, ER during 2nd wk with flu-like
symptoms. Then pts develop papular rash, becomes pustular, deaths
Short window of time between first cases and second wave
Victims identified by physicians or other primary health-care providers
Public health officials need to determine if attack occurred, identify organism, prevention
strategies
Discuss the steps in preparing for biological and chemical attacks
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Communication programs to deliver information
o Enhance bioterrorism-related education and training for health-care professionals
o Prepare educational materials for public
Enhance epidemiologic capacity to detect and respond to biological attacks
o Support development of diagnostic tests
o Establish surveillance for microbial strains (Including unusual or drug- resistant strains)
o Supply reagents to public health agencies
o Encourage research on antiviral drugs and vaccines (Stockpile appropriate vaccines and
drugs)
Education
o Enhance awareness of chemical terrorism (EMS, police, firefighters, physicians, nurses)
o Educational materials for public during and after a chemical attack
Detection/prevention
o Develop and provide bioassays for detection and diagnosis
o Enhance epidemiologic capacity for detecting and responding
o Stockpile chemical antidotes
Know the Category A Critical biological agents and the different categories of chemical agents
*Biowarfare Agents are classified into 3 categories:
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Category A (high-priority agents)
o Easily disseminated or transmitted between people
o High mortality rates, potential for major public health impact
o Might cause public panic and social disruption
o Require special action for public health preparedness
Category B
o Moderately easy to disseminate
o Moderate morbidity and low mortality rates
o Require enhancements of CDC's diagnostic capacity
Category C
o Availability, easily produced and disseminated
o Potential for high morbidity and mortality rates
Category A agents:
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All respiratory or blood transmission
Agents/Diseases
o Anthrax (Bacillus anthracis)
o Botulism (Clostridium botulinum toxin)
o Plague (Yersinia pestis)
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Smallpox (variola major)
Tularemia (Francisella tularensis)
Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa,
Machupo])
#2: Bioterrorism Agents - review entire PowerPoint for these questions
Know the criteria for classification of pathogens into the Categories of Bioterrorism Agents
*refer to 3 Categories above
Know the Category of Bioterrorism Agents for each pathogen discussed.
Know the route of transmission that would be seen in a bioterrorism case scenario for each pathogen
discussed.
Know the diagnosis (including laboratory tests) and treatment and/or prevention for the pathogens
where discussed.
#3: Nosocomial Infections
Define HAI and give examples of endogenous and exogenous sources of infection.
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Healthcare Associated Infection (HAI). The CDC defines an HAI as a localized or systemic
condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin
(s).
Endogenous: from the patient’s body
Exogenous: sources external to the patient (personnel, equipment, visitors, hospital
environment)
Explain the contributions made by Ignaz Semmelweis and Joseph Lister to the field of infection control.
Ignaz Semmelweis:
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Dr. Semmelweis determined that physicians going directly from autopsies to labor and delivery
were infecting their patients.
He suggested that physicians wash their hands before delivering babies which resulted in
decreased infection and mortality.
He is credited with instituting the first standards of infection control.
Joseph Lister:
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Used carbolic acid to chemically sterilize surgical equipment and bandages.
List the top 4 types of HAI.
1. 32% - Urinary tract infections (UTI). Most Common HAI
2. 22% - Surgical site infections (SSI)
3. 15% - Pneumonia
4. 14% - Bloodstream infections (bacteremia)
List the most common Gram positive and Gram negative microbes responsible for HAI.
Most common Gram POSITIVE microbes:
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Staphylococcus aureus
Coagulase negative staphylococci (CoNS, includes S. epidermidis)
Enterococci sp.
Most common Gram NEGATIVE microbes:
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E. coli
Pseudomonas aeruginosa
Enterobacter sp.
Klebsiella pneumoniae
Describe the importance of C. difficile with respect to HAI.
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Gram positive anaerobe, spore former, toxin producer
Patients most at risk:
o Hospitalized patients on antibiotics
o Greater than 65 years old
Antibiotics kill off normal flora allows C. difficile to grow uncontrollably, results in diarrhea and
pseudomembranous colitis.
Essential in the care of any patient with CDI
o Good hand hygiene-- Soap and water, hand sanitizers are not sporicidal.
o Contact isolation
Describe the 3 factors relevant to HAI.
1. Antimicrobial use in hospitals and long term care facilities.
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Microbes in health care settings are constantly coming into contact with disinfectants,
antiseptics and antimicrobials => increasing antimicrobial resistance.
2. Failure of basic infection control.
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Most common mode of transmission is via hands
3. Patients are immunocompromised.
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Simply placing a urinary catheter or an IV catheter compromises the initial defense
barriers providing potential pathogens an entryway.
