1. are consistent with the laws to which it

1.  Discuss the primary roles and challenges of
federal, state and local government in public health.

The public health
system is a multi-disciplinary system that addresses health of the population which
aims at promoting
health, prevent diseases and epidemics through surveillance, understanding
population’s health needs and formulate interventions. Government agencies in
different levels has significant roles in ensuring these public health objectives
are addressed. Governmental public health agencies are broken down into three
major levels: Federal, State, and Local. Public health agencies at the federal,
state, and local levels are sometimes referred to as the “backbone” of the
public health system (Salinsky, 2010). These institutions of the government
have unique roles and functions that are important to their duties for public

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The primary function
of the federal public health is to set health policies and standards for the
nation. Their mainly focus on getting the attention of the nation on major
public health problems through effective employment of all levels of government
and private groups. They provide assistance and resources to state and
local level
health systems and ensuring they have the adequate capabilities to provide
essential public health services to the population they support. In partnership
with state and local governments and other relevant stakeholders, it will make
it easy for the Federal Government to understand, survey and formulate policies
to accomplish public health goals. Here are some of the federal agencies in the
United States: CDC, FDA, USDA, Medicare and Medicaid. All of these agencies
work together and share same mission which is to improve health.

There are 55
state health agencies in the United States and each have a designated state
health department that are responsible to meet their specific objectives. The
State public health agencies serve a big role in managing the activities of
local health departments and their programs.  These state agencies enable the state citizens
to be aware of health policies in place and also ensures that local agencies and
private groups are consistent with the laws to which it is subject. They have
an important role in policy making through identifying health problems,
identifying possible interventions, prioritizing these interventions, providing
evidence for policy makers, and implementing the policies through education,
training and assistance. The state health agencies ensure that adequate
resources (legal, financial, human, technological and material) to
perform essential public health services are available.

The Local health departments
vary their scope of responsibilities on geographic size and size of the
population they served. They are the frontline of health care service and they depend
mainly on state policies. Most local health departments deliver a wide range of
services to diverse populations with limited resources and few workers.  Local health departments in large city may
have a broad range of functional capacities and in small local health
departments they often provide a narrower set of health services. Most local
health departments provide services that engage in clinical preventive services
such as immunizations and communicable disease control, medical treatment
services, community outreach and education, epidemiology, environmental health
regulation and population-based services.

Government public
health systems faced significant challenges at all levels. One of these challenges
is inadequate resources which is most common at the local health departments. Resources
for some public health services have been reduced at the same time the demands
have been increasing. One more challenge is the lack health insurance for some
of the citizens which has a major effect on health of individuals and creates significant
financial burden on healthcare institutions. In the aftermath of bioterrorism
such as the September 11 attack and anthrax attack, disease surveillance
activities of many health departments have significantly increased and currently
at the mission of the federal, state, and local emergency planning and

2.  How did Bronson et al. (2009)
define evidence-based policies? Discuss the three domains of evidence.

Health policies provide
standards to all health care activities. By establishing policies and procedures,
it will provide clarity and guidance when dealing with critical healthcare
issues, legal liabilities and regulatory requirements.  According to Bronson et al. (2009), evidence-based
policies is the use of best available evidences and enabling the researchers to
provide data or information from a scientific, economic, social, and political views
and communicating these data to policy makers.  

Quantitative and
qualitative evidences are both important features when developing an evidence
based policy. Quantitative evidence for policymaking are numerical values and qualitative
evidence involves non-numerical observations from an individual participant, group
interviews or focus groups.  The
combination of these two tends to have a stronger influential impact when analyzing
and developing policies.

In evidence-based
public health policy, there are three domains: the process, the content, and
the outcomes. The first domain in evidence-based public health policy is the
“policy process” which focuses on identifying key factors to inform
policymaking.  Identifying the problem that
requires government intervention is the first part of this domain.  The second part is addressing those problems
by drafting an alternative policy. Lastly, recognizing political factors both
inside and outside government that impacts the policymaking development. Public
policies must be not only “technically sound, but also politically and
administratively feasible, Bronson et al. (2009).

second domain is the “policy content” which purpose is recognizing the certain
policy features that are likely to be effective. Policymakers use the
quantitative data and qualitative data to examine, modify and implement

the third domain is documenting the effects of implemented policies “policy
outcome” which is vital in supporting evidence-based policy. Evaluating these
evidence-based policies are significant to the understanding of the effect of
policies on individual and community health behaviors.

policy is an important tool and resource to address the nation’s health
challenges. Evidence and research are big factors in policy making decisions
however, the effectiveness of these evidence-based policies is the main goal. Evidence-based
polices are applied by all levels of government in the policymaking and development
of health care programs.