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  • What is public health?

  • Who is the typical public health professional?

  • What are the Ten Essential Public Health Services?

  • Why is it important to implement and monitor the Ten Essential Public Health Services?

  • How are the Ten Essential Services used in community practice?

  • Inspiring, real world examples of the Ten Essential Public Health Services

Before you read this section's infomation about the Ten Essential Services, we invite you to take a quiz. Answers are provided at the bottom of this page. See how well YOU do!

As you read the front page of the local paper, you notice an alarming article about an outbreak of “disease X” in your community. You read on to learn about the scientifically established cause of “disease X”, and precautionary measures for avoiding exposure.

This valuable information was published as a front-page story because:

  • The local football team lost its game last night
  • The front-page columnist is on vacation
  • State and local health officials and their staff have worked for weeks to gather data, conduct laboratory and statistical tests, generate hypotheses, and collaborate with the media to alert and educate the public about “disease X” as effectively as possible.

On your way into the local grocery store, you notice a flier advertising a toll-free hotline number for enrolling uninsured children in a federally funded health insurance program.

This insurance program is being offered because:

  • The federal government has a budget surplus and is looking for a way to spend it
  • A leading telephone company offered the state health department a great deal on 1-800 numbers
  • Public health professionals have documented the numbers of uninsured children in their states, and worked with federal and state policymakers to institute outreach and “wrap around services” that assure the universal provision of health care.

While shopping in the local mall, you come across a group of nurses offering free blood pressure and cholesterol screenings.

The nurses are offering these screenings because:

  • They need to moonlight
  • They enjoy people watching at the mall
  • They are public health nurses dedicated to community health promotion, including the prevention of heart disease

You and your sweetheart share a romantic dinner at your favorite restaurant. Not only is the meal delicious – you do not get food poisoning!

This enjoyable experience has been brought to you by:

  • The restaurant management
  • Your local health department
  • A joint effort of the restaurant management and your local health department

In an urban area, prevalent liquor stores are slowly being replaced by grocery stores. The mass transit system has been re-routed to guarantee store access to urban residents without vehicles.

This change in the community’s planning and development is probably a result of:

  • The Department of Transportation needing to increase revenue
  • The liquor storeowners deciding that they weren’t doing enough business and moving elsewhere.
  • A collaborative effort of citizens, public health professionals, city planners, and local government officials who share

the common goal of preventing substance abuse and alcoholism among members of their urban community.

Answers: 1. c; 2. c; 3. c; 4. c; 5. c

What, besides the same answer, do the quiz scenarios above have in common? They are real life, everyday examples of some of the Ten Essential Public Health Services that public health professionals strive to deliver in the counties and states that they serve.

This Tool Box section will teach you what the Ten Essential Public Health Services are, and illustrate the function of those Services in public health. When you have completed the tool, you will be able to identify under which Essential Service public health activities in your community are implemented. More importantly, we hope that you will understand how the synergy of efforts within all ten Essential Service areas can contribute to the health of your community’s populations.

To help you get started with identifying how the Ten Essential Public Health Services are reflected in day-to-day public health activities, Table 1 below matches five of the Ten Essential Public Health Services with their corresponding quiz scenarios.

Table 1: Examples of How Essential Services Are Reflected in Day-to-Day Public Health Activities

Quiz Scenario
Essential Public Health Service Implemented
Informing the public about an epidemiological outbreak investigation in the community
“Diagnose and investigate health problems and health hazards in the community”
Promoting enrollment in a federally subsidized health insurance program
“Link people to needed personal health services and assure the provision of health care when otherwise unavailable”
Health education and health promotion to prevent heart disease
“Inform, educate, and empower people about health issues”
Maintenance of a sanitary restaurant environment for public well-being
“Enforce laws and regulations that protect health and ensure safety”
Shaping health policy, city planning, and transportation routes to create an environment that fosters positive health behavior
“Develop policies and plans that support individual and community health efforts”

We hope that you want to read on and learn more. But before we discuss each of the Essential Services, we will visit the broader concept of defining the purpose and function of public health.

