Policy Democracy and Public Administration

This report is a theoretical essay on the inevitable conflicts that consistently occur between public agencies that are managed by unelected civil servants and the political environment in which these individuals and organizations operate in. Public agencies in the healthcare environment are prime examples of successful interdepartmental cooperation in most cases, but, there are also examples where they can demonstrate both internal and external in-fighting. "The health sector workforce, which usually comprises a significant element within the total public sector workforce, may be either directly employed by the public sector health system, or work in public-funded agencies or organizations (e.g., social insurance funded). In many countries healthcare will also be delivered by organizations in the private sector and by voluntary organizations." (World Bank Group) As concerns like the nation's aging population, a rapidly depleting Medicare Trust or the many potential pandemics such as SARs, Swine Flu, Aides and even the approach to dealing with the problems of our national mental health including the many seriously physically and mentally injured soldiers returning from two wars -- all of these issues need to be addressed.

The problem is that far too often, various departments of the United States Government have to work together even though they may or may not see eye-to-eye. "Health and Human Services was working diligently with the U.S. Department of Agriculture (USDA), the Department of State, and the U.S. Agency for International Development to monitor the situation and prepare for an epidemic should one occur. More importantly, a survey conducted by Bloomberg School's Center for Public Health Preparedness, published in the April 2006 edition of the journal BMC Public Health, found that of 308 respondents, half would not report to work during a pandemic. Although the healthcare industry would be in the center of the storm in the event of a pandemic, 'the workforce was not yet prepared for the crisis.'" (Encyclopedia of American Industries)

Consider that the objective of paying for many national or state-based health programs, oligarchy like bureaucratic environments and the need for a pristine public image alone are all grounds for predictable conflicts between most health related public agencies. One need only look at CNN, the New York Times or the Wall Street Journal to see that healthcare has become one of the most important issues that our nation is currently facing. So, as this national healthcare debate consumes the nation, behind the scenes, extremely powerful health related public agencies managed by unelected civil servants are all vying for control in order to maintain their grasp on the health related powerbase. This essay will try to understand some of these organizations' power structures and how their internal and external conflicts affect healthcare.

Current Healthcare Climate, Money Is the Key

President Obama has been trying desperately to implement a national universal healthcare program. The objective is to get healthcare coverage to every citizen in the United States. This is of course a monumental task and all of those who are either for or against the program have their reasons. But, most people are unaware of the fact that there are already hundreds of programs geared to meet the needs of Americans' healthcare. For example, the National Coalition on Health Care is "the nation's largest and most broadly representative alliance working to improve America's health care." (National Coalition on Health Care) Founded in 1990 and often referred to simply as the 'Coalition,' the aim of this non-profit group is to be rigorously non-partisan but is comprised of almost 96 individual groups and they employ or represent approximately 100 million Americans. "Members are united in the belief that we need and can achieve better, more affordable health care for all Americans." (National Coalition on Health Care) Some honorary Co-Chairs include former Presidents George Bush, Sr., Gerald R. Ford, and Jimmy Carter, former Governor Robert D. Ray (R-IA) and former Congressman Paul G. Rogers (D-FL). These types of existing programs are also often managed by unelected civil servants and they work in very stressful political environments.

These are the types of organizations that will really run the healthcare system if president Obama can successfully implement his healthcare initiatives and objectives. These programs also are already courting members of Congress in order to fund their operations. "The public health infrastructure is the foundation that supports the planning, delivery and evaluation of public health activities. The strength of this foundation depends on sustained, consistent investment and cooperation between all levels of government. However, the public health infrastructure has been underfunded and neglected for many years." (Center for Disease Control)

When we talk of healthcare, we have to takes into consideration the fact that as a nation we have a serious obesity problem, AIDS, children's school meal programs, kids with guns, and of course, more recently the Swine Flu and the list goes on and on. These types of public programs often managed or certainly influenced by unelected civil servants are in very extensive political environments and their aim is to secure funding. Depending on the organizational support base, funding migrates from cause to cause based on the current hot news topic or the political support that can be obtained.
Should our government fund gun violence control because it seems as if it is a major source of crime, accidents, and suicides over the current shortage of H1N1 vaccines? All of the health programs such as gun control, AIDS awareness, childhood obesity or flu vaccines are valid needs with serious underlying issues. For example, dealing with obesity is a real concern because nearly sixty-four percent of Americans are now classified as obese and therefore run the risk of heart disease and cancer, two of the worst outcomes from obesity. But in the same sense, automobiles and lawn mowers in unison with factories pollute our air and water and cause incalculable damage to lungs and health. That cause is just as valid: the point is that the current healthcare climate is in constant need of financial support and there are powerful organizations managed by unelected civil servants who work in difficult political environments. These are the people leading the charge to obtain funds -- internal and external in-fighting between those in need of financial support can only be a natural result. These public health programs are all affected by the actions of unelected civil servants who will be fighting for additional funding during the healthcare debate:

Birth Problems Registry and the Women Infants & Children - WIC

Breast and Cervical Cancer Program

National Breastfeeding Programs and Local Liaison Office, Maternal and Child Health Program

Community Health Centers

Diabetes, Environmental Health Program

Governor's Council for Physical Fitness and Sports

HIV/STD

Immunization Information Program

Lead Poisoning & Prevention Program

Nutrition News, Oral Health, Rabies Education

School Screening Forms, Tobacco and Health

Office of Tuberculosis Information

Office of Women's Health

National or State

The goals of Public Health programs are logically to prevent disease while also promoting good health. This is done by applying both scientific and technical knowhow through focused effort. When funding becomes an issue, our public health system may be completely unprepared which in turn can escalate minor health scares into devastating health catastrophes. When one thinks of a large scale public health program, they may be thinking of the federal government's intent on safeguarding the public's health.

But what actually becomes a health system is more in line with state, local and municipal public health policies or programs managed by local civil service employees being instructed as best as possible by larger national entities also run by civil servants. Consider the H1N1 vaccine shortages around the nation. The problem is of course seen as a national issue, but it is managed as more of a shortage per local communities. Thus, a national organization like The Center for Disease Control may pass on requests that are then carried out by local entities. "Vaccination is the best protection against contracting the flu. Find H1N1 (Swine) flu and seasonal flu vaccines where you live. You need two vaccines to be fully protected this year. The seasonal flu vaccine is different from the H1N1 flu vaccine. The CDC is encouraging people to get both vaccinations. Nationwide distribution of the H1N1 flu vaccine is underway to all states. Vaccine production is now at or near full capacity." (Flu.Gov)

In this way, the public health system can cover large areas that need assistance but from a grassroots approach. Most Americans know very little about how the public health infrastructure looks at a state or even smaller local jurisdictional level. At each and every level of communication in this overall system, conflicts occur between the public agencies that are managed by unelected civil servants. The true public health system should be considered an ecosystem where each cell has its own infrastructure. For example, a local jurisdiction's healthcare system may consist of a partnership between numbers of schools, hospitals, universities, community-based organizations, employers, foundations, or any combination of other possible settings. The majority of the time, this system works quite well and makes a…