Discuss the CDC’s role in the monitoring and prevention of HAIs.
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The CDC maintains the National Healthcare Safety Network (NHSN)
o Compiles monthly reports of nosocomial infections from over 3,000 participating U.S.
hospitals.
The CDC publishes guidelines for the prevention of healthcare associated infections
#4: Environmental/Occupational Health
Know the definitions of environmental health & occupational health
Environmental health:
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Environmental Health addresses all physical, chemical, biological factors external to a person,
and all related factors impacting behaviors
Focuses on anything that may impact health in:
o Natural environment (outdoor)--Example: outdoor air quality
o Artificial environment (indoor)--Example: asbestos
Focuses on identification and control/prevention of environmental factors that can potentially
affect health
Occupational health:
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Occupational health protects safety, health, and welfare of people engaged in work or
employment. May also protect family members, employers, & customers
Goal is to create safe work environment; identify and control risks in workplace
Know the different areas of concern for environmental health
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Air quality -- outdoor and indoor, tobacco smoke
Food safety -- agriculture, transportation, processing, distribution
Water safety -- recreational water illness prevention, safe drinking water
Radiological health -- exposure to ionizing radiation
Waste management -- solid waste management, wastewater treatment plants, hazardous
materials management
Toxic chemical exposure -- consumer products, housing, workplaces, air, water, soil
Noise pollution
Vector control
Answer the questions in Case Study #1
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What could be causing his symptoms? Exposure to toxic lead fumes/poisoning (organic lead).
Where did he likely come into contact with the contaminant? At the automotive radiator repair
shop he plays after school.
Is anyone else at risk? The employer and employees (& their family members), and customers
Compare and contrast the types of radiation discussed
Ionizing radiation (can cause cancer) types:
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Alpha radiation
o Large: has 2 neutrons and 2 protons, Blocked by paper, Very little hazard to a humans
unless ingested
Beta particle
o Consists of an energetic electron, Can be stopped by metal
Gamma ray
o Made of photons, more penetrating, stopped by thick layer of lead
Define the role of OSHA (Occupational Safety and Health Administration, part of US Dept. of Labor)
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Role of OSHA is to ensure safe and healthful working conditions for working men and women by
setting and enforcing standards and by providing training, outreach, education and assistance
Discuss hazard and risk assessment
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Hazard Assessment
o Individual workplace hazards identified, assessed and controlled/eliminated as close to
source (location of the hazard) as possible
Risk assessment includes:
o Identification of hazards
o Identification of affected workers
o Evaluation of the risk
o Identification of control measures
o Can be quantitative (by assigning #) or qualitative (description)
Know the different types of workplace hazards
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Physical hazards
o Noise/vibration, ionizing radiation, electricity, asphyxiation, cold/heat stress
o Mechanical hazards (collisions, falls, equipment-related injury)
Biological hazards
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o Blood-borne pathogens, air-borne pathogens
Chemical hazards
o Acids/bases, heavy metals, solvents, asbestos, fumes
Psychosocial issues
o Work-related stress, bullying, sexual harassment
Describe the contents and purpose of a MSDS (Material Safety Data Sheet)
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A form that contains important information for a substance
o Should include instructions for safe use and potential hazards (melting point, boiling
point, flash point, toxicity, health effects, first aid, storage, disposal, spill-handling
procedures)
o Must be made available in workplace for all hazardous chemicals being used
#5: Emerging Infectious Diseases
Define terms used in epidemiology.
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Emerging Infectious Disease (EID):
o An infectious disease that has newly appeared in a population or that has been known
for some time but is rapidly increasing in incidence or geographic range.
Etiology:
o The cause
Incidence:
o # of new cases within a specified time period.
Prevalence:
o Total # of cases in a given time period.
Morbidity:
o The number of cases resulting in illness/poor health.
Mortality:
o The number of cases resulting in death.
Endemic:
o Present in a low but constant level in an area. (common cold, heart disease)
Outbreak:
o An occurrence of disease greater than would be expected in a particular time/place
Epidemic:
o A sudden outbreak that spreads throughout the area. More cases then predicted within
population. (cholera epidemic in Haiti)
Pandemic:
o Epidemic that spreads throughout the world. (AIDS, H1N1 influenza)
Describe the system used to account for reportable diseases.
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Physician/Clinical Laboratory reports to the Local Health Dept. => LHD reports to State Health
Dept. => SHD reports to CDC
Worldwide/Global: WHO keeps track of EID’s
List any 4 of the 8 theories of how/why emerging infectious diseases still exist.