What is public health?

As you probably concluded from the quiz scenarios, public health is everywhere – it is a part of the infrastructure that keeps our communities safe and healthy.

Depending on which resource you read, you will find varying definitions of the mission of public health.  However, the most current and widely accepted mission definition is:

“Promote physical and mental health, and prevent disease, injury, and disability.”

Public health services may go unnoticed within a community because they are often (but not always) preventive versus reactive.  For example, which community service are you more likely to notice - an environmental health specialist inspecting the safety of a local university’s food service establishments, or a fire truck speeding down the street with its lights and sirens on?

Despite having a relatively ‘low profile’ status, public health services play a key role in assuring the health and well being of communities.  Throughout the 1900s, the average lifespan of persons in the United States increased by more than 30 years.  According to an article by Bunker, Frazier, and Mosteller (1994), 25 years of this are attributable to advances in public health.

Who is the typical public health professional?

There really is no “typical” public health professional. The public health workforce in the United States consists of approximately 500,000 individuals with diverse professional training and experience.

  • Some are nurses, physicians, or laboratory technicians by training.
  • Some are educators, nutritionists, or social workers by training.
  • Some are biostatisticians or epidemiologists.
  • Others are economists or lawyers.
  • Community-based or “grassroots” workers might include concerned parents, grandparents, or civic leaders who volunteer their time.

How do all of these people with a unified purpose but different skills work together successfully to carry out the mission of public health? They have a logic model to consult: the Ten Essential Services of Public Health.

The Ten Essential Services of Public Health differ in some ways from other logic models presented in Chapter 2 of the Tool Box.  Other logic models discussed incorporate prescribed processes (e.g., from planning to implementation to evaluation) diagrammed in a flow chart that can then be applied to one priority goal like teen pregnancy prevention. In contrast, there is no prescribed order of implementation for the Ten Essential Services—no flow chart, and no one specific outcome that results from implementing all ten Essential Services. Rather, the Ten Essential Services have the potential to create a comprehensive infrastructure that can provide a supportive context for any public health priority in a community.

Although the more prescriptive logic models may be narrow in scope once applied to one goal, they can also undertake a comprehensive approach within a community.  For example, a planning phase might involve stakeholders from non-public health sectors of the community, in an effort to foster the most supportive context for change. This is not unlike the impact of the Ten Essential Services.

You may be wondering,

“Why do people need a logic model for direction if they are already working towards the same mission?”

Because of their diverse backgrounds, some professionals have been trained to follow different paradigms (models) in their specialties.  One example is the “medical model” versus the “public health model.”  The most significant difference between the two models is that public health activities focus on entire populations, while clinical activities focus on individual patients.  Table 2 below summarizes key differences between the paradigms that are typically used to train clinical and public health professionals.

Table 2:  Public Health versus Medical Models of Professional Training

 

Public Health Model

Medical Model

Primary focus on population

Primary focus on the individual

Public service ethic, tempered by concerns for the individual

Personal service ethic, conditioned by awareness of social responsibilities

Emphasis on prevention and health promotion for the whole community

Emphasis on diagnosis, treatment, and care for the whole patient

Paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care

Paradigm places predominant emphasis on medical care

The Ten Essential Public Health Services provide a common ground for professionals trained in either paradigm, as well as grassroots workers and non-public health civic leaders, so they can work collaboratively towards fulfilling the public health mission:

“To promote physical and mental health, and prevent disease, injury, and disability.”

Now that you have a better understanding of public health, let’s talk about the origin, purpose, and function of the Ten Essential Public Health Services.

What are the Ten Essential Public Health Services?

From 1988 to the early 1990s, the recognized “core functions” of public health were:

  • Assessment
  • Policy development
  • Assurance

In 1993, with a new presidential administration and federal and state attempts to reform the health care system in the United States, public health leaders decided to set forth a more detailed and utilitarian consensus statement that would “speak with one voice” to public health professionals, the general population, and the policymakers who would shape health care reform.

