Public Health Core Functions and Essential Services

Brief history of Public Health: Preindustrial (before 1900)

• Disease was common

• Sanitation was poor

• Health care was limited

Brief history of Public Health: Industrial Era (late 1800s-1900s)

• Cities grew

• Epidemics spread

• Governments began creating health departments

Brief history of Public Health: Modern Era

• Scientific advances

• Vaccines

• Surveillance

• Public health agencies improved population health

Brief history of Public Health: Today

• Public health addresses chronic disease

• Health equity

• Preparedness

• Emerging threats like COVID-19

Public Health before 1988

Despite decades of progress, significant challenges remained;

• Public health responsibilities were not clearly defined

• Local, state, and federal agencies often worked independently

• Services varied widely across communities

• Funding and resources were inconsistent

• Limited accountability for public health performance

“Public health was neither clearly defined, adequately supported, nor fully understood”

Institute of Medicine (1988)

IOM’s future of Public Health

• Government’s role?

  • “To see that vital elements are in place and the mission is being adequately addressed”

• Core functions of Public Health

  • Assessment

  • Policy development

  • Assurance

10 Essential Public Health Services

• 3 core functions

• 10 essential Public Health Services

• Places Health Equity at the center

• Serves as the national framework for public health practice

Assessment

• Assess and monitor population health

• Investigate health problems

Policy development

• Communicate and educate

• Build community partnerships

• Develop polices

• Use laws and regulations

Assurance

• Enable equitable access

• Build workforce

• Improve through evaluation

• Build infrastructure

Essential services as a framework

• Defines what every public health system should do

• Guides public health practice nationwide

• Supports performance measurement

• Forms the basis for accreditation and quality improvement

Assess and monitor Population Health

• Understand the health of the community

  • Collect health data

  • Monitor disease trends

    • E.X: Tracking influenza cases to identify and outbreak

Investigate, Diagnose, and address health hazards and Root causes

Find the cause, stop the spread, and protect the community

• Identify health threats, determine root causes, and take action to protect public health

  • Investigate outbreaks and emerging health threates

  • Take action to control and prevent further harm

    • E.X: Investigating a Salmonella outbreak linked to contaminated salad served at multiple restaurants

Utilize Legal and Regulatory Actions

Enforce laws and regulations are implemented and enforced to protect the public’s health and safety

• Enforce public health laws and regulations

• Inspect and monitor for compliance

  • E.X: A restaurant is cited for improper food storage temperatures that could lead to foodborne illnesses

Communicate effectively to inform and educate

Share the right information to the right people at the right time

• Develop clear, consistent health messages

• Use multiple communication channels

  • E.X: Flu season campaign: The health department shares messages about flu prevention, vaccine clinics, and when to seek care through many channels to keep the community informed and protected

Strengthen, support, and mobilize communities and partnerships

• Build strong relationships and collaborations with individuals, organizations, and communities to achieve better health outcomes

  • Build and maintain partnerships across sectors

  • Engage and involve community members

    • COVID-19 Vaccination Community Partnership: Local partners worked together to increase vaccination rates in the community

Create, Champion, and implement policies, plans, and laws

Develop and champion evidence-based policies, plans, and laws that create healthier communities and reduces health equities

• Use data and community input to identify priority issues

• Partner with stakeholders to develop policies and plans

  • E.X: Local health department partners with the city to pass a smoke-free parks ordinance

Enable Equitable Access to the services people need

Ensure everyone has fair and just opportunities to get the health services they need to be healthy

• Identify barriers to accessing health services

• Work to remove barriers and improve access

  • E.X: A community has low rates of prenatal care due to cost and transportation barriers. The health department partners to improve access

Build and Support a Diverse and skilled public health workforce

Ensure a competent, diverse, well-trained, and supported public health workforce to deliver effective services and improve health

• Recruit and retain a diverse workforce

• Provide ongoing training and professional development

  • E.X: A local health department invests in its workforce to better serve the community

Improve and innovate through evaluation, research, and continuous quality improvement

Strengthen public health performance and impact by using evaluation, research, and quality improvement to make evidence-based decisions

• Monitor and evaluate programs and services using data and metrics

• Conduct or use research to better understand health issues and solutions

  • E.X: A local health department notices low vaccination rates among teens

Build and maintain a strong organizational infrastructure for Public Health

Ensure that public health organizations have the leadership, resources, and systems needed to deliver high-quality services and respond to community needs

• provide strong leadership and governance

• secure and manage sustainable funding

  • E.X: A local health department strengthen its infrastructure to better serve the community and prepare for emergencies