Public Health: What It Is and How It Works, Fourth Edition

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Public HealthWhat It Is and How It Works,
Fourth Edition

• Chapter-by-Chapter Power Point Slides
• Links to Internet-based resources

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Chapter 5Core Functionsand Public Health
Practice
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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

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What Public Health Does Then and Now
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The Public Health System
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Integrated Community Health System
Group Practices
Hospitals
Health Department
MCOs
Nursing Facilities
MCO Hospitals
CHCs/MHCs
Drug Treatment
Mental Health
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Public Health Functionsbefore 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

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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

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IOMs 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.

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IOMs 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

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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

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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

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How Public Health Works Essential Services
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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

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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

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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.

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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

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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

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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

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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

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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

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Evaluate Effectiveness, Accessibility and Quality

• Assessing program effectiveness
• Understanding why interventions work or dont
  work in a specific setting
• Providing information necessary for allocating
  resources and reshaping programs

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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

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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

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21st Century CommunityPublic Health Practice

• Community health needs assessments
• Asset mapping
• Community health improvement models and
  initiatives
• APEXPH evolves into MAPP

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Unique Features of Public Health Common Bond
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Its about communities.
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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 healths core functions
• Assessments find serious gaps in meeting national
  targets

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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).

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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.

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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?"

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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 2000909(5)690-691