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Chronic Disease, Health Promotion, and Epidemiology Units: State Health Departments are at the forefront

State health departments have moved far beyond their original purpose of ensuring sanitation and preventing contagious diseases. In the 21st century, they have a broad role in coordinating efforts to foster health at the population level. Health departments are typically made up of multiple divisions, each overseeing a number of programs. Health promotion, chronic disease, and epidemiology are among the common units. These divisions may be organized in different ways. One or more of these units may be a section under another. They share many common goals.

The Role of Health Promotion and Chronic Disease Prevention Units

The rationale behind health promotion and chronic disease units is this: Diseases are, in many cases, both preventable and manageable -- and the human and monetary costs of not doing so are too great to ignore.

Diet, tobacco and substance exposure, and physical activity are considered important causative factors for many diseases. States invest in helping smokers quit and in educating people about the dangers of new alternatives like e-cigarettes. They form multi-pronged approaches to improve diet from infancy on. Factors are complex and go far beyond the obvious. Scientists are discovering, for example, that infants who are breastfed are less likely to be obese as adults; here workplace policy comes into play. State policy also influences what low-income families can purchase with WIC or other governmental nutrition assistance – and whether their neighborhood stores have healthy food options. Public health workers are aware that environmental factors are exerting their influence from birth – and even before.

Diabetes and pre-diabetes are areas where health departments invest in teaching self-management. Health departments may support innovative programs for managing childhood asthma. They also promote age-appropriate screenings and preventative services.

Cancer control may be part of the same division as health promotion and chronic disease prevention. While cancer has not traditionally been thought of as a chronic disease, the process of preventing and treating it can be very similar to the process of treating and preventing heart disease or diabetes. Cancer is one area where results are being seen; both the age-adjusted incidence and the age-adjusted mortality rate have decreased in recent years. The Center for Disease Control supports a cancer control program in all states.

Improving health outcomes and lowering health spending requires concerted effort at the societal level as well as the individual level. Health promotion and chronic disease units often have a large role in creating five- or ten-year health plans. They may also create detailed health plans in particular target areas. It takes partnerships between public health and healthcare and also between health departments and other sectors like transportation, housing, and early childhood education to realize goals. It also takes data -- and this is where epidemiology comes into play.

The Role of Epidemiology

Epidemiology is occasionally included in the organizational structure as a separate unit. Often, epidemiology appears under the banner of various departments. Epidemiologists are often called disease detectives and for some, this may conjure for some the image of scientists rushing to uncover the causes for sudden outbreaks of new infectious or pathogen-related disease. This is indeed part of the picture, but epidemiologists study the risk factors (and protective factors) influencing development of many types of illness. The Georgia Department of Health, for example, established an Alzheimer’s Disease Registry in 2014; Alzheimer’s is one of seven major focus areas of chronic disease epidemiology in Georgia’s Chronic Disease Prevention Section (https://dph.georgia.gov/chronic-disease-data).

Epidemiologists discover surprising links, like connections between oral health and overall health. They continue to explore poorly understood health phenomena. They engage in active and passive surveillance and make policy recommendations. They combine data from different sources to identify current trends.

Positions in Public Health

Risk factors and disease outcomes can vary greatly from one county to the next or from one ethnic group to the next. Detailed population data is important for determining not only the causes of poor health but the most effective ways of reaching the target populations. If one wants to target adolescent boys living in high-poverty neighborhoods, for example, one needs to be able to think a little like adolescent boy. Universities teach students effective ways to design health campaigns. There’s a lot involved. Professionals need to determine which populations are targets at what stages.

Health departments compile vast amounts of data. They employ specialists with a range of skill sets, from biostatistics to public health education. There are typically many program managers and specialists with expertise in a range of areas. Epidemiology is an area where educational standards can be especially high. While educational minimums for epidemiologists vary from one state health department to another, in many instances, those at the highest levels have doctoral degrees. It is not uncommon for the state epidemiologist -- or other high ranking epidemiologist -- to have an MD. Some have both an MD and another supportive degree like Master of Public Health.

You may also want to read "How Public Health Institutes Operate".