1. Accumulated experience in the application of essential public health functions

2. Understanding of the different settings
Public health practitioners are expected to be effective in different environments.
Effective public health practitioners have to work with many different partners and paradigms.
Who employs the public health professionals and what are their agendas?
What is the performance of essential public health functions?

3. Essential public health functions
“The indispensable set of actions, under the primary responsibility of the state, that are fundamental for achieving the goal of public health, which is to improve, promote, protect, and restore the health of the population through collective action.”
PAHO/WHO. Public Health in the Americas: Conceptual Renewal, Performance Assessment, and Bases for Action. Washington, DC: PAHO/WHO, 2002.
a set of fundamental actions that address determinants of health, maintain and protect population health through organized efforts of society.
Public health functions represent public goods, and in this respect governments would need to ensure the provision of essential functions, but would not necessarily have to implement and finance them.
They prevent and manage the major contributors to the burden of disease by using effective technical, legislative, administrative, and behaviour-modifying interventions, and thereby provide an approach for intersectoral action for health.
There are several models of PH functions, and services, which are regional or country specific.

4. Essential Public Health Functions
Models of PH Functions ....
Essential Public Health Functions
EPHF 1. Monitoring, evaluation, and analysis of health status
EPHF 2. Surveillance, research, and control of the risks and threats to public health
EPHF 3. Health promotion
EPHF 4. Social participation in health
EPHF 5. Development of policies and institutional capacity for public health planning
and management
EPHF 6. Strengthening of public health regulation and enforcement capacity
EPHF 7. Evaluation and promotion of equitable access to necessary health services
EPHF 8. Human resources development and training in public health
EPHF 9. Quality assurance in personal and population-based health services
EPHF 10. Research in public health
EPHF 11. Reduction of the impact of emergencies and disasters on health
PAHO/WHO, 2002
PAHO/WHO
WHO Western Pacific Region
USA UK
Canada
Australia
Other Countries
USA, 1988

5. USA (CDC), 1994 Essential PH Services
Monitor health status to identify community health problems.
Diagnose & investigate health problems & health hazards in the community.
Inform, educate, & empower people about health issues.
Mobilize community partnerships to identify & solve health problems.
Develop policies & plans that support individual & community health efforts.
Enforce laws & regulations that protect health & ensure safety.
Link people to needed personal health services & assure the provision of health care when otherwise unavailable.
Assure a competent public health & personal health workforce.
Evaluate effectiveness, accessibility, & quality of personal & population-based health services.
Research for new insights & innovative solutions to health problems.
USA, 1988

6. Australia, 2000 Public Health Core Functions
Assess, analyse & communicate population health needs & community expectations
Prevent & control communicable & noncommunicable diseases & injuries through risk factor reduction, education, screening, immunisation & other interventions
Promote & support healthy lifestyles & behaviours through action with individuals, families, communities & wider society
Promote, develop & support healthy public policy, including legislation, regulation & fiscal measures
Plan, fund, manage & evaluate health gain & capacity building programmes designed to achieve measurable improvements in health status, & to strengthen skills, competencies, systems & infrastructure
Strengthen communities & build social capital through consultation, participation & empowerment
Promote, develop, support & initiate actions which ensure safe & healthy environments
8Promote, develop & support healthy growth & development throughout all life stages
Promote, develop & support actions to improve the health status of Aboriginal & Torres Strait Islander people & other vulnerable groups

7. Canada, 2003 Essential Public Health Functions
Population health assessment;
Health surveillance;
Health promotion;
Disease and injury prevention;
Health protection.
National Working Group

8. Estonia, 2008 Essential Public Health Operations
surveillance and assessment of the population’s health and well-being;
identifying health problems and health hazards in the community;
health protection;
preparedness and planning of public health emergencies;
disease prevention;
health promotion;
evaluation of quality and effectiveness of personal and community health services;
leadership, governance and the initiation, development and planning of public health policy;
ensuring a competent public health workforce; and
public-health-related research.

9. WHO Europe, 2011 Essential Public Health Operations
Surveillance and assessment of the population’s health and well-being;
Identification of health problems and health hazards in the community;
Preparedness for and planning of public health emergencies;
Health protection services (environment, occup., food safety);
Disease prevention;
Health promotion;
Assurance of a competent public health and personal health care workforce;
Governance, financing and evaluation of quality and effectiveness of PHS;
Communication for PH; and
Health-related research.