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Human encroachment into undeveloped areas (Jungles)
Population growth
Increased worldwide travel.
Increased worldwide trade of imported foods, plants and animals.
Immigration
Inadequacy of public health hygiene systems (Sanitation)
Overuse/misuse of antibiotics
Evolution/mutations of microbes
Describe the progression of the SARS outbreak and what contributed to it.
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Outbreaks of severe pneumonia in healthy individuals was first seen November 2002 in China,
with no idea of what was causing the deadly pneumonia
China did not report the disease to WHO until Feb. 2003.
Several teams from the WHO and the CDC traveled to Asia to investigate
First described on Feb. 26, 2003 -- Identified as a new and deadly disease by World Health
Organization (WHO) physician Dr. Carlo Urbani (who subsequently died from SARS on March 29,
2003)
Outbreak began in Guangdong Province, China.
Then spread to Hong Kong. One person infected 16 people on one floor of hotel leading to
international spread => PANDEMIC
In just a few weeks, SARS had spread through air travel to at least three continents
In the same amount of time, researchers collaborated to identify the virus, sequence its
genome, and take steps toward rapid diagnosis
Within 1 month = 3000 cases, 100 dead in 20 countries
SARS was stopped by quarantine, cooperation and collaboration, travel restrictions (pts and
healthcare staff were quarantined).
At the end of the outbreak 8098 cases in 28 countries,774 deaths in total
SARS info: Coronavirus, transmitted via respiratory aerosols. Symptoms: fever, cough, sore
throat, difficulty breathing, diarrhea, lethargy, myalgia.
#6: Medical Error Papers
To Err is Human
Define medical errors.
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The failure of a planned action to be completed as intended, or the use of a wrong plan to
achieve an aim
Know the types of medical errors and list examples of each.
Discuss how medical errors occur and the strategies for improvement.
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Med errors are caused by faulty systems, processes, and conditions that lead people to make
mistakes or fail to prevent them
Strategies for improvement:
o Establishing a national focus to create leadership, research, tools, and protocols to
enhance the knowledge base about safety (AHRQ-agency for healthcare research &
quality)
o Identifying and learning from errors by developing a nationwide public mandatory
reporting system, and by encouraging healthcare organizations & practitioners to
develop and participate in voluntary reporting systems
o Raising performance standards and expectations for improvements in safety through
the actions of oversight organizations, professional groups, and group purchasers of
health care
o Implementing safety systems in healthcare organizations to ensure safe practices at the
delivery level
Five years after to err is human—what have we learned?
Discuss the stakeholders involved in reducing medical errors.
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Federal Gov’t: $50 annually for pt safety research
Veteran’s Health Admin: system-wide pt safety training/practice/research
JCAHO: non-gov’t; improved accountability
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NQF: public-private partnership; generated standards for mandatory reporting
CDC, Centers for Medicare & Medicaid Services, surgical organizations: program to reduce
surgical complications
Amer. College of Physicians: incorporated safety topics into their meetings/education/research
Nat’l Pt Safety Foundation: increasing awareness
Institute for Healthcare Improvement: helped hospitals redesign their systems for safety
Leapfrog Group: purchasers & payers; Encouraged adoption of safer practices
Physicians, nurses, therapists, pharmacists: most important stakeholders
Describe the barriers to change that exist to the attempts to improve patient safety.
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Complexity – many specialties/professions; technology
Commitment to individ/professional autonomy – challenge of learning a non-blaming systemsoriented approach to errors
Fear – fear that information would undermine public trust, fear of loss of autonomy, fear of
malpractice liability (which inhibits willingness to admit/discuss errors)
Lack of leadership – at hospital and health plan level
Paucity of measures
Current reimbursement structure works against improving safety – insurance companies
sometimes won’t pay for new/safer practices; Pt injury => more billing/$$$
Discuss the various agencies, organizations and their varied attempts at altering the healthcare arena for
patient safety.
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Fed Gov’t (Dept. Health & Human Services): electronic medical records
JCAHO: furthering the adoption of the NQF proven safe practices
The Accreditation Council on Graduate Medical Education: practice-based learning and systembased practices in residency training schemes
Hospitals/Health Systems: providing team training; providing full-disclosure of pt injuries;
providing bonuses/incentives for safe care (pay for performance)
Payers: disincentives; cease paying for preventable adverse effects (so hospital gets stuck with
paying for their mistake)
What are the repercussions of disclosing a medical error?
