10 Essential Public Health Services

The 10 Essential Public Health Services codify the responsibilities of public health agencies and institutions.

Purposes of Public Health
Organized according to the "three fundamental purposes of public health"— assessment, policy development, and assurance—the essential services include the following:

Assessment

 * 1) Monitor health status to identify community health problems.
 * 2) Diagnose and Investigate health problems and health hazards in the community.

Policy Development

 * 1) Inform, Educate, and Empower people about health issues.
 * 2) Mobilize community partnerships to identify and solve health problems.
 * 3) Develop policies and plans that support individual and community health efforts.

Assurance

 * 1) Enforce laws and regulations that protect and ensure public health and safety.
 * 2) Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
 * 3) Assure a competent public and personal health care workforce.
 * 4) Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services.
 * 5) Research for New Insights and Innovative Solutions to Health Problems.

History
In 1988, the Institute of Medicine (IOM) released an assessment of the U.S. public health system titled, The Future of Public Health. The report described the network of county, state, and national public health agencies as being in "disarray" and prompted a national discussion about the state of public health in the country. Questioning the ability of existing public health systems to provide essential services, the report sought to establish a comprehensive framework delineating the "three fundamental purposes of public health." These purposes included "assessment, policy development, and assurance." Though health policy academicians identified with and understood the IOM framework, policy makers found its highly conceptual language difficult to apply. Therefore, as part of President Clinton’s 1994 healthcare reform efforts, a federal working-group was tasked with reviewing and supplementing the framework. Under the auspices of both the Center for Disease Control and Prevention’s (CDC) Public Health Practice Program Office and the Office of Disease Prevention and Health Promotion, the group sought to These efforts culminated in the publication of The Essential Services of Public Health in late 1994.
 * 1) explain what public health is,
 * 2) clarify the role of public health within the larger healthcare system and
 * 3) provide accountability by linking public health performance to health outcomes.

The report was well received. Public health agencies and professional organizations began to align guidelines and employ self-assessment tools in support of the ten Essential Services. The CDC launched a number of research projects aimed at developing strategies for measuring how well public health agencies provided the services. Many of these studies were the first of their kind and ushered in an era of health agency monitoring and assessment.

In 2002, the CDC and several national public health associations launched the National Public Health Performance Standards Program (NPHPSP). With the goal of developing a consensus-based set of performance standards for state and local public health delivery systems, the NPHPSP adopted the Essential Public Health Services as "the fundamental framework" underpinning its assessment strategy. The NPHSP consists of three instruments— The State Public Health System Assessment, The Local Public Health System Assessment, and The Local Public Health Governance Assessment—and covers the gamut of public health action as described by the Essential Public Health Services.

Monitor health status to identify community health problems
It is essential for public health organizations to monitor the health status of populations in order to identify trends and to target health resources. Components of this service include: utilization of appropriate tools to interpret and disseminate data to audiences of interest; collaboration in integrating and managing public health; and accurate and periodic assessment of the community’s health status. Specifically, public health organizations can monitor the health status of their populations by creating a disease reporting system, community health profiles, and health surveys. For example, the Los Angeles Department of Public Health completes a Los Angeles County Health Survey (LACHS) every two to four years to obtain population-based data. This information is used for public health assessment and planning and for evaluating changes in health over time in Los Angeles County.

Diagnose and Investigate health problems and health hazards in the community
In order to appropriately allocate public health resources, it is essential to diagnose and investigate health problems and hazards in the community. Components in this service include: population-based screening of diseases; access to public health laboratories capable of completing rapid screening and high volume testing; and epidemiologic investigations of disease outbreaks and patterns of disease. The Los Angeles County Health and Examination Survey (LA HANES) was piloted in 2011 and aims to establish a profile description of health outcomes of residents of Los Angeles County (e.g. adult obesity and cardiovascular disease is monitored via collection of physical measurements such as blood pressure and body mass index). These survey results will inform public education and chronic disease prevention efforts. Emergency preparedness is also an essential component of public health organizations. Teams must be available and prepared to combat natural disasters, severe weather, outbreaks, bioterrorism, mass casualties and chemical emergencies.

Inform, Educate, and Empower people about health issues
Once public health priorities have been established through monitoring and investigation of health problems in the community, educational activities that promote improved health should be disseminated. Components in this service include: both the availability of health information and educational resources and the presence of health education and health promotion programs. This can be achieved through media advocacy and social marketing. An example of this is the Eat Less, Weigh Less campaign executed by the Los Angeles County Department of Public Health that aims to increase awareness about appropriate portion sizes using advertisements on buses, billboards and social media. It is also essential to establish health education and health promotion program partnerships with organizations in the community, such as schools, churches and employment facilities.