10. Comparison of WHO-EURO’s Essential Public Health Operations, the Pacific Essential Public Health Functions, the CDC’s Essential Public Health Services and PAHO’s Essential Public Health Functions
The Tables 1 and 2 show the Essential Public Health Operations (EPHO’s) of WHO-EURO adopted at the WHO European Regional Committee 61 (Baku, Azerbaijan, September 2011) in the first column. Three other sets are included for comparison: The Western Pacific Essential Public Health Functions (WPHF), CDC’s Essential Public Health Services (EPHS’s) and the Essential Public Health Functions (EPHF’s) as published by PAHO,. For comparison with the EPHO’s the other 3 examples are rearranged to fit as far as possible with the EPHO’s, however the numbers of their original sequence are maintained. Similar sets of basic characteristics for improving the public health are missing especially for the African continent whereas the Pacific EPHF’s are based on a study of 3 countries only (Fiji, Malaysia, Vietnam). While the headline terminology differs in terms of Functions, Operations and Services as well as the total number of items, also the areas listed are not always analogous. However, all four sets start with health monitoring and continue with identification of priority health hazards in the community as the second item. For the 3rd EPHO only the EPHF’s of PAHO contain a corresponding function, interestingly at the end of their list as No. 11. Out of the subsequent EPHO’s 4, 5 and 6, i. e. Health Protection, Disease Prevention and Health Promotion only health promotion is covered by all four sets whereas Health Protection is not covered by PAHO and Prevention not by CDC. EPHO 7 on assuring a competent public health and personal health care workforce is taken wordily from the CDC set and amended by the word “Training” in the PAHO functions (No. 7). However, education and training as well as continued education in public health are extensively covered by the sub-objectives in appendix 1 to the EPHOs source document.

11. WFPHA Survey, 2012

12. Simple model of public health performance ?
PH employers
SDPHs
PH professionals
Performance of EPHFs

13. Searching for interfaces and synergies: … from Core PH Functions to Core Competencies, Teaching Curricula and PH Performance
EFFICIENT AND ACCOUNTABLE PERFORMANCE
COMPETENCY BASED EDUCATION AND TRANING
CORE PUBLIC HEALTH COMPETENCIES
CORE PUBLIC HEALTH FUNCTIONS

14. EPHF 1: Monitoring, evaluation, and analysis of health status
• Evaluating the country’s current health status, trends, and determinants, with a focus on identifying inequalities in risks, threats, and access to health services.
• Identifying the population’s health needs, which includes evaluating the health risks and assessing demand for services.
• Managing important statistics and the situation of high-risk and/or specific groups.
• Producing information pertinent to the evaluation of health services performance.
• Identifying resources from outside the sector that can improve health promotion and the quality of life.
• Developing technology and methods to manage, interpret, and communicate information to public health’s decision makers, external actors, suppliers, and citizens.
• Defining and developing agencies to evaluate the quality of the collected data.

15. UK. 2002, 2012 Standards for organisations with a public health function
LEVEL FOR ASSESSMENT AND IMPROVEMENT OF QUALITY OF THE PUBLIC HEALTH FUNCTION :
The individual public health practitioner
Departments of public health and other similar groups of public health professionals
Employing organisations
Partner organisations
CHECKLIST :
Effective health programmes in place
Explicit professional standards laid out
Risk management programme in place – including emergency plans
Critical incident reporting procedure in place
Complaints procedure set out
Performance appraisal system in place and recognised as the employing organisation's responsibility
CPD programme for all staff
Links forged with performance management
Regular departmental meetings to - review
procedures audit department’s work
develop annual work programmes/business plans
ensure adequate resources and infrastructure
Mechanisms in place to deal with poor performance
External appraisal (including peer review)
Induction of new staff
Health and safety policy

16. ASPHER Survey, 2011 – 2012 The Association of Schools of Public Health in the European Region
To enable ASPHER to contribute efficiently to the worldwide discussion on harmonising essential public health functions, core competencies, and performance standards

17. Current and desired level of EPHOs performance as determined by employers in comparison to the estimate of the training output by SDPHs
Not transferred, Low, Medium, Fairly high, Very high
The rays in the spider web indicate the ranks of the 5 point Likert Scale

18. Example from pilot: MoH department for planning and organization in Serbia EPHO 1: Surveillance of diseases and assessment of the population’s health

19. A principal recommendation is that governments need to ensure equitable access to essential EPHFs and that the delivery of EPHFs should be tailored to different national and local circumstances.
Bettcher DW, Sapirie S, Goon EH.
Essential public health functions: results of the international Delphi study. World Health Stat Q. 1998; 51:44–54.

20. Group Work: Essential Public Health Functions

21. Individual and Group Work
Please consider the following dimensions:
Population health
Public Health systems development
Public Health Workforce
The Public Health labour market
The most important stakeholders
The role of NGOs community
Other aspects
Attitudes Values
Experience
Knowledge
Skills

22. Group Work
Aims:
to list the benefits and disadvantages of adopting a framework of essential public health functions
to discuss the feasibility of creating a global framework of essential public health functions
to discuss how to move forward with developing a global framework

23. Group Work
Questions:
Is there a need for a framework of public health functions that would define and measure any endeavor in public health?
Based on the groups’ experience and opinions, what are the benefits and disadvantages of defining and implementing essential public health functions at a national or regional level?
Do the members of the group agree on the need for, and feasibility of, developing a global set of public health functions? Why, or why not?
If yes, how would the group suggest moving forward with the development of a global framework? What do they see as the challenges?