Public Health: What It Is and How It Works, Fourth Edition Chapter-by-Chapter Power Point Slides Links to Internet-based resources

Chapter 5 Core Functions and Public Health Practice

Chapter 5 Will Help You To: explain the "governmental presence in health" concept identify and describe public health's core functions and essential services discuss how public health core functions are operationalized in practice describe approaches to improving state-local public health systems

What Public Health Does: Then and Now

The Public Health System Community- Based Organizations Private Nonprofit Associations Other Public Sector Personal Health Services Industry Educational Institutions Official Agencies

Integrated Community Health System Voluntary Agencies Social Services Churches Nursing Facilities Home Health MDs Group Practices MCO Group Practices Hospitals Health Department MCOs Nursing Facilities Employers MCO Hospitals MCO MDs CHCs/MHCs Drug Treatment Mental Health

Public Health Functions before the IOM Report 1914: first review of state and local public health activities (Chapin and AMA) 1920-1970: APHA focuses on governmental public health infrastructure (Winslow, Emerson, etc.); emphasis on “Basic Six” Services 1950-1988: new challenges, health care safety net, “governmental presence in health”

Public Health Practice and Core Functions after the IOM Report IOM Report: nation has lost sight of its public health goals; found public health system in considerable “disarray” Healthy People 2000 APEX-PH Core Functions and Essential Public Health Services National Public Health Performance Standards

IOM’s Future of Public Health Public Health Mission “…assuring conditions in which people can be healthy.” Substance of Public Health “…organized community efforts aimed at the prevention of disease and the promotion of health.”

IOM’s Future of Public Health Governmental Role “The governmental public health agency has a vital function: to see to it that vital elements are in place and the the mission is being adequately addressed.” Core Functions of Public Health Assessment Policy Development Assurance

Translating Public Health Functions into Practice Assessment: What Should Be Done? Decisions based in values Policy Development: What Will Be Done? Decisions based on resources and priorities Assurance: How Can We Best Do It? Decisions based on scientific evidence

What Public Health Does Prevent epidemics and spread of disease Protect against environmental hazards Prevent injuries Promote and encourage healthy behaviors Respond to disasters and assist communities in recovery Assure the quality and accessibility of health services

How Public Health Works: Essential Services

Monitor Health Status Ongoing assessment of community health status Identification of threats to health Determination of health service needs Attention to special high risk populations Identification of community assets & resources Interpretation & communication Multisectoral information systems Well, what is entailed in each of these EPHS. Let’s take a look at them one by one and cite some examples from the practice world. Community Health Assessments (IPLAN, APEX, PATCH, MAPP, etc)…not just health planners, but nurses, environmental health, managers, inspectors and our community partners. Making data and information freely available on the Internet

Diagnose and Investigate Early identification of unusual event patterns Access to public health lab capabilities Active infectious disease and environmental surveillance activities Technical and human resource capacity for thorough investigation Case finding via reports and linking illnesses to environmental and community factors. Emerging infections, Resistant diseases, lab capability, cluster investigations (ID, cancer, suicide, etc) Car seats as contributor to childhood injuries……safe paths to schools programs.

Inform, Educate, Empower Community organization Social marketing and targeted communication Access to health information Collaboration with health care providers on health messages and programs Joint health education efforts with media, schools, churches, work sites, etc. Sex education in the schools People killing people----anti violence efforts Organize support groups for abused women

Mobilizing Partnerships Convening and facilitating partnerships Undertaking defined health improvement planning efforts and projects Building coalitions to draw upon the full range of potential human and material resources to improve community health Patterning with business to assure employee health Partnering with hospitals on community health improvment

Develop Policies and Plans Leadership development at all levels Systematic community-wide planning for health improvement Developing & tracking goals and objectives Joint evaluation with medical care system Development of policy and legislation to achieve public health goals Working within communities to reduce tobacco use Finding creative ways to break language barriers Improving disaster planning

