Introduction
Despite an enormous amount of federal budget allocated to mandatory programs, any progress in public health programs is difficult to witness for many reasons. The progress which is actually based upon the conditions and standards of ‘ideal’ health, either public or personal, is never attained. On one hand, when the Government officials believe such health standards to be attainable, they must realize that such preventable evils not only require an enormous expenditure and loss of money, but also proper training of the moral, mental and social standards of the people, so that their mitigation or removal, and that measures for prevention will affect infinitely more than remedies for the cure of disease (Gostin, 2002, p. 26).
In this case, though huge budgets are allocated the latter is never managed. On the other hand, people’s higher expectations from the public health programs do not make them realize that to learn the causes of disease and to learn how to prevent disease is something that cannot be measured by money value.
One reason for which public health issues are underestimated is the lack of working collectively, as a society we do not participate collectively in assuring the conditions for people to be healthy. The emphasis on cooperative and mutually shared obligation only expects from the collective entities i.e., governments and communities to take responsibility for healthy populations. Individuals are never bothered to act towards collective entities; they are never concerned about safeguarding their health, even if they have the economic means to do so
. Since individuals can purchase housing, clothing, food, and medical care, they are expected and must behave in positive ways to promote health and safety by eating healthy foods, exercising, using safety equipment, and refraining from smoking, using illicit drugs, or drinking alcoholic beverages excessively.
Another reason for facing obstructions in the progress of public health programs is the state and local problem that inhibits coordination within the public assistance system. It is often seen that state and local input into the project design and rule-making process is usually absent. State and local governments are often not well-served by their representatives in other areas and rarely have the time to participate in the federal regulatory process. Too many programs are designed in ways that inhibit state and local flexibility in the implementation of programs. Only state and local service providers offer a responsive set of services tailored to local needs. Federal efforts often discourage or, at a minimum, serve as barriers to state and local innovation.
On the other hand, many critics claim state and local governments to be a big part of the problem. In order to increase beneficiary access and improve program administration, it is imperative to overcome state and local barriers to coordination, such as bureaucratic territoriality, different philosophical perspectives on the causes of and solutions to poverty, conflicting federal and state regulations, and reporting requirements governing different programs, overlapping but not identical goals and performance measures, and administrative differences in operating procedures for processing clients, contracting and reporting. A variety of coordination techniques are available but not all are being used.
So much variety in poverty levels as well as the array of eligibility criteria for federal assistance programs has made implementation difficult for state and local governments and for potential aid recipients (Jennings & Zank, 1993, p. 15). The operating rules of the various governmental levels involved in running the programs also vary by program and state. There is the different eligibility criterion for which the progress is difficult to mark, particularly in conditions where such programs are imposed to mark the lowest income eligibility levels with fixed standards that follow proper documentation.
Relationship between Federal, State, and local public health agencies in addressing a particular public health problem
There is a ‘coordinating relationship’ between Federal, state, and local public health agencies since 1991, when American social policy was introduced. Since then, National commissions identify that the main cause behind the failure of a particular public health problem is the proliferation of uncoordinated programs as the source of severe problems. Such problems affect the well-being of children, infant mortality, and the delivery of public assistance and job training services (Jennings & Zank, 1993, p. 3). Other reports point out the critical need to coordinate foster care and infant mortality programs while several national conferences brought the coordination issue to the attention of policymakers and program administrators, offering a variety of suggestions to improve service delivery and bring coherence to policy.
Despite spending billions of dollars in federal and state programs to combat infant mortality through prenatal and neonatal care, the range of programs and agencies underscores the difficulty of providing comprehensive services to mothers and babies, particularly those living in minorities. Critics believe that the minority population faces these hardships which are compounded by the aggressive dismantling of the Medicaid system at the federal and state levels.
Such dismantled approach is mainly responsible for making the poor suffer at the hands of uncoordinated federal, state, and local levels. Such an uncoordinated example is that of between 2005 and 2006 when Mississippi Republican Governor Haley Barbour oversaw the disenrollment of 54,000 people from the state’s Medicaid and Children’s Health Insurance programs (Spencer, 3 May 2007).
The infant mortality rate is not distorted by the age profile of the American population in the same way as the crude death rate, and for international comparisons, the infant mortality rate not only serves well but is usually the only measure of infant deaths available. As an index of the infant death situation in the United States and of differences between various groups, however, the infant mortality rate is too unrefined to show the uneven distribution of infant deaths throughout the first year of life (Zopf, 1992, p. 77).
As far as the relationship is concerned between health programs, nothing, in particular, has been done to combat infant mortality rates in minority populations. Health agencies never understood that only parts of the complex constellation of biological, social, economic, and other factors cause high infant mortality rates. Coordination in this respect was never followed by a proper schedule and no efforts were done to cope up with the cultural and ethnic values of minorities.
For example, the mother-only family is much more common among blacks than other racial and ethnic groups in the United States but it is a symptom of these other factors, and rather than seek a single cause or correlation, that would have done better to recognize the many conditions that interact to keep black fetal and infant mortality rates high (Zopf, 1992, p. 94). Why geographic distribution of infant mortality rates matter and the reason behind higher rates in some regions, divisions and states are because of racial distribution and other differences, these concerns are never composed in accordance with the infant health services.
The long-term solution, therefore, is to coordinate all the tasks and involve fundamental social restructuring and equitable realignment of opportunities for blacks and whites, especially young women, within the social system, and whatever steps are necessary to enhance individual responsibility. A more short-term solution is to institute a national health program and to make its protections available to all minority-based populations.
The most important factors in making public health workforce recruitment, retention and training are difficult
Many public discussions about such issues, that address the obstructions in public health workforce recruitment and training programs focus on the low-income American families who receive income-conditioned public assistance through programs administered by three different agencies-Aid to Families with Dependent Children (AFDC) administered by the Department of Health and Human Services (HHS), food stamps administered by the U.S. Department of Agriculture (USDA), and Section 8 housing certificates administered by the Department of Housing and Urban Development (HUD).
Though there are many programs that support needs for education and training and even emphasize and work out to determine the major hindrances in upgrading the staff, nevertheless any program has been able to fill the gap left out by complexities. An example is that of programs that are administered by at least four federal agencies and each of these programs carries out the same functions of eligibility determination and provision of benefits and services.
Each federal agency interprets legislation, promulgates regulations and administrative guidelines, and monitors state and local program activity to make sure that the legislation and regulations are adhered to. Each devotes attention to changes in programs funded through other agencies to determine what impact, if any, they may have on their own programs. Logic suggests that if these programs were better coordinated at the federal level, duplication of effort would be reduced and administrative efficiency increased at the federal level. There would be increased opportunities to uncover and rectify problems in coordination among the programs that are manifested at the state and local levels.
There are barriers like time, costs, historical reasons, and cultural values which are involved in executive branch reorganization, and in addition, the jurisdictional issues associated with congressional committees and executive departments and the problems of responding to special interest groups present formidable obstacles to reorganization. Despite so many efforts there are two factors that lead to difficulties in context with the potential targets for reorganization and should be investigated.
First, there is a great deal of overlap within the executive branch in providing job training services, the Departments of Agriculture, Health and Human Services, and Labor administer separate employment and training programs, serving essentially the same target groups (Jennings & Zank, 1993, p. 234). That clearly indicates that the rest groups are never focused or remain out of focus. These and other relevant job training programs should be merged into one agency operating under the same policy leadership and direction. Ideally, that agency’s operation should combine the best aspects of these programs, for example, state, local, and private sector participation and tying welfare to work.
Another important factor in delivering training programs is the lack of learning from each other. Federal agencies can learn from the example of local agencies and vice versa. An example is that of Rural Coast Bend, Texas, Private Industry Council administers an integrated employment and training system composed of the Food Stamps employment and training program, the Job Opportunities and Basic Skills program, and certain aspects of the Job Training Partnership Act. Housing all three programs together have eased client processing. The Industry Council has also managed to keep track of the three separate funding streams, calendar-program years, and mandates. Therefore there is a lesson for federal officials that these programs can be effectively administered and run by a single organization.
References
Gostin O. Lawrence, (2002) Public Health Law and Ethics: A Reader: University of California Press: Berkeley, CA.
Jennings T. Edward & Zank S. Neal, (1993) Welfare System Reform: Coordinating Federal, State, and Local Public Assistance Programs: Greenwood Press: Westport, CT.
Spencer Naomi, 2007. Web.
Zopf E. Paul, (1992) Mortality Patterns and Trends in the United States: Greenwood Press: Westport, CT.