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 An Introduction to
Community &
Public Health NINTH EDITION

James F. McKenzie, PhD, MPH, MCHES

Professor Emeritus
Ball State University

Robert R. Pinger, PhD

Professor Emeritus
Ball State University

Denise M. Seabert, PhD, MCHES

Professor and Associate Dean
Ball State University
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Library of Congress Cataloging-in-Publication Data

Names: McKenzie, James F., 1948- author. | Pinger, R. R., author. | Seabert, Denise M., author.
Title: An introduction to community & public health / James F. McKenzie, Robert R. Pinger, Denise M. Seabert.
Other titles: Introduction to community and public health
Description: Ninth edition. | Burlington, Massachusetts : Jones & Bartlett Learning, [2017] | Includes bibliographical references and index.
Identifiers: LCCN 2016037285 | ISBN 9781284108415
Subjects: | MESH: Community Health Services | Delivery of Health Care | Public Health Practice | Epidemiologic Factors | United States
Classification: LCC RA445 | NLM WA 546 AA1 | DDC 362.1–dc23
LC record available at https://lccn.loc.gov/2016037285

6048

Printed in the United States of America

20 19 18 17 16  10 9 8 7 6 5 4 3 2 1
CONTENTS
Preface xii
Acknowledgments xvi

UNIT ONE
FOUNDATIONS OF COMMUNITY AND PUBLIC HEALTH 1

CHAPTER 1 COMMUNITY AND PUBLIC HEALTH: YESTERDAY, TODAY,

AND TOMORROW 2
Scenario 3
Introduction 3
Definitions 3
Factors That Affect the Health of a Community 6
A History of Community and Public Health 9
Earliest Civilizations 10
The Eighteenth Century 11
The Nineteenth Century 11
The Twentieth Century 12
The Twenty-First Century 19
Chapter Summary 26
Scenario: Analysis and Response 27

CHAPTER 2 ORGANIZATIONS THAT HELP SHAPE COMMUNITY AND

PUBLIC HEALTH 31
Scenario 32
Introduction 32
Governmental Health Agencies 32
International Health Agencies 33
National Health Agencies 35
State Health Agencies 44
Local Health Departments 46
Whole School, Whole Community, Whole Child (WSCC) Model 47
Quasi-Governmental Health Organizations 47
The American Red Cross 48
Other Quasi-Governmental Organizations 49
Nongovernmental Health Agencies 49
Voluntary Health Agencies 49
Professional Health Organizations/Associations 50
Philanthropic Foundations 52
Service, Social, and Religious Organizations 52
Corporate Involvement in Community and Public Health 53
Chapter Summary 53
Scenario: Analysis and Response 54
iv Contents

CHAPTER 3 EPIDEMIOLOGY: THE STUDY OF DISEASE, INJURY, AND

DEATH IN THE COMMUNITY 57
Scenario 58
Introduction 58
Definition of Epidemiology 59
History of Epidemiology 60
The Importance of Rates 62
Incidence, Prevalence, and Attack Rates 62
Interpretation of Rates 63
Reporting of Births, Deaths, and Diseases 64
Standardized Measurements of Health Status of Populations 67
Mortality Statistics 67
Life Expectancy 70
Years of Potential Life Lost 70
Disability-Adjusted Life Years 71
Health-Adjusted Life Expectancy 74
Sources of Secondary Data 74
The U.S. Census 75
Vital Statistics Reports 75
Morbidity and Mortality Weekly Report 75
National Health Surveys 75
Epidemiological Studies 78
Descriptive Studies 78
Analytic Studies 80
Determining Causation 81
Chapter Summary 82
Scenario: Analysis and Response 83

CHAPTER 4 COMMUNICABLE AND NONCOMMUNICABLE DISEASES:

PREVENTION AND CONTROL OF DISEASES AND
HEALTH CONDITIONS 89
Scenario 90
Introduction 90
Classification of Diseases and Health Problems 90
Communicable versus Noncommunicable Diseases 91
Acute versus Chronic Diseases and Illnesses 91
Communicable Diseases 92
Chain of Infection 93
Modes of Transmission 93
Noncommunicable Diseases 95
Diseases of the Heart and Blood Vessels 95
Malignant Neoplasms (Cancer) 97
Other Noncommunicable Disease Problems 97
Prioritizing Prevention and Control Efforts 98
Leading Causes of Death 99
Years of Potential Life Lost 99
Economic Cost to Society 99
 Contents v