Explain the effect that disclosing a medical error has on the physician-patient relationship and the
likeliness of legal action
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Full disclosure has little effect on the likelihood that an injured pt will seek legal counsel
Disclosing a med error can improve a pt’s confidence in the physician and lead to improved
outcomes
Explain the concept that disclosure is Preventive Medicine against future errors
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Proper disclosure includes an explanation regarding the nature of an error & the measures being
taken to prevent similar occurences in the future
List and discuss the desires of patients when a medical error occurs.
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Pts prefer a detailed disclosure, including:
o What happened
o Why it happened
o The consequences
o Strategies for preventing future errors
#12: Clinical Epidemiology
Know the definitions of epidemiology and other terms covered
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Epidemiology
o Study of patterns of health and illness and associated factors at population level
Refer to #5 EID for other terms
Discuss causality and when this term could be used
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Causality = cause of disease outbreak
Biostatistics used to identify probability of association between cause and disease outcome.
However, statistical association (or correlation) does not always equal causation.
In 1965 Austin Bradford Hill detailed criteria for assessing evidence of causation:
o Strength
 Larger association is more likely causal effect
o Consistency
 Stronger association when same findings observed by different people and
different samples
o Specificity
 Causation likely if very specific population with specific disease and no other
likely explanation (More specificity = bigger probability of causal effect)
o Temporality
 Effect happens after the cause (i.e., cancer after exposure to radiation)
o Biological gradient
 Greater exposure causes greater incidence
o Plausibility
 Plausible mechanism between cause and effect helpful
o Coherence
 Between epidemiological and laboratory findings increases likelihood of effect
o Experiment
 "Occasionally it is possible to appeal to experimental evidence"
o Analogy
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The effect of similar factors may be considered
Describe the types of studies used in clinical epidemiology
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Qualitative studies
o Case studies
 Case series studies
 Qualitative study of one pt or small group of pts with similar disease
 Self-controlled case-series studies
 Compare pt exposure periods to periods when they are unexposed (Pts
diagnosed with disease and followed; Follow-up time divided into
exposed and unexposed periods and incidence of disease compared)
Quantitative studies
o Case-control studies
 A retrospective study that looks in pt’s past for possible exposures that may
have been encountered
 Cases are pts diagnosed with disease; Controls are pts not diagnosed with
disease. Cases and controls should be matched as closely as possible (age, sex,
ethnicity)
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Cohort studies
 Prospective studies that select participants based on exposure status
 Participants are at risk of, but do not have, disease at initiation of the study
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Cohort is then followed prospectively for development of disease (Ex: cohort of
smokers and cohort of non-smokers followed over time to estimate incidence of
lung cancer)
Know the 10 steps of an outbreak investigation
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Step 1: Prepare for field work
o Research disease, gather supplies/equipment
o Consult all parties to determine your role
Step 2: Establish existence of outbreak
o Verify that suspected outbreak is real outbreak
o Outbreak exists if observed # of cases > expected #
o However, observed # of cases > expected # may not indicate outbreak due to changes in
population, new diagnostic techniques
Step 3: Verify the Diagnosis
o Review clinical findings and lab results
o If uncertain about lab tests, have specialist review/order secondary tests
o Visit with pts, take detailed history for shared risk factors
Step 4: Define and Identify Cases
o Establish case definition--classify pts as having disease or not
o Case definition usually includes 4 components:
 Clinical information
 Characteristics about pts affected
 Information about location or place (restricts definition)
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 Time during which outbreak occurred
o Cases defined as:
 Confirmed case – must have lab verification
 Probable case – typical symptoms, no lab confirmation
 Possible case - few typical symptoms
o Identify and count cases
 Passive surveillance -- send out letter describing situation
 Active surveillance -- telephone or visit facilities to collect information
 Sometimes public health officials alert public
o Regardless of disease, collect following data
 Identifying information -- name, address, phone #/ e-mail
 Demographic information -- age, sex, race, occupation
 Clinical information -- symptoms and date of onset
 Risk factor information -- exposure to food, water sources
 Data collected on questionnaire, line listing
Step 5: Describe Data in Terms of Time, Place, Person
o Descriptive epidemiology
 Shows what information is reliable and informative
 Provides comprehensive description of outbreak
 Epi curve – # of cases by date of onset
 Provides information on geographic extent
 “Spot map" where affected people live, work, may have been exposed
 Hospital clustering usually indicates focal source or person-to-person
spread
 Scattering of cases throughout a facility more consistent with common
source (dining hall)
 If size of population varies between areas affected, spot map can be
misleading; use proportion of pts in each area (attack rate)
 Determine populations at risk
Step 6: Develop Hypotheses
o Should address source of agent, mode of transmission, possible exposures
Step 7: Evaluate Hypotheses
o Compare hypotheses with established facts
o Use analytic epidemiology; tests hypotheses, used when cause unclear
 Cohort study: compare pts exposed to risk factor with unexposed pts
 Case-control study: compare pts with disease to pts without disease
Step 8: Refine Hypotheses and Carry Out Additional Studies
Step 9: Implementing Control and Prevention Measures
o Should be done ASAP
o Aimed at specific links in chain of infection, agent, source, reservoir
o Control measures at transmission or exposure
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Step 10: Communicate Findings
o Oral briefing for local health authorities
o Written report
Analyze an epidemiology curve and discuss its importance in an outbreak investigation
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Epi curve – # of cases by date of onset
 Tell where you are in course of epidemic; project its future course
 Estimate probable time period of exposure
 Shape determines pattern of epidemic, exposure time, incubation
o Single source epidemic: steep up slope and gradual down slope;
people exposed to same source over brief period
o Continuous common source epidemic: has plateau instead of
peak
o Person-to-person spread: series of progressively taller peaks 1
incubation apart
#13: Current Trends
Identify the leading cause of death, for all age groups, in 2007.
