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

2. Chapter 5 Core Functions and Public Health Practice

3. 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

4. What Public Health Does: Then and Now

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

6. 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

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

8. 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

9. 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.”

10. 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

11. 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

13. 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

14. How Public Health Works: Essential Services

15. 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

16. 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.

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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.

26. 21st Century Community Public Health Practice
Community health needs assessments
Asset mapping
Community health improvement models and initiatives
APEXPH evolves into MAPP

27. Unique Features of Public Health:
Common Bond

28. It’s about communities….

29. 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

30. 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 " Illinois this would be

31. 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.

32. 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?"

33. 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):