Mobilize community partnerships to identify and solve health problems
Public health organizations on the local, state and national level can mobilize community partnerships to identify and solve health problems. Components of this service include: building coalitions to utilize the full range of available resources; convening and facilitating partnerships that will undertake defined health improvement projects; and provide assistance to partners and communities to solve health problems. Of particular importance is identification of potential stakeholders who will contribute to or benefit from public health activities. First 5 LA is a community partner who supports targeted programs that address the needs of Los Angeles County children ages zero to five and their families. They work closely with the Los Angeles County Department of Public Health to improve the physical and emotional health of this population. It is important to note that many of these stakeholders may not be considered to be health-related at first glance. For example, organizations involved in urban planning may be influential in improving the health of its residents. This could include increasing the walkability of a community or the number of parks or bike trails in a neighborhood.

Develop Policies and Plans that support individual and community health efforts
Policies can be effective in modifying human behavior and reducing negative health outcomes. Components in this service include: development of policy to guide the practice of public health; alignment of resources and strategies for community health efforts; and systematic health planning strategies to guide community health improvement. In response to increasing rates of obesity and cardiovascular disease, the New York City Board of Health passed a ban on the sale of sodas and other sugary drinks larger than 16 ounces at restaurants, street carts and movie theaters. In addition to policies that can support health efforts, laws can reduce negative health outcomes. For example, dram shop liability is a law that holds the owner or server at a bar or restaurant where a patron consumed their last alcoholic beverage responsible for injuries or deaths caused as a result of alcohol-related incidents. A systematic review completed by the Task Force on Community Preventive Services, found strong evidence of the effectiveness of this law in reducing alcohol-related harms.

Enforce laws and regulations that protect and ensure public health and safety
It is important that individuals and organizations comply with existing laws and regulations in order to ensure the overall health and safety of the general public. Components of this service include: reviewing, evaluating, and revising laws and regulations put in place to protect the health and safety of the public; educating persons and organizations about these laws and regulations to improve compliance and encourage enforcement of them; and enforcing actions that protect the health of the public (e.g., protection of drinking water; enforcement of clean air standards; enforcement of laws prohibiting the sale of alcoholic and tobacco products to minors, of laws concerning seat belt and child safety seat use; mandating childhood immunizations; facilitating timely follow-ups in the event of hazards and outbreaks of exposure-related diseases; monitoring quality of health services; conducting the timely review of new drugs, biologics, and medical devices; ensuring food safety; and enforcing housing and sanitation codes).

Link people to needed personal health services and assure the provision of health care when otherwise unavailable
Having access to care when it is needed is important in helping individuals prevent and avoid unfavorable health outcomes and medical costs. At the local level, components of this service include: identifying populations that face barriers to accessing health services and addressing their personal health needs, assuring the linkage of these populations to appropriate health services by coordinating provider services, and developing and implementing interventions that address the barriers they face in attempting to access care. At the state and governance levels, components of this service include: assessing access to and availability of state health services; partnering with public, private, and non-profit sectors to provide a coordinated system of health care; assuring access to this coordinated health care system by using outreach efforts that link individuals to the health services they need; developing and implementing a continuous improvement process to assure the equitable distribution of resources for those in greatest need of these services. The National HIV/AIDS Strategy (NHAS) employs this service idea as one of the action steps for achieving increased access to care and improved health outcomes for people living with HIV.

Assure a competent public and personal health care workforce
Health care workers and staff who are competent (i.e., skilled in the core principles of public health practice) are more likely to provide care and other services more effectively and efficiently compared to those who are not. Components of this service include: making sure that the workforce meets the health needs of the population, maintaining public health workforce standards by developing and implementing efficient licensure and credentialing processes and incorporating core public health competencies into personnel systems, and adopting continuous quality improvement methods and long-term learning opportunities for public health workforce members. In two 2002 reports, the Institute of Medicine (IOM) recommended instituting a certification examination as a way of ensuring minimum competence in public health. Web-based training strategies may be useful in providing the long-term learning opportunities that many current and upcoming public health workers need in order to serve as well-informed advocates of public health and safety.

Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services
Given scarce resources, it is important to keep track of whether or not programs and/or policies end up producing intended outcomes. Components of this service include: assessing the accessibility, quality and effectiveness of services and programs delivered; providing policymakers with the information they need in order to make well-informed decisions regarding the allocation of scarce resources; tracking efficiency, effectiveness, and quality of services analyzing data on health status and service utilization; and striving to improve the public health system’s capacity to well serve the population. Cost-effectiveness analysis has been proposed as one possible strategy for informing policymakers on how best to allocate health care resources.

Research for New Insights and Innovative Solutions to Health Problems
Through research, the health and health care problems that individuals face can be better understood, and therefore be better and more appropriately addressed given the evidence provided by such research efforts. Components of this service include: fostering the development of a continuum of innovative solutions for health programming in terms of both practical field-based efforts as well as academic efforts, establishing a consortium of research institutions and other institutions of higher learning to encourage more collaborative and cross-cutting efforts, and ensuring the public health system’s capacity to perform timely epidemiological and health policy analyses.