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50 JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE /MARCH 1997 <br />Spiritual <br />Envilmment <br />Natural Sow <br />Environment Environment <br />Community <br />Government/ Built <br />Politics Genetics Medical Environment <br />20% Delivery <br />System <br />10% <br />Education Community <br />�/ R Safety <br />Lifestyle Environment <br />° 20% Arts/Culture/ <br />Housing 0 Heritage & <br />Recreation <br />Transportation/ <br />Mobility <br />Access to <br />Health Care <br />Economy/ <br />Employment <br />Figure 1. Individual and community factors that influence health (Source: Daughters of Charity National Health <br />System; 1994). <br />including the concept of health as a human right.5.6 <br />Public health is ultimately and essentially an ethical <br />enterprise committed to the notion that all persons <br />are entitled to protection from hazards and to min- <br />imization of risks of death and disability.' The or- <br />ganizational framework for public health involves <br />activities under the formal structures of government, <br />related efforts in private and voluntary agencies, and <br />the educational and research efforts of universities. <br />An innovation of U.S. efforts in public health is the <br />multidisciplinary approach to disease prevention.° <br />The accomplishments of public health and related <br />social changes have extensively changed the pattern <br />of death and disease in modern society. Infant mor- <br />tality in the United States has fallen from 150 per <br />1,000 live births in 1900 to 8.5 per 1,000 in 1992.9.10 <br />Life expectancy from birth has risen from 47 years in <br />1900 to more than 76 years in 1992.10 This represents <br />an increase of over two days of life expectancy for <br />every week since the beginning of this century. <br />Much of the gain in life expectancy can be attributed <br />to provision of safe water and food, sewage disposal, <br />90 <br />i <br />i <br />• <br />