became an essential governmental function with specialized federal,
state, local and tribal public health agencies. During this period,
workers for public health systematized sanitation, improved food
and water safety, gained new understanding of diseases, and brought
us powerful new vaccines and antibiotics. These advances led to a
30-year increase in the life expectancy of the average American.
Public Health 2.0 emerged in the second half of the 20th cen-
tury, heavily shaped by the 1988 Institute of Medicine report The
Future of Public Health. During this era, governmental public health
agencies set high professional and standards. Public health experts
defined a common set of goals and core functions, then developed
and implemented target capacities and performance standards for
governmental public health agencies at every level.
In the US, our professionalized public health system has nearly
eliminated loss of life from infectious diseases such as cholera and
non-resistant tuberculosis. The leading causes of death in the US
PUBLIC HEALTH
Senate Bill 18, will improve birth outcomes and children’s health.
The Center for Health Equity at the Department of Public Health
and Wellness conducted a Health Impact Assessment on the bill
when it was introduced. We spoke with stakeholders and conducted
a comprehensive review of existing data on the health impacts of
working while pregnant to provide a more thorough understanding
of how certain work environments can impact health. We also looked
at evidence for the types of accommodations that can be made to
reduce health inequities and improve health outcomes for pregnant
workers and their developing children.
The Center for Health Equity released the Health Impact As-
sessment (HIA) to the press and to our partners, who were able to
incorporate the HIA into their advocacy. The Kentucky Pregnant
Workers Act will allow women to continue to support their families
during pregnancy without risking their health or the health of their
new babies. The HIA is a good example of how public health can
in older adults are chronic diseases like heart disease, cancers and
COPD. Our younger generations are dying from despair and trau-
ma – from suicide, homicide and drug overdose at alarming rates. play a vital role in policy development to improve population health.
In order to continue making strides in health outcomes and life
expectancy, interventions such as encouraging people to exercise
and eat more nutritious foods will be inadequate. It’s difficult to
exercise when your neighborhood has crumbling sidewalks and
gun violence. It’s hard to eat well when you’re working two jobs,
raising your kids and grandkids, and have no neighborhood gro-
cery store. Public Health 3.0 recognizes that healthy choices must
be easy choices for everyone and for that to happen, our systems
have to change. The state legislature passed the Smoke Free Schools Act, House
Bill 11, on the very last day of this year’s session. The Smoke Free
Schools Act prohibits the use of tobacco products and vaping de-
vices on all school property and at all school events. Governor
Bevin has signed the measure, which will take effect starting with
the 2020-21 school year. This is a significant step towards reducing
the exposure to secondhand smoke and growing use of e-cigarettes
among adolescents.
This modern analysis has broadened public health practice be-
yond traditional public health department programs. Cross-sector
collaboration for policy development and change is intrinsic in
the Public Health 3.0 vision. Only through inter-organizational
cooperation can policy and system-level actions be taken to affect
the root causes of poor health.
The Louisville Metro Department of Public Health and Wellness
has embraced the Public Health 3.0 model and has restructured, to
better address the root causes of health inequities and poor health
in our city. We believe this will lead to improved population health.
Over the past few months we’ve worked with our community part-
ners to help bring about several policy changes we hope will help.
KENTUCKY PREGNANT WORKER’S ACT
The Kentucky legislature passed the Kentucky Pregnant Workers
Act during the last session. The law, which applies to businesses
with at least 15 employees, gives pregnant workers and new moms
the right to reasonable accommodations at work. The measure,
SMOKE FREE SCHOOLS ACT
CRIMINAL RECORD EXPUNGEMENT
You may remember that in March 2018, the Department of Public
Health and Wellness, along with community members and officials
from agencies and organizations across the city, published Coming
Together for Hope, Healing and Recovery, a two-year plan to respond
to Louisville’s substance use crisis. One of the challenges that many
people face in recovery is a criminal record, which prevents them
from finding employment and safe housing. One of the goals of the
plan is to make expungement, a court ordered process of sealing a
criminal record, easier and more affordable.
During the past session, the Kentucky legislature enacted a mea-
sure that allows for expungement of most class D felonies including
possession of drugs and drug paraphernalia. Not included are sex
offenses, child abuse and violent crimes. The filing fee has also been
reduced from $500 to $250. This is a step in the right direction. The
HIA is looking at the effects of expungement on health, particularly
on rates of remission of substance use disorder.
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