Prevention, Intervention, Control, and Eradication of

Diseases 99
Levels of Prevention 100
Prevention of Communicable Diseases 100
Prevention of Noncommunicable Diseases 107
Chapter Summary 111
Scenario: Analysis and Response 111

CHAPTER 5 COMMUNITY ORGANIZING/BUILDING AND HEALTH

PROMOTION PROGRAMMING 114
Scenario 115
Introduction 115
Community Organizing/Building 116
Need for Organizing Communities 117
Assumptions of Community Organizing 117
Community Organizing Methods 118
The Process of Community Organizing/Building 120
Recognizing the Issue 120
Gaining Entry into the Community 120
Organizing the People 121
Assessing the Community 122
Determining the Priorities and Setting Goals 123
Arriving at a Solution and Selecting Intervention Strategies 124
The Final Steps in the Community Organizing/Building
Process: Implementing, Evaluating, Maintaining,
and Looping Back 125
A Special Note about Community Organizing/Building 125
Health Promotion Programming 125
Basic Understanding of Program Planning 125
Creating a Health Promotion Program 126
Assessing the Needs of the Priority Population 127
Setting Appropriate Goals and Objectives 129
Creating an Intervention That Considers the Peculiarities
of the Setting 131
Implementing the Intervention 133
Evaluating the Results 134
Chapter Summary 135
Scenario: Analysis and Response 136

CHAPTER 6 THE SCHOOL HEALTH PROGRAM: A COMPONENT OF

COMMUNITY AND PUBLIC HEALTH 139
Scenario 140
Introduction 140
Whole School, Whole Community, Whole Child: A Collaborative
Approach to Learning and Health 141
The School Health Advisory Council 142
The School Nurse 142
The Teacher’s Role 142
vi Contents

The Need for School Health 143

Foundations of the School Health Program 144
School Health Policies 145
Policy Development 146
Policy Implementation 146
Policy Development Resources 146
Monitoring the Status of School Health Policy in the United States 147
Components of the Whole School, Whole Community,
Whole Child Model 147
Administration and Organization 147
School Health Services 148
Healthy School Environment 150
School Health Education 151
Development of and Sources of Health Education Curricula 152
Counseling, Psychological, and Social Services 153
Physical Education and Physical Activity 153
Nutrition Environment and Services 153
Community Involvement 154
Family Engagement 154
Employee Wellness 154
Issues and Concerns Facing School Health 154
Lack of Support for School Health Initiatives 154
School Health Curriculum Challenges 155
School-Based Health Centers 156
Violence in Schools 157
Chapter Summary 159
Scenario: Analysis and Response 159

UNIT TWO
THE NATION’S HEALTH 163

CHAPTER 7 MATERNAL, INFANT, AND CHILD HEALTH 164

Scenario 165
Introduction 165
Family and Reproductive Health 169
Teenage Births 170
Family Planning 171
Maternal Health 177
Preconception and Prenatal Health Care 177
Infant Health 180
Infant Mortality 180
Improving Infant Health 181
Child Health 186
Childhood Mortality 186
Childhood Morbidity 187
 Contents vii

Community Programs for Women, Infants, and Children 191

Maternal and Child Health Bureau 192
Women, Infants, and Children Program 192
Providing Health Insurance for Women, Infants, and Children 194
Providing Child Care 196
Other Advocates for Children 197
Chapter Summary 198
Scenario: Analysis and Response 199

CHAPTER 8 ADOLESCENTS, YOUNG ADULTS, AND ADULTS 204

Scenario 205
Introduction 205
Adolescents and Young Adults 205
Demography 206
A Health Profile 208
Community and Public Health Strategies for Improving the
Health of Adolescents and Young Adults 218
Adults 219
A Health Profile 219
Community and Public Health Strategies for Improving the
Health of Adults 224
Chapter Summary 226
Scenario: Analysis and Response 227

