The Role of Structure and agency in the Public health Problems

The role of structure and agency in the public health problems particularly on use of tobacco, the use of illicit drugs, and homelessness may be identify with the policies and guidelines that assess and addresses the negative effect of tobacco, drugs and homeless on public health. In order to understand the role of structure and agency in the public health problems, it is very necessary that we have clear understanding of what are the structures and agencies in the public health system. Structure in public health system varies according to the models that are most effective to certain public health system.

Larry S. Gage, Anne B. Camper, and Robert B. Falk (2006), stated in their article entitled Legal Structure and Governance of Public hospitals and Health Systems that, many hospitals and public health system have chosen their own structures through legislations when the existing model did not adequately address their needs (p.6). Gage, Camper, and Falk identified some structures or model of public health based on how these public health systems are addressing the need of the public health. The Direct Operation by Local Government structure of public health system meant that the management of public health services is directly administered by the local government even if the public health systems have the advisory board (Gage, Camper, & Falk p. 6).

Another structure of public health system is the Direct Operation by State Government or University.  Gage, Camper, and Falk noted that, most public health systems are subject to Procurement, civil service, and other restriction customized to a big state government or a university, rather than to a health care system. The advantage of this structure/model it facilitates integrated planning and distribution of resources while in the case university hospitals it helps incorporate the teaching and the exploratory missions with the patient care.

The Separate Board within Government Entity structure/model is relatively autonomous entity as it manages its daily operation through its public health board. Although they do not represent a legally independent body, they exercise a higher degree of autonomy than direct operation by state or local government. There are other structures of public health system providing benefits to state residents, which are government entities regardless of their structures or model used to operate the public health system.

The role of the Structure and agency in Public health problems

As we have seen in the discussion above, structure is important in the operation of the public health system, particularly to facilitate the provision necessary to sustain its delivery of basic services to the public. It also helps to facilitate resources, as well as to setting the direction of its operation, based on the guidelines provided by either the State or the University, and implement programs designed to address public health problems.

            Three of the most pressing problems of the public health today are the use of tobacco, the use of illicit drugs, and homelessness.

The Use of Tobacco

The use tobacco has been the most controversial issue among other public health problems as the tobacco industry contributes a substantial amount both politically and economically. Ronald Bayer and James Colgrove (2004) cited in their article entitled Unfiltered: Conflicts over Tobacco Policy and Public Health the study funded by the tobacco industry in 1994 that some 1.8 million people were employ in tobacco-related jobs and the industry has generated a huge $36 billion financial contribution in form of state and federal tax revenues (p.8). Nevertheless, Bayer and Colgrove pointed out that, during the 1950’s series of pioneering studies on the effect of smoking on public health reveals that lung cancer and respiratory diseases are linked to smoking (p. 9).

This study was upheld a decade later by the Royal College of Physicians of London in 1962 by categorically stating that cigarette smoking is a cause of bronchitis and lung cancer and most likely contributes to the existence of coronary heart disease (Bayer & Colgrove, p. 9). Today, it is established that cancer of the lung, lip, mouth, larynx, stomach, bladder, and esophagus; and also non cancerous respiratory diseases such as chronic bronchitis and pulmonary emphysema, cardiovascular disease, peptic ulcer, and many other internal diseases. However, despite of the enormous diseases linked to cigarette smoking, Bayer and Colgrove noted that in 1964, half of men and a third of the women in the United States smoked.

Because of the powerful influence of the tobacco industry, efforts to limit the use of tobacco had been largely unsuccessful. The lack of agencies that would collectively carry on the efforts to fight against the effect of cigarette smoking has made it difficult to address the problem, as the political forces that the industry can muster are powerful enough to resist efforts to stop cigarette smoking, in view of its ill effects on public health. Tobacco industry can easily thwart all measures that might challenge the standing of smoking in American society.

It is clear that the role of structure and agency in addressing public health programs is very important in order to implement measures that may pose challenge to large business firms involve in the problem.  The role of public health agencies is to identify risk or harms and interfere to avoid or restructure them. It was apparent that the failures of the Federal Trade Commission to address the health problem caused by cigarette smoking in the 1960s were the lack of necessary support coming from established agencies such as the American cancer Society and the National Tuberculosis Association.

The Structures of public health system implement the policies and health measures that benefit the public but when the measures are opposed by affected large business firm, the role of the agency is to provide necessary assistance to overcome the hurdles that hinders the implementations of those measures. Such is also the case in the needle experiment scheme aimed at controlling HIV infection.

Warwick Anderson (1991) in his article The New York Needle Trial: The Politics of Public Health in the age of Aids explained that the experiment was condemned outright by the law enforcement agency calling it “unthinkable” while many of the New York cities minority leaders denounced it as unthinkable (p. 1506). Because of the lack of agencies that teamed up with public health professional, no matter how beneficial to the majority the initiative is, it can hardly be successful against the powerful and highly structured forces contending the implementations of such measures.

