Public Health Frameworks: Core Functions, Social Determinants, and Interventions

Community Health

The health status of a population and the actions taken to improve health outcomes within that community.

Assessment

The public health function that involves collecting and analyzing data to identify health problems.

Policy Development

The public health function that involves creating policies and plans to address health issues.

Assurance

The public health function that ensures services and protections are provided equitably.

Three Core Functions of Public Health

Assessment, Policy Development, and Assurance.

Socioeconomic Status (SES)

A person's or group's social and economic position based on factors such as income, education, and occupation.

Two Mechanisms Linking SES to Health

Access to material resources and chronic stress pathways.

Federal Poverty Level (FPL)

A federal income threshold used to determine eligibility for certain assistance programs.

FPL Formula

(Family Income ÷ FPL) × 100

SNAP

Supplemental Nutrition Assistance Program that helps low-income families purchase food.

Typical SNAP Eligibility Threshold

Approximately 130% of the Federal Poverty Level.

Redlining

A discriminatory housing practice that denied loans and investment to certain neighborhoods, often communities of color.

Health Effects of Redlining

Poverty concentration, poor housing, environmental hazards, reduced healthcare access, and health disparities.

Environmental Health

The study of how environmental factors affect human health.

Cumulative Exposure

The combined impact of multiple environmental or social hazards over time.

Example of Cumulative Exposure

Exposure to air pollution, lead, and housing instability simultaneously.

Disproportionate Burden

When vulnerable communities experience greater environmental hazards due to structural inequalities.

Food Insecurity

The lack of reliable access to enough nutritious food.

Food Desert

An area with limited geographic access to grocery stores and healthy food options.

Food Apartheid

A condition where structural and policy-driven inequities create unequal food access.

Difference Between Food Desert and Food Apartheid

Food deserts focus on geography; food apartheid focuses on systemic inequities.

Charitable Food Intervention

A short-term approach such as food banks or food drives.

Structural Food Intervention

A long-term solution such as living wages, zoning reform, or grocery investment.

Logic Model

A planning tool that shows how program resources lead to outcomes.

Inputs

Resources used in a program such as funding, staff, and partnerships.

Activities

Actions performed by a program such as workshops or screenings.

Outputs

The direct products of program activities.

Short-Term Outcomes

Immediate changes in knowledge, attitudes, or skills.

Long-Term Outcomes

Population-level health improvements achieved over time.

Example of an Output

500 residents attended workshops.

Example of a Short-Term Outcome

Increased knowledge of diabetes prevention.

Example of a Long-Term Outcome

Reduced diabetes prevalence.

Output vs Outcome

Output is what was done; outcome is what changed.

Incarceration as a Social Determinant of Health

Incarceration affects employment, housing, income, healthcare access, and health outcomes.

Structural Factor

A policy or social condition that influences living conditions and health.

Structural Connection Analysis

Explaining how a policy shapes living conditions and leads to health outcomes.

Upstream Intervention

An intervention that addresses root causes and systems.

Downstream Intervention

An intervention that addresses individual behavior or symptoms.

Example of an Upstream Intervention

Soda tax.

Example of a Downstream Intervention

Nutrition education classes.

Why Upstream Interventions Are Important

They create more sustained population-level change.

Socioecological Model

A framework that explains how multiple levels influence health.

Individual Level

Personal knowledge, attitudes, and behaviors.

Interpersonal Level

Influence from family, friends, and social networks.

Organizational Level

Influence from schools, workplaces, and organizations.

Community Level

Influence from community relationships and environments.

Policy Level

Influence from laws, regulations, and government policies.

School Wellness Policy

Socioecological model example at the organizational level.

Needs Assessment

A process used to identify and prioritize community health needs.

Strong Needs Assessment Characteristics

Uses demographic data, health data, historical context, and measurable indicators.

Morbidity Data

Data about disease occurrence in a population.

Mortality Data

Data about deaths in a population.

Weak Problem Definition

Maternal health disparities.

Strong Problem Definition

Postpartum depression among Black mothers in North Omaha.

Why Specific Problem Definitions Are Better

They are measurable, targeted, and easier to evaluate.

Biological Hazard

A living organism or biological agent that can cause disease.

Examples of Biological Hazards

Bacteria, viruses, and mold.

Assessment Example

A health department tracking opioid overdose rates.

Policy Development Example

Passing a soda tax to reduce sugary drink consumption.

Assurance Example

Providing vaccination clinics to underserved communities.

How Redlining Contributes to Maternal Health Disparities

It concentrates poverty, environmental hazards, and barriers to healthcare.

What Is Measured in a Needs Assessment

Demographics, morbidity, mortality, and community conditions.

What Level Does a Soda Tax Target

The policy level.

What Level Does Nutrition Education Target

The individual level.

What Level Does Family Support Target

The interpersonal level.

What Level Does a Community Coalition Target

The community level.

What Level Does a School Wellness Policy Target

The organizational level.

Practice Question Answer: Which Core Function Collects Health Data?

Assessment.

Practice Question Answer: 300 Residents Attended Workshops

Output.

Practice Question Answer: More Upstream Intervention

Soda tax.

Practice Question Answer: Family at 120% FPL and SNAP Eligibility at 130%

Likely eligible.

Practice Question Answer: Smoking Cessation Short-Term Outcome

Increased knowledge or intention to quit smoking.

Practice Question Answer: Why Diabetes Flyers May Fail

They target knowledge rather than structural causes.

Practice Question Answer: Why Training Community Health Workers Is Not a Long-Term Outcome

It is an output, not a population-level change.

Assessment Memory Trick

Assessment = Data.

Policy Development Memory Trick

Policy Development = Plan.

Assurance Memory Trick

Assurance = Services.

Food Desert Memory Trick

Geographic issue.

Food Apartheid Memory Trick

Structural inequity.

Upstream Memory Trick

Policy and systems change.

Downstream Memory Trick

Individual-level change.

Redlining Memory Trick

Historic housing discrimination affecting health today.