Historical Overview

Public Health, while poorly understood by many, has made many notable contributions to the health and well-being of our citizens. In the 1800s people around the world died by the thousands from diseases like cholera, typhoid, sexually transmitted infections and smallpox, just to name a few. At one time, 90,000 Chicagoans died because their drinking water had mixed with sewage after a flood of Lake Michigan. Such outcomes had improved drastically by the turn of the century. Just in the last 70 years, our life expectancy has increased greatly. By the year 2000 there were 250,000 fewer cases of whooping cough than in the 1930s; 900,000 fewer cases of measles than in 1941 and 21,000 fewer cases of polio than in 1951. Thanks to the efforts of the World Health Organization and Rotary International, there are only two countries worldwide currently battling polio.

When cities around the U.S. began to become more populated, those near water port entrances saw record numbers of infectious diseases and unsanitary conditions as a result of overcrowded, impoverished living conditions and stowaways trying to get to the new land. Worldwide travel demonstrated that infectious diseases and environmental hazards had no jurisdictional boundaries. Public Health boards emerged to address such issues.

Public Health Structure in Illinois

In Illinois there are 102 counties and 95 local health departments, leaving only two counties without local health departments. Public Health departments around the country provide similar services, guided by their state’s essential services and core programs. All services provided by local health departments are centered around three core functions: assessment, policy development and assurance. This means that the public health workforce assesses the community’s health and safety needs; communicates with their board of health to develop policies to address the needs; and assures that health and safety needs are being met. The assurance function is the least understood, as Public Health must assure that healthcare needs are being met without necessarily performing the services itself.

Illinois Public Health follows 10 essential services:

1. Monitor health status to identify community health problems.
2. Diagnose and investigate health problems and health hazards in the community.
3. Inform, educate and empower people about health issues.
4. Mobilize community partnerships to identify and solve health problems.
5. Develop policies and plans that support individual and community health efforts.
6. Enforce laws and regulations that protect health and ensure safety.
7. Link people with needed personal health services and assure the provision of healthcare when otherwise unavailable.
8. Assure a competent public health and personal healthcare workforce.
9. Evaluate effectiveness, accessibility and quality of personal and population-based health services.
10. Research new insights and innovative solutions to health problems.

Funding Challenges

Funding for local health departments in Illinois varies with grants, tax levies and federal and state monies. In addition, some departments have access to a 501(c)(3) funding source. There are grants standard to local health departments, such as the Local Health Protection grant, which 100 percent of Illinois’ local health departments receive based on per capita county size. Before 2006, this amount had not been increased for over 10 years. It increased after the aggressive legislative work of the Illinois local health departments netted $3 million to the state budget to be divided among the 102 counties, based on a similar per capita population formula. Other grant recipient programs include Family Case Management funds, which also had not changed since the program was established in 1993. This fund may see a 3 percent increase for the 2008 budget. Funding for local health departments remains a challenge.

What is New in Public Health?

Public Health has evolved over the years to take on new health initiatives, such as the newly passed legislation on body art. This legislation, currently being written, addresses all establishments that provide tattooing and body piercing below the neck, to assure that health and safety practices are being followed.

Public Health works within homeland security regions. Although these regions were previously established, they became more active immediately after 9-11. Public Health now meets regularly with law enforcement, fire, emergency planners and disaster response agencies such as the American Red Cross to address security issues, response activities and mass communication strategies.

Mass medication distribution is also planned by local Public Health in collaboration with police, fire and other emergency responders. This plan, also known as SNS, or Strategic National Stockpile, provides for mass inoculations in the event of an act of bioterrorism, designating medication distribution sites to which the public will be directed in the event that a mass medication response is necessary. Local Public Health has the responsibility to carry out such a task.

With the mention of avian flu, pan flu planning prompted more committees among the healthcare providers and Public Health. The thought of losing approximately 30 percent of the workforce due to flu has “business as usual” planning around the loss expectancy.

And lastly, a new initiative at the direction of the CDC is the development of CRIs—Cities Readiness Initiatives. So far only three of these initiatives are established in Illinois: one in the southwest area around East St. Louis, one in the northeast Chicago region and the newly designated one in central Illinois, composed of Peoria, Stark, Marshall, Woodford and Tazewell counties. The focus of this group involves an intensive review and planning for communication and emergency activities for a mass medication distribution response.

Working quietly behind the scenes, Public Health continues to participate in the safety and security of the community. We still have “business as usual” to address: issues of communicable disease, food and water safety, immunizations and assuring that our community has access to healthcare. The absence of infectious and communicable diseases means that your Public Health is working for you. IBI