CHAPTER 9 OLDER ADULTS 230

Scenario 231
Introduction 231
Definitions 231
Myths Surrounding Aging 232
Demography of Aging 233
Size and Growth of the Older Adult Population in the
United States 233
Factors That Affect Population Size and Age 235
Other Demographic Variables Affecting Older Adults 236
A Health Profile of Older Adults 238
Mortality 239
Morbidity 239
Health Behaviors and Lifestyle Choices 241
Mistreatment of Older Adults 242
Instrumental Needs of Older Adults 242
Income 242
Housing 243
Personal Care 245
Health Care 247
Transportation 248
Community Facilities and Services 249
Chapter Summary 251
Scenario: Analysis and Response 252
viii Contents

CHAPTER 10 COMMUNITY AND PUBLIC HEALTH AND

RACIAL/ETHNIC POPULATIONS 255
Scenario 256
Introduction 256
Racial and Ethnic Classifications 257
Health Data Sources and Their Limitations 258
Americans of Hispanic Origin Overview and Leading
Causes of Death 259
African Americans Overview and Leading Causes of Death 261
Asian Americans Overview and Leading
Causes of Death 263
American Indians and Alaska Natives Overview
and Leading Causes of Death 266
U.S. Government, Native Americans, and the Provision
of Health Care 266
Indian Health Service 267
Immigrant and Refugee Health 267
Minority Health and Health Disparities 269
Infant Mortality 271
Cancer Screening and Management 272
Cardiovascular Diseases 274
Diabetes 274
HIV Infection/AIDS 274
Child and Adult Immunization Rates 276
Social Determinants of Health and Racial and
Ethnic Disparities in Health 276
Equity in Minority Health 279
Cultural Competence 279
Empowering the Self and the Community 282
Chapter Summary 283
Scenario: Analysis and Response 283

CHAPTER 11 COMMUNITY MENTAL HEALTH 287

Scenario 288
Introduction 288
Definitions 290
Classification of Mental Disorders 290
Causes of Mental Disorders 292
History of Mental Health Care in the United States 294
Mental Health Care before World War II 295
Mental Health Care after World War II 296
Mental Health Care Concerns in the United States Today 298
Serious Mental Illness in People Who Are Homeless 299
Mental Illness and Violence 299
The New Asylums: Mental Health Care in Jails
and Prisons 300
Meeting the Needs of People with Mental Illness 301
 Contents ix

Government Policies and Mental Health Care 306

The Affordable Care Act 307
Chapter Summary 308
Scenario: Analysis and Response 308

CHAPTER 12 ALCOHOL, TOBACCO, AND OTHER DRUGS:

A COMMUNITY CONCERN 314
Scenario 315
Introduction 316
Scope of the Current Drug Problem in the United States 316
Definitions 319
Factors that Contribute to Alcohol, Tobacco, and
Other Drug Abuse 320
Inherited Risk Factors 320
Environmental Risk Factors 320
Types of Drugs Abused and Resulting Problems 322
Legal Drugs 322
Controlled Substances and Illicit (Illegal) Drugs 328
Prevention and Control of Drug Abuse 335
Levels of Prevention 335
Elements of Prevention 335
Governmental Drug Prevention and Control Agencies
and Programs 337
Nongovernmental Drug Prevention and Control Agencies
and Programs 341
Chapter Summary 344
Scenario: Analysis and Response 344

CHAPTER 13 HEALTH CARE DELIVERY IN THE UNITED STATES 349

Scenario 350
Introduction 350
A Brief History of Health Care Delivery in the United States 351
Health Care System: Structure 356
The Spectrum of Health Care Delivery 356
Types of Health Care Providers 359
Health Care Facilities and Their Accreditation 364
Health Care System: Function 369
Understanding the Structure of the Health Care System 369
Health Insurance 378
Managed Care 389
Other Arrangements for Delivering Health Care 392
Health Care Reform in the United States 393
Consumer-Directed Health Plans 393
Health Care Reform in the U.S: How Did It Happen,
Where Is It Headed? 395
Chapter Summary 398
Scenario: Analysis and Response 399
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