Public health leaders worked to define a more detailed logic model of core public health functions.  The end result was a consensus statement that included the Ten Essential Public Health Services, adopted in 1994.

Why is it important to implement and monitor the Ten Essential Public Health Services?

  • The Ten Essential Public Health Services are really about actualizing the public health paradigm that we presented in Table 2.  Let’s review the key principles involved:
  • A primary focus on the population
  • A public service ethic, tempered by concerns for the individual
  • An emphasis on prevention and health promotion for the whole community
  • The paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care

The theme of prevention is the most powerful element in the implementation of the Ten Essential Public Health Services.

  • Through prevention, countless injuries, illnesses, and even chronic diseases can be avoided.
  • Through prevention, lives can be saved.
  • Through prevention, health care cost can be contained.
  • Through prevention, individuals, their families, and their communities can benefit from the population-based reach of the Ten Essential Public Health Services.

It is important to not only implement but also monitor—or track, assess, and modify, as needed—the Ten Essential Public Health Services.  With data or other information about the Services’ costs or expenditures, implementation, and impact, monitoring can contribute to informed policy decisions about public health program development and funding at local, state, and national levels.

How are the Ten Essential Services used in community practice?

On the pages that follow, each Essential Service is discussed in order from 1 to 10.  Each discussion includes a definition of the Service and some examples of national or community practice.  Keep in mind that the Services do not necessarily need to be implemented in the “1 – 10” sequence, or even independently.

The Ten Essential Services are independent yet complementary goals for communities to work toward.  You should actually strive to implement the services simultaneously in your community as a means of carrying out the mission of public health.  However, you may find that you identify with only one or two in terms of your role in your community’s public health initiatives as you read through this section.

Essential Service #1Monitor health status to identify community health problems.

Public health surveillance—the ongoing, systematic collection, analysis, and interpretation of health related data—is at the core of this Essential Service.

Essential Service #1 encompasses public health activities such as:

  • Identification of threats to health and assessment of health service needs;
  • Timely collection, analysis, and publication of information on access, utilization, costs, and outcomes of personal health services;
  • Attention to the vital statistics and health status of specific groups that are at higher risk than the total population; and
  • Collaboration to manage integrated information systems with private providers and health benefit plans.

National level, population-based surveillance systems administered by the Centers for Disease Control and Prevention (CDC) include:

  • The Behavioral Risk Factor Surveillance System;
  • National Vital Statistics System;
  • National Health Interview Survey; and
  • Cancer registries;

You can access CDC data electronically at the Centers for Disease Control and Prevention website. You may not immediately think to use national level data when working at the community level.  However, national level surveillance data can provide trend data to use as a benchmark as you assess health status measures (e.g., the number of children immunized prior to entering preschool) in your community. Prior to investing resources and time in a program, it is often necessary to conduct a needs assessment.  Community data collected via a needs assessment can be compared to existing data at the national level.  If you discover that your community actually has an excellent rate for a health status measure as compared to 75% of the states in the country, you may shift your prevention program priorities to a different measure or target population!

If you do not have the time or resources to conduct your own needs assessment, you can search for community level data in resources including:

  • State-level ‘report cards’ on maternal and child health indicators (see the federal Title V Information System with data for all U.S. states and territories).
  • School health reports; and
  • Law enforcement agency surveillance, such as the number of DUI arrests

Essential Service #2Diagnose and investigate health problems and health hazards in the community.

Essential Service #2 encompasses public health activities such as:

  • Epidemiologic identification of emerging health threats;
  • Public health laboratory capability using modern technology to conduct rapid screening and high volume testing;
  • Active infectious disease epidemiology programs; and
  • Technical capacity for epidemiologic investigation of disease outbreaks and patterns of chronic disease and injury.