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In 2007, heart disease was the leading cause of death followed by cancer.
Identify the causes of mortality which have decreased for each specific age group:
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Children 1-14 years old: Unintentional injuries
Persons 25-44 years of age: Cancer, HIV
Persons 45-64 years of age: Cancer, Heart disease
Persons greater than 65 years of age: Heart disease
Identify the predominate age group in which smoking cigarettes has declined.
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Grades 9-12 or Ages 15-18
Determine the rates of childhood and adult obesity.
In 2008:
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Almost 1 in 5 children (20%) over 5 years of age were obese; with rates increasing!
About 1/3 of adults were obese, and about 2/3 were overweight or obese.
Compare the rates of serum cholesterol and statin use among adults.
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The % of adults 45 years and over with high serum total cholesterol declined .
The % of adults 45 years and over using statin drugs increased over 10 fold.
Describe the delay in seeking medical care and the rates of health insurance coverage amongst the 3
groups: private, uninsured and Medicaid.
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The percentage of adults who delayed or did not receive medical care due to cost increased
among persons with private insurance and the uninsured.
The percentage of working-age adults with private health insurance decreased while the
percentage who were uninsured increased.
#14: PH Policy Agencies
Know the purpose of the World Health Organization and its core functions
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International agency that coordinates and acts on global public health issues
Core functions:
o Provide leadership on global health matters
o Shape health research agenda and stimulate generation and dissemination of valuable
knowledge
o Set norms and standards
o Articulate evidence-based policy options
o Providing technical support to countries
o Monitoring and assess health trends
Know the role of the Department of Health and Human Services and the responsibilities of the 11
operating divisions
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HHS is U.S. government’s agency for protecting health of all Americans; provides essential
human services, especially for those who are least able to help themselves
11 operating divisions/responsibilities:
o Admin for Children and Families: ACF is responsible for promoting economic and social
well-being of families, children, individuals, communities
o Admin on Aging: AoA is responsible for ensuring continuation of aging services at state,
territory, local and tribal levels
o Agency for Healthcare Research and Quality: AHRQ mission is to improve quality, safety,
efficiency, and effectiveness of health care for all Americans
o Agency for Toxic Substances and Disease Registry: ATSDR is responsible for regulating
public health effect of hazardous substances in environment
o Centers for Disease Control and Prevention: CDC is responsible for conducting and
supporting public health activities in the U.S.
o Centers for Medicare and Medicaid Services: CMS is responsible for administering
Medicare, Medicaid, and Children's Health Insurance Program (CHIP)
o Food and Drug Admin: FDA is responsible for protecting American people from unsafe
or mislabeled food, drugs, and other medical products and to make sure consumers
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have access to accurate, science-based information about the products they need and
rely on every day
Health Resources and Services Admin: HRSA is responsible for improving access to
health care services for people who are uninsured, isolated, medically vulnerable
Indian Health Service: IHS is responsible for providing federal health services to
American Indians and Alaska Natives
Nat’l Institutes of Health: “nation’s medical research agency”
Substance Abuse and Mental Health Services Admin: SAMHSA focuses on reducing
impact of substance abuse and mental illness on America's communities
Occupational Safety and Health Admin (OSHA)
Discuss the five strategic focus areas of the CDC
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Support state and local health departments
Improve global health
Decrease leading causes of death
Strengthen surveillance and epidemiology
Reform health policies
Discuss the role of OSHA
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OSHA mission: assure safe and healthful working conditions for working men and women by
setting and enforcing standards and by providing training, outreach, education and assistance