Enforcing Laws & Regulations Enforcement of sanitary codes Protection of drinking water supplies Enforcement of clean air standards Animal control Follow-up of hazard investigations Monitor quality of medical care Review of new drugs, biologics & devices New Immunization Requirements Isolating and treating communicable diseases

Link to & Assure Care Assurance of effective access and entry Culturally appropriate materials and staff Ongoing care management Transportation services Targeted outreach & education for special populations Providing prenatal care and instruction Supporting private health care providers

Assure Competent Workforce Education, training, assessment of personnel Efficient processes for licensure & credentialing Lifelong learning models Active partnerships with professional training programs Continuing education for management and leadership development Not just academics…. Assure quality care through education partnerships Continuing education through distance learning

Evaluate Effectiveness, Accessibility and Quality Assessing program effectiveness Understanding why interventions work or don’t work in a specific setting Providing information necessary for allocating resources and reshaping programs Monitoring of care at state level Developing QI initiatives

Research and Innovation Participation in and support for full continuum of innovation Ongoing linkage with institutions of higher learning Internal capacity to mount timely epidemiologic & economic analyses and conduct health services research Instituting new programs Reducing mortality through screening

Basis for Public Health Practice EPHS… Linked to the core functions Cyclical and continuous processes Managed at the systems level Enhanced through active research Organizing framework for individual and collective practice In sum, the essential public heath services framework has become the foundation and basis for public health practice. This framework is closely linked to, if not derived from, the core functions of public articulated by the IOM Report in 1988, it represents as series of related and interrelated activities that are best carried out in a continuous and cyclical pattern. It allows for organization of and management of public health practice at a system as well as a program level, and it is enhanced through application of active research and inquiry. In sum the EPHS formulation is the organizing framework for public health today in terms of our individual and collective practice needs. It represents a real opportunity to improve public health practice and to assure that we include both the right notes and the proper intervals between the notes in our public health symphony.

21st Century Community Public Health Practice Community health needs assessments Asset mapping Community health improvement models and initiatives APEXPH evolves into MAPP

Unique Features of Public Health: Common Bond

It’s about communities….

Core Function Performance Performance assessment tools and instruments Healthy People 2000 Objective 8.14: 90% of population to be served by LHD effectively carrying out public health’s core functions Assessments find serious gaps in meeting national targets

Discussion Review the organization of health responsibilities in Illinois (or another state of your choice) and then describe how the essential public health services are delegated and carried out among various offices and agencies of state government (not just by the state health department) in that state. You can access the State of Illinois web site directly or through the site for the Illinois Department of Public Health. (For other states, the official state web site is usually "http://www.state.stateinitials.us"....for Illinois this would be http://www.state.il.us).

Discussion You are the new administrator at your local health department and the recently elected county board president has directed you to develop new health-related initiatives that will improve the health of the county's residents. Briefly describe how would you approach this charge.

Discussion Summarize the Board of Health meeting that you recently attended. Identity the name of the Board of Health whose meeting you attended, the date, and authorities and roles that you attribute to that Board of Health based on what you observed at the meeting. Basically you will answering the question, "How does this Board of Health influence the health of the population within its jurisdiction?"

Additional Resources Healthy People 2010 Toolkit: A Field Guide to Health Planning. Public Health Foundation; 1999 Invisible Safety Net Video: Part 3--Core Functions University of Washington School of Public Health and Community Medicine, Northwest Center for Public Health Practice; 1994 Mobilizing for Action through Planning and Partnerships (MAPP). NACCHO, 2000 National Public Health Performance Standards Program. CDC Public Health Practice Program Office, 2000. Practice of Public Health. Turnock BJ. Chapter in Encyclopedia of Public Health by Breslow L, editor. New York NY; MacMillian; 2000 Public Health Functions Web Site. Public Health Functions Project The Past and Future of Public Health Practice. Fee E and Brown TM. AJPH 2000:909(5):690-691