At the national level, the United States Department of Health and Human Services oversees the Agency for Toxic Substances and Disease Registry (ATSDR).  The Agency’s overall function is to “serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances.”

Via grants and cooperative agreements, ATSDR provides funding and technical assistance for states to identify and evaluate environmental health threats to communities, as well as educate the communities about health risk or other findings.

At the local level, public health laboratories provide diagnostic testing, disease surveillance, applied research, laboratory training and other essential services to the communities they serve.  Laboratory work is diverse, yet accomplished by highly trained and skilled professionals.

Public health laboratory professionals and epidemiologists are the ones working behind the scenes on the issues that you hear about in the news.  These include:  newborn screening; Lyme disease; West Nile virus; food borne illness outbreak investigations; and bio-terrorism threats. The Association of Public Health Laboratories was founded by state and territorial public health laboratory directors serving communities across the United States.  You may want to visit this web site to learn more about the public health laboratory expertise and services available in your own community.

Essential Service #3Inform, educate, and empower people about health issues.

You have probably come across—and even participated in— health promotion and social marketing efforts in your community.

Essential Service #3 encompasses public health activities such as:

  • Social marketing and targeted media public communication (e.g., Toll-free information lines);
  • Providing accessible health information resources at community levels (e.g., free, mobile health screening initiatives);
  • Active collaboration with personal health care providers to reinforce health promotion messages and programs; and
  • Joint health education programs with schools, churches, and worksites (e.g., stress reduction seminars; parenting support groups for enhancing mental health; and health fairs).

You may have noticed national media campaign advertisements on television, billboards, or even posters or fliers in your doctor’s office.  Some examples include the “Back to Sleep” campaign to prevent Sudden Infant Death Syndrome, or the anti-substance abuse campaign, “Just Say No.”

Many national awareness weeks also relate directly to public health efforts.  The American Public Health Association, headquartered in Washington, D.C., actually sponsors a “National Public Health Week” each spring.  You can find additional information, and links to free tools and resources for National Public Health Week.  You may decide to sponsor an event such as a fun run or health fair to raise public health awareness in your own community!

Essential Service #4Mobilize community partnerships to identify and solve health problems.

These activities represent a comprehensive approach to community health, in which professionals and even entire sectors of a community collaborate to plan, implement, monitor, evaluate, and subsequently modify activities, and repeat the process as needed.

Essential Service #4 encompasses public health activities such as:

  • Convening and facilitating community groups and associations, including those not typically considered to be health-related, to undertake defined preventive, screening, rehabilitation, and support programs; and
  • Skilled coalition-building ability in order to draw upon the full range of potential human and material resources in the cause of community health.

This is not unlike the PATCH logic model – the Planned Approach to Community Health

Included in the PATCH strategy are five elements that are fundamental to the success of any community health promotion process:

  • Community members participate in the process.
  • Data guide the development of programs.
  • Participants develop a comprehensive health promotion strategy.
  • Evaluation emphasizes feedback and program improvement.
  • The community capacity for health promotion is increased.

You can read about a similar process for mobilizing community partnerships to identify and solve health problems in the Community Tool Box's Community Action Guide: A Framework for Addressing Community Goals and Problems.

The overall goal of action planning is to increase your community’s ability to work together to affect conditions and outcomes that matter to its residents—and to do so both over time and across issues of interest.

As your community works towards a broad vision of health for all, creating supportive conditions for change requires comprehensive efforts among diverse sectors of the community.  These include health organizations, faith communities, schools, and businesses.  Representatives of each sector come together to form a community coalition.  Your community coalition can strive to influence systems changes—programs, policies, and practices that can enhance or detract from the community’s capacity to be a supportive environment for healthy living.

Essential Service #5 Develop policies and plans that support individual and community health efforts.

