172 COMMUNITY HEALTH
and types of hospitals, with attention to emergency services
and rehabilitation care are important. Slightly different stud-
ies for evaluation of care must be given to rural areas where
hospital accessibility, highway networks, and estimated tran-
sit times for ambulance services, become critical elements in
area’s health study.
Residents and visitors, businesses and news media, con-
tinually assess the health of a community by studying reports
that describe adherence to or departures from desired norms
of community living. Governmental publications provide
estimates and statistical analyses of regularly collected data
about commerce, industry, and banking. Visitors fairly accu-
rately sense or rate a community’s ambience by noting the
frequency and types of cultural activities for residents or vis-
itors, the numbers and quality of public and private schools,
and available recreational facilities. Competent urban plan-
ning encourages and supports neighborhoods that have
identity and local pride, perhaps with islands of green park
land, all served by excellent roads and public mass transit
that make for easy access to cultural and recreational areas.
Community health depends upon diverse activities, many
that result from excellent engineering and some directly
related to personal health or sickness care of citizens.
The central official health authority for a community is
its public health department, a major health agency under
direct control of the mayor or county executive. The health
department is established by statute, and its chief health offi-
cer is a legal guardian of community health with an authority
that includes subpoena power to enforce applicable health
codes and regulations. Sizes and complexity of official health
agencies range from two or three persons in a town or village
to major departments of states and territories, or the national
U.S. Department of Health and Human Services (DHHS)
and the international World Health Organization (WHO).
Health agencies or departments have a tradition of pro-
fessional knowledge and compassionate service, two char-
acteristics that usually provide a modest freedom from
administrative interventions. This varies somewhat in pro-
portion with budget allocations but it allows health depart-
ments a certain flexibility to design their services as needed
to carry out community health tasks. Child health care in
an affluent suburb will be patterned differently from clinics
for expectant mothers and infants and family planning in
low income or poverty areas. Centers for treatment of drug
abuse and addictions or patients recently discharged from
state mental health hospitals need to be close to where those
conditions are frequently encountered.
Basic services of most health departments include the
epidemiology of infectious diseases; treatment clinics with
emphases on sexually transmitted diseases and tuberculosis;
family planning services, often a euphemism for contracep-
tion but they may also include advice on abortions in the
first trimester of a pregnancy; child health care in well-baby
clinics where newborn infants and preschoolers are followed
closely with childhood immunizations and school health ser-
vices; pediatric dentistry; services for drug and alcohol abus-
ers who want relief from these personal burdens; and special
clinics or services when needed by special communities, suchas victims of AIDS or chronic psychiatric ailments. Health
education, once a major activity in a local health department,
now is carried out by schools and numerous single-focus vol-
unteer organizations, like those for heart disease or cancer.
Health promotion, too, has received much attention in the
public press and from an increase in general awareness of
the advantages of stopping smoking tobacco, weight control,
cholesterol levels, and balanced diets.
Environmental control services, a major division of any
health department, include restaurant inspection and food
services control, with added concerns for area-wide sanita-
tion, housing, industrial hygiene, and animal control. Control
and abatement of environmental hazards vary as an empha-
sis shifts from human health effects to a general community
salubriousness, pushed by legislative actions that reflect the
relative effectiveness of lobbyists for human health adher-
ents or environmental activists.
Concentrations of population and their needs vary
among cities, towns, or counties whose geographies, ethnic
compositions, and industrial bases differ sufficiently so
that each health unit needs flexibility in designing services.
Many health departments have citizen or legislative over-
sight through various boards of health, and functional tasks
vary with the problems that confront the individual jurisdic-
tions. Malaria control, for example, is a prime concern for
tropical and some developing countries while the energies of
urban health agencies may be heavily invested in tuberculo-
sis detection and treatment. Each is governed by regulations
or distinct health codes that have been written to implement
laws enacted by respective legislatures. Although occasional
conflicts can arise between neighboring communities when
confusion or contradiction exist in regulations or information
flows, relatively consistent scientific and engineering stan-
dards developed by professional societies or governmental
experts are available to make health codes more uniform,
despite restrictions of jurisdictional boundaries.
Public health responsibilities were once synonymous
with local and urban health departments and a few public
health schools that were based in major universities. Since
about 1960, however, many other community agencies have
assumed much of traditional public health’s former activities
and have blurred the previously clear image of official health
departments.
Federal funds to carry out public health programs once
were limited to health departments but have been made
available as grants to groups such as voluntary associations,
hospitals, medical schools, neighborhood associations, and
Indian tribes or ethnic groups. Interested community health
care provider groups now provide needed auxiliary services
such as health education and promotion, medical services
to disadvantaged groups, and family planning. They also
carry out limited data collection and disease specific epi-
demiology that support their ongoing research activities.
Coordination of numerous separate and isolated studies
and consolidation of focused findings can be difficult for
local health departments who may not have had a role in
the investigations. William Foege, a former director of the
Centers for Disease Control, has described the environmentC003_002_r03.indd 172C003_002_r03.indd 172 11/18/2005 10:17:41 AM11/18/2005 10:17:41 AM