Principles of Standards and Measures Advance the collective public health practice Moderate level: not minimum, not maximum Be clear, reduce redundancy, minimize burden Build quality improvement into standards Apply to all sizes of HDs and all forms of governance structure Establish same standards for Tribal, state, and local health departments Be reflective of emerging public health issues and opportunities; and Promote effective internal and external collaborative partnerships.

PHAB 12 Domains Based on Core Functions of Public Health & Ten Essential Public Health Services The Essential Public Health Services provide the fundamental framework for the PHAB standards and measures, as these activities describe the full range of public health responsibilities. Using the 10 Essential Services framework assures that the PHAB standards fully cover the gamut of public health activities needed. History lesson for how the 10 Essential Services came to be: Many of you may be familiar with the core functions, which were outlined in the 1988 Institute of Medicine report - The Future of Public Health. As stated in the IOM report, the three core functions of public health are assessment, policy development and assurance. This is a good start to describing public health, but 1994, when the country was exploring issues related to health care reform, the public health sector felt that a better definition and description of public health was needed. A “Core Functions of Public Health Steering Committee” was convened to address this need. This Steering Committee involved representatives from Public Health Service Agencies (CDC, HRSA, Office of Disease Prevention and Health Promotion, etc.) and key National Public Health Organizations. The committee produced a statement called “Public Health in America.” Public Health in America – Vision and Mission The Public Health In America statement provides a vision and mission for public health as well as the context of what public health should be prepared to do and how public health service is delivered. The vision for public health is broad, “Healthy People in Healthy Communities.” The mission identified is to “Promote Physical and Mental Health and Prevent Disease, Injury, and Disability”. The last part of the Public Health in America statement defines the “Essential Services of Public Health”. The ten essential services are shown up here on the screen and include: Monitor health status to identify and solve community health problems Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure the provision of health care when otherwise unavailable Assure a competent public and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems Basically, any public health activity can fit into one of these ten categories. So for example, Essential Service #1 includes activities such as data collection, community health assessments and the maintenance of population health registries. As another example, Essential Service #7 includes personal health care services as well as transportation and other enabling services and assuring the availability of culturally appropriate personnel and materials. Since the release of the ten Essential Services, numerous initiatives have explored the utility and feasibility of these services and have found them to be a good descriptor of public health.

Twelve Domains of Standards Conduct assessments focused on population health status and health issues facing the community Investigate health problems and environmental public health hazards to protect the community Inform and educate about public health issues and functions Engage with the community to identify and solve health problems Develop public health policies and plans Enforce public health laws and regulations Promote strategies to improve access to healthcare services Maintain a competent public health workforce Evaluate and continuously improve processes, programs, and interventions Contribute to and apply the evidence base of public health Maintain administrative and management capacity Build a strong and effective relationship with governing entity The standards are made up of domains, standards, measures and required documentation. There are 12 domains made up of standards that pertain to a broad group of public health services. Domains 1 through 10 relate to the 10 Essential Services Domain 11 relates to management and administration Domain 12 relates to governance

Comprehensive Community Health Assessment Collect and manage data Domain 1 Conduct assessments focused on population health status and health issues facing the community Comprehensive Community Health Assessment Collect and manage data Surveillance system Primary and secondary data Analyze data for trends in health hazards, environmental public health, and social determinants of health Use the data to inform policy, processes, programs, and interventions.

Domain 2 Conduct timely investigations of health problems and environmental public health hazards Conduct investigations (protocols, multiple investigations of infectious and non-infectious, manage process for reportable disease) Contain and mitigate health problems and environmental public health hazards (protocols, All Hazards Emergency Operations Plan, After Action Reports) Public health laboratory and epidemiology capacity ( 24/7 rapid detection, surge capacity, partnerships with other HDs for investigations) Plan, policies, and procedures for urgent and non-urgent communication (protocols, health alerts, coordinate responses, communicate with the public)

Domain 3 Inform and educate about public health issues and functions Health education and health promotion (a planned approach and strategies to protect the public and provide information) Healthy behaviors, health risks, and healthy decisions for specific populations, with their input and feedback Specifically address factors that contribute to specific populations; higher health risks and poorer health outcomes Provide information on PH issues and PH functions Relation with the media Branding strategy Communication procedures Risk Communications plan Information through a variety of methods Culturally sensitive and linguistically appropriate

Engage with the community Domain 4 Engage with the community to identify and solve health problems Emphasis is on the process, the use of the partnership, and the mutual collaboration Engage with the community Partnerships and coalitions Share Models for engaging the community Community policy or program change implemented through partnership Promote community’s understanding to support policies and strategies Engage with community members Engage with policy makers (advisory board, elected officials)

Domain 5 Develop public health policies and plans Be the experts for PH policy, practices, and capacity inform, track/monitor, advise Community health improvement plan Broad participation Consider social determinants and policy changes to address health inequities Health department strategic plan All hazards emergency operations plan

Domain 6 Enforce public health laws and regulations Laws = regulation, executive orders, statutes, and other types of laws Process for reviewing public health laws Inform others when changes are needed Educating the public and others on the importance and interpretation of public health laws Enforcing public health laws Inspections Compliance Analysis of compliance

Domain 7 Promote strategies to improve access to healthcare services Assess health services and capacity Collaborative process Consider emerging issues in public health, the health care system, and health care reimbursement Identify populations with barriers Identify populations with barriers to health care and gaps in services Identify and implement strategies to improve access Implement strategies Culturally competent initiatives

Domain 8 Maintain a competent public health workforce Encourage development of sufficient number of qualified PH workers Partnerships with schools to promote public health Assure a competent workforce Workforce development plan and implement Competent workforce Professional and career development Supportive work environment

Domain 9 Evaluate and continuously improve processes, programs, and interventions Performance management system (overall approach to program evaluations) Engage all staff Performance management policy/system Implement - analysis of progress on achievement of goals, objectives and measures Customer satisfaction 2. Quality improvement processes QI plan QI activities based on plan

Domain 10 Contribute to and apply the evidence base of public health Use best practice available Evidenced-based and/or promising practice Foster innovation Communicate research and/or best and promising practices Protection of human subjects Expertise to consider implications of research

Domain 11 Maintain administrative and management capacity Operational infrastructure Policies and procedures Ethical decision making process Confidentiality Culturally and linguistically appropriate approaches and health equity HR system and policies and procedures Information management Facilities clean, safe, and accessible 2. Financial management Financial and programmatic oversight Written agreements Financial management system Seek resources

Operational definitions of roles, responsibilities and authorities Domain 12 Build a strong and effective relationship with governing entity Operational definitions of roles, responsibilities and authorities Inform governing entity about PH and HD Engage governing entity in HD’s responsibilities Communication