Because state and local public health programs are often funded at least in part with Federal dollars, accountability is often a key issue.  Public health programs therefore document progress towards positive change in health behavior or health status indicators.  For example, the Federal Maternal and Child Health Services Block Grant, which imposes a $3 state match for every $4, requires annual reporting of “performance measures.”  Some of those are state-negotiated to allow for flexibility in tracking health behavior or health status indicators that are unique to a state’s populations. Data such as these can be presented to policymakers to document the value or effectiveness of a program. Those data can also be used for continued program planning and modification.

Essential Service #5 encompasses public health activities such as:

  • Leadership development at all levels of public health;
  • Systematic community-level and state-level planning for health improvement in all jurisdictions;
  • Development and tracking of measurable health objectives as a part of continuous quality improvement strategies;
  • Joint evaluation with the medical health care system to define consistent policy regarding prevention and treatment services; and
  • Development of codes, regulations, and legislation to guide the practice of public health.

Active Living by Design is a national program of The Robert Wood Johnson Foundation, and is a part of the University of North Carolina at Chapel Hill School of Public Health.  The program establishes and evaluates innovative approaches to increase physical activity through community design, public policies, and communications strategies.  The program funds community partnerships to develop, implement and sustain collaboration among a variety of organizations in public health and other disciplines, such as city planning, transportation, architecture, recreation, crime prevention, traffic safety and education, and key advocacy groups.  Collaborators focus on land use, public transit, non-motorized travel, public spaces, parks, trails, and architectural practices that advance physical activity.

One example of an Active Living by Design initiative is:  “Obesity and The Built Environment:  Improving Public Health through Community Design.”  You can learn more about this and other initiatives by visiting Active Living by Design.

Essential Service #6 Enforce laws and regulations that protect health and ensure safety.

While you may not always be conscious of how public health regulations have influenced your community environment, think about some of the things that you see or experience when you visit restaurants.  You may have noticed a framed certificate hanging on the wall, with “Sanitation Grade A.”  This certificate is a result of local health department inspections to assure that the restaurant is in compliance with food storage, handling, and preparation regulations.

While at that same restaurant, you may also notice a sign that says, “No smoking.”  This may be a direct result of a statewide law that was designed to improve the environmental health conditions in your community.

If you have school-aged children and have had to prepare them for entrance into the public school system, you know that the full series of immunizations is required.  Immunizations are required for school-aged children in the United States because when widespread immunizations are in place, we all benefit from what is referred to as “herd immunity.”  When a group of people (e.g., an entire community, state, or nation) is immunized against an infectious disease, it makes it more difficult for the disease to spread and cause an epidemic.

Essential Service #6 encompasses public health activities such as:

  • Full enforcement of sanitary codes, especially in the food industry;
  • Full protection of drinking water supplies;
  • Enforcement of clean air standards;
  • Timely follow-up of hazards, preventable injuries, and exposure-related diseases identified in occupational and community settings;
  • Monitoring quality of medical services (e.g., laboratory, nursing homes, and home health care); and
  • Timely review of new drug, biologic, and medical device application.

Essential Service #6 may be implemented in your community as a result of either state or federal legislation.  Not only can you take on a leadership role in your community to assure that public health regulations are enforced; you can be a catalyst for change by identifying and prioritizing new issues, and sponsoring new regulations through public health advocacy.

Essential Service #7: Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

Essential Service #7 encompasses public health activities such as:

  • Assuring effective entry for socially disadvantaged people into a coordinated system of clinical care;
  • Culturally and linguistically appropriate materials and staff to assure linkage to services for special population groups;
  • Ongoing “care management;”
  • Transportation services;
  • Targeted health information to high risk population groups; and
  • Technical assistance for effective worksite health promotion/disease prevention programs.

The implementation of this Essential Service is inherently linked to the social, economic, and political climate in communities, states, and the nation.  To assure the provision of health care when it is otherwise unavailable, the United States federal government funds two “safety net” programs: Medicaid and the State Children’s Health Insurance Program (SCHIP).

