Public Health Core Functions

LOUIS ROWITZ, PhD

DIRECTOR

Mid-America Regional Public Health Leadership Institute

Public Health

Response•Bioterrorism•Emerging infections•Other health status

Surveillance Laboratory

Practice

Epidemic

Investigations

Workforce Capacity & Competency

Information & Data Systems

Organizational Capacity

Essential Capabilities

Basic Infrastructure

Pyramid of Public Health System Preparedness

CORE FUNCTIONS:A PRACTITIONER AND AN AGENCY PERSPECTIVE

DIAGNOSIS ASSESSMENT

RULES OF PROFESSIONAL

PROTOCALS

POLICY DEVELOPMENT

TREATMENT ASSURANCE

ASSESSMENT IS…

All the activities involved in community diagnosis:

• Surveillance

• Needs assessment

• Analysis of cause of problems

ASSESSMENT IS…

• Collection and interpretation of data

• Case-finding

• Monitoring and forecasting trends

• Research and evaluation

ASSESSMENT DATA SOURCES:Personal Health Data:

• Vital statistics• Epidemiology• Health screening• Special disease or

population registries

• Laboratory test data• Hospital discharge

data• Research• Behavioral Risk

Factor Data

ASSESSMENT DATA SOURCES:Data about community concerns & resources:

• Health resource inventory

• Public forums• Polling

• Special methods- APEX, PH part 2,

PATCH, MAPP, etc

• Information from private & non-profit providers

• Research

Four MAPP Assessments

• Community themes and strengths assessment

Identifies issues that interest the community, perceptions about quality of life, and community assets

Four MAPP Assessments

• Local public health system assessment

Measures the capacity and performance of the local public health system-all organizations and entities that contribute to the public’s health

Four MAPP Assessments

• Community health status assessment

Assesses data about health status, quality of life, and risk factors in the community

Four MAPP Assessments

• Forces of change assessment

Identifies forces that are or will be affecting the community of the local public health system

ASSESSMENT DATA SOURCES:Methods of distribution of

findings:

• Annual vital statistics report

• Special projects report

• State health report

• Monographs• Fact sheets• Professional

publications• Media releases

ASSESSMENT DATA SOURCES:Data on the range & quality of

services:

• Selected treatment management review data

• Consumer complaint follow-up information

• Facility & professional licensure data

• Research

ASSESSMENT DATA SOURCES:Environmental Health Data:

• Sanitary survey

• Air & water monitoring

• Public reforms

• Facility inspections

• Laboratory test data

• Research

THE POLICY DEVELOPMENT PROCESS ENTAILS…

• Collaboration

• Decision-making about problems

• Choice of goals and steps to meet them

• Conflict resolution and negotiation

THE POLICY DEVELOPMENT PROCESS:

• Defines health needs• Sets priority health issues by analyzing the

outcome of assessment• Develops policies and plans to address the

most important health needs by setting goals & objectives with measurable objectives

• Develops alternative strategies for implementing plans

• Identifies necessary & available resources

THE POLICY DEVELOPMENT PROCESS USES:

• Scientific information

• Data from the assessment process

• Information from concerned citizens & providers

THE POLICY DEVELOPMENT PROCESS USES:

• Concepts of political & organizational feasibility

• Community values

• An open process, involving all private & public sectors by communicating, networking & building constituencies

THE ASSURANCE FUNCTION INVOLVES:

• Implementation of legislative mandates and statutory responsibilities

• Development of adequate responses to crises

• Support crucial services that have worked in the past

THE ASSURANCE FUNCTION INVOLVES:

• Regulation of services and products provided in both the public and private sectors

• Maintain accountability to the people by setting objectives and reporting on progress

THE ASSURANCE FUNCTION INVOLVES:

• Maintenance of a level of service needed to attain an intended impact or outcome that is achievable given the resources and techniques available

ASSURANCEThe Assurance function calls upon public health agencies to:

• Provide public health nursing services

• Provide environmental health services

• Encourage, purchase or provide additional population-based services

• Maintain emergency response capacity

ASSURANCEThe Assurance function calls upon public health agencies to:

• Administer quality assurance

• Help recruit & retain health care practitioners

• Maintain administrative capacity

THE TEN ORGANIZATIONAL PRACTICES OF PUBLIC HEALTH

Assessment 1. Assess the health needs of the community

2. Investigate the occurrence of health effects and health hazards in the community

3. Analyze the determinants of identified health needs

THE TEN ORGANIZATIONAL PRACTICES OF PUBLIC HEALTH

Policy

Development

4. Advocate for public health, build constituencies, and identify resources in the community

5. Set priorities among health needs

6. Develop plans and policies to address priority health needs

THE TEN ORGANIZATIONAL PRACTICES OF PUBLIC HEALTH

Assurance 7. Manage resources and develop organizational structure

8. Implement programs

9. Evaluate programs and provide quality assurance

10. Inform and educate the public

The capacity of the public health system is its ability to perform the core functions of assessment, policy development, and assurance on a continuous, consistent basis made possible by maintenance of the basic infrastructure of the public health system, including human, capital, and technology resources. The smooth running of the system requires the application of sound leadership skills at all levels of the public health system.

-Modified from the Washington State Public Improvement Plan, March 1994

Public Health in the U.S.

Vision:

Healthy People in Healthy Communities

Mission:Promote Physical and Mental Health and Prevent Disease,

Injury, and Disability

Public Health• Prevents epidemics and the spread of

disease• Protects against environmental hazards• Prevents injuries• Promotes and encourages healthy

behaviors• Responds to disasters and assists

communities in recovery• Assures the quality and accessibility of

health services

Essential Public Health Services

• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards in the community

• Inform, educate, and empower people about health issues

Essential Public Health Services

• 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

Essential Public Health Services• Link people with needed personal

health services and assure the provision of health care when otherwise unavailable

• Assure a competent public health and personal health care workforce

Essential Public Health Services• Evaluate effectiveness, accessibility,

and quality of personal and population-based health services

• Research for new insights and innovative solutions to health problems

Source. 1990 Centers for Disease Control and Prevention

Public Health: The foundation of a national health system

Public Health System Infrastructure•Human Resources Development (Training)

•Information Systems•Community Planning Systems

Secondary Medical Care

Primary Medical Care

Essential Population-Based Public Health Services

•Human Resources Development(Training)

•Information Systems

•Community Planning Systems

Tertiary Medical

Care

Capacity to Deliver Public Health Services

The Future