The Use of Illicit Drugs

            The use of illicit Drugs may not be equally compared to the numbers of tobacco or cigarette users as there are strict laws governing the use of illegal drugs. However, the effect on public health of the use of illicit drugs are equally dangerous and some times, even fatal. The problem of the use of illicit drugs had come to its height in the early 1970s when the use of heroin had been increasing dramatically. James Q. Wilson stated in his article entitled Against the Legalization of Drugs that in view of this social malady, well known personalities in the intellectual society had even proposed for the legalization of the use of heroin.

This proposal was not adopted, as it could have led to a more serious problem in the public health. During this time, more young people had been victims of drug addiction, which lead to many deaths of overdoses, or have acquired hepatitis due to their use of dirty needles. Because of such impact of the use of drugs on public health, Wilson stated that many people thought heroin epidemic would soon overwhelm the society (p. 21).

However, what the people feared about did not happened as public health measures implemented has effectively addressed the problem. Drug users were strictly controlled although the use of illicit drug was not totally stopped. Wilson attributed the success in controlling the increase of drug users to the effect of drugs on health as the very users of drugs had watched more and more users died of overdoses.

            The role of structure and agency in this public health problem is apparently to control the supply of the illegal drugs. The proposal to legalize the use of drugs could have only worsened the general situation of the public health system, as it will not pay any one to become addict or make some one an addict. Further more, by controlling the from  buying particularly those whose financial capacity are limited. Although it is common even in many countries around the world that selling illegal drugs is a crime, but it is worth mentioning that efficient and effective implementation of the law has made it difficult for drug pushers and users to sustain their activities resulting to the decline of the new recruits to use drugs.

The public health structures and agencies implementing strategic alliance with the law enforcement agencies are effectively addressing the public health problem. Wilson cited that in 1976, the age of common illicit drug users in hospital emergency rooms was about twenty-seven. This dropped to thirty-two ten years later, and even to over thirty years of age as years past by. The implication of this observation of the age of people using drugs is that they do not increase in numbers. It means that the role of public health structures and agencies in the public health problems about the use of illicit drugs are more on evaluating current measures whether it would truly be beneficial to the public health, and cooperate with law enforcement agencies, about the possible implementation of health policies.

The effect Homelessness on Public health

            Anthony Jackson stated, “The housing industry trades on the knowledge that no Western country can politically afford to permit its citizens to sleep in the streets.” In her report to prepared for the Family Housing Fund, Ellen Hart-Shegos pointed out that, majority of homeless people are single parent women, who themselves were homeless as children (p. 2). These women hurdles many hindrances to healthy pregnancies, such as chronic and acute health problems, chemical abuses, and lack of prenatal care.

Homelessness severely affects children too. Hart-Shegos noted that the child’s experience of homelessness slow down the physical, social, emotional, cognitive, and behavioral development (p. 2). Academic performance of homeless children is hindered both by the circumstances of their homelessness and by their poor cognitive development. They hardly score well on math, spelling, reading, and vocabulary test and they generally consistently display more health problems even than underprivileged children who have housing. Trevor Hancock in his article entitled Homelessness noted some factors that contribute to homelessness.

Among these factors is the lack of affordable housing, inadequate income supports, and changes in the industrial economy that leads to unemployment, the erosion of family and social supports, and so fort. Hancock cited the effect of homelessness to public such as high rates of infectious disease, physical disorders, disability, mental health problems, and even premature deaths (Honcock). Hancock cited that homeless people are also prone to trauma, and well as to physical and sexual assault. Studies reveal that homeless people are also prone to suffer from cardiovascular, respiratory and other diseases such as arthritis, and rheumatism.

            The role of public health structure and public health agencies is to assist these homeless people and provide them necessary help for them to help their own selves. The public health structures and the public health agencies should not just give these people fish to eat but teach to learn how to fish and assist them in their efforts to get out of their situation.

Conclusion

            Based on the above discussion, the Public health structure can thus be defined as the people behind the management of public health system, which implement the basic policy and guidelines of the public health system. They may compose of the advisory board and other organizational structures with in the public health system. Public health agency on the other hand may be defined as a particular office that has a specific function within the public health system. They may have autonomy from the public health structure but they are to assist them to achieve its goal to be able to address the public health problem confronting the society.

Reference List

Anderson, W. (1991). The New York Needle Trial: The Age of Public Health in the Age of AIDS Vol. 81No. 11

Bayer R. & Colgrove, J. (2004). Unfiltered England: Harvard University Press

Gage, L.S., Camper, A. B., & Falk, R. (2006) Legal Structure and Governance of Public Hospitals and Health Systems

http://faculty.smu.edu/tmayo/1984.pdf

Hancock, T. Homelessness

http://www.healthline.com/galecontent/homelessness

Hopper, K. (2008) A Poor Apart: Social Exclusion, Homelessness and Mental Illness (ppp).

Shegos, E. Homelessness and its effects on Children

http://www.fhfund.org/_dnld/reports/SupportiveChildren.pdf

Wilson, J. Q., (1990). Against the legalization