Medicaid is the largest source of funding for medical and health-related services for people and families with low incomes and resources.  This program became law in 1965, and is jointly funded by the federal and state governments (including the District of Columbia and the Territories) to assist states in providing medical long-term care assistance to people who meet certain eligibility criteria.

The Balanced Budget Act of 1997 created a new children's health insurance program called the State Children's Health Insurance Program (SCHIP).  SCHIP is a state administered program, and each state sets its own guidelines regarding eligibility and services for children up to age 19 who are uninsured.  Families who earn too much to qualify for Medicaid may still be able to qualify for SCHIP.

To learn more about the Medicaid and SCHIP programs and how they can benefit members of your community, please visit: Centers for Medicare and Medicaid Services.

The availability of programs like Medicaid and SCHIP is not sufficient.  Public health professionals also have to provide outreach services to the populations in need of these programs.  Outreach might include:

  • Consumer education about the existence of a program;
  • Assistance with applying for a program;
  • Linking enrollees to related health programs (for example, pregnant women, infants, and children under the age of 5 enrolled in Medicaid also qualify for the Federal Supplemental Food Program for Women, Infants, and Children—WIC, and vice versa);
  • Physically transporting clients to the medical services that they need.

Culturally and linguistically appropriate materials are a critical component of outreach efforts in a country in which many immigrant languages are spoken.  Public health professionals can use decennial census data or community level needs assessments to determine how many and which languages are spoken in a geographic region.  To provide outreach and other services in a culturally competent manner, public health professionals can apply guidelines developed by the National Center for Cultural Competence.  The Center produces publications that teach people how to adapt health promotion materials already developed and written in English.

Essential Service #8Assure a competent public health and personal health care workforce.

Essential Service #8 encompasses public health activities such as:

  • Education and training for personnel to meet the needs for public and personal health service;
  • Efficient processes for licensure of professionals and certification of facilities with regular verification and inspection follow-up;
  • Adoption of continuous quality improvement and life-long learning within all licensure and certification programs;
  • Active partnerships with professional training programs to assure community-relevant learning experiences for all students; and
  • Continuing education in management and leadership development programs for those charged with administrative / executive roles.

There are many opportunities for certified education, training, and continuing education in public health. The Association of Schools of Public Health is a membership organization of the 27 accredited schools of public health that prepare people for a public health profession. The accrediting body, an independent agency recognized by the United States Department of Education, is the Council on Education for Public Health.

Continuing education opportunities abound at professional conferences and in professional journals.  Furthermore, the advent of the Internet has brought new access to continuing education through the availability of online certificate and other training programs.  These distance-based programs—particularly the ones offered through accredited schools of public health—offer an invaluable alternative to the sometimes-prohibitive costs and time commitment of travel for state and local public health professionals.

The Centers for Disease Control and Prevention sponsors many training and continuing education opportunities on site and in the accredited schools of public health across the country.  One example is Academic Centers for Public Health Preparedness (A-CPHP). These centers work together to improve the capacity of the front line public health and health care workers to quickly respond to bioterrorism, infectious disease outbreaks, and other public health threats and emergencies.The network of Centers represents a unique partnership between the schools of public health, the Association of Schools of Public Health, the Centers for Disease Control and Prevention, and representatives from state and local public health agencies, and the Association of State and Territorial Health Officials (ASTHO) and National Association of County and City Health Officials (NACCHO).

Other programs meet the education and training needs of rising public health professionals while simultaneously enhancing workforce capacity in the field.  One example is the Federal Maternal and Child Health Bureau’s Graduate Student Internship Program, which places Maternal and Child Health graduate students in state health departments for summer internships via a competitive process for both health departments and students.

Essential Service #9Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

Evaluation helps public health professionals continually refine or revise program approaches in future years of funding.  Furthermore, evaluation data provide information about the relative costs and effort for tasks so activity and budget adjustments can be made.

Essential Service #9 encompasses public health activities such as:

  • Ongoing evaluation of health programs based on analysis of health status and service utilization data, to assess program effectