Evolution of Public Health System

Question 1

18th and 19th Century

Answer 1

●Clean water and clean streets → typhus and cholera
●Good housing → tenement lodging for TB control
●“Clean air, clean babies, clean milk”

Question 2

20th Century

Answer 2

●Public Health: advocates, regulates (hospitals, medical practice), provides and mandates (immunizations, treatment → TB, STIs)
●1998: 100 year old pipe ruptures in Manhattan (Sewer)

Question 3

21st Century

Answer 3

●Diseases of energy imbalance – inactivity, cheap & fatty food (diabetes, CVD, arthritis)
●Resilience to climate change
●Progress depends on environmental change – active design guidelines, access to healthy food, protection from flooding and extreme heat, promote physical activity, promote healthy eating, rebuild the water supply, improve air quality, clean up brownfields

Question 4

Historical evolution of public hospital systems in NYC

Answer 4

• Almshouses very first in care for elderly, poor etc.
• NYS constitution since 1800s assigned responsibilities to state and sub-divisions (i.e. counties, municipalities, towns) of almshouses, poorhouses, pest-houses and asylums
• Beginning of municipal hospital system grew out of infirmaries and pest-houses attached to almshouses (i.e. places of care for seniles, orphans, cripples)
• Overtime, municipal system grew to 21 hospitals spread throughout 5 counties (acute, chronic and TB hospitals)

Question 5

NYC public hospital system now

Answer 5

Now advent of Medicare/Medicaid, 11 hospitals, own managed care plans, special protections for immigrants, called NYC Health and Hospitals (H+H)
●H+H supported by private and public insurance and tax levies
-Developing own integrated healthcare system

Question 6

historical evolution of the state hospital system and trans-institutionalization

Answer 6

-State hospitals initially confinements for the mental and now temporary care
-Massive closure of state hospitals has led to trans-institutionalization of chronic mentally ill into jails, prisons and shelters
●1 of 3 prisoners in US jails have chronic mental illness

Question 7

Ongoing evolution of the health care system

Answer 7

-Moving to outpatient settings
-Specialized intensive care centers with 24/7 service
-Surgeries moving into ambulatory care centers or office based surgeries
●ACA gives funding to ambulatory care centers the succeed in preventing hospitalizations→ decreasing national expenditures
-Government and insurance moving away from FFS to value based purchasing (rewards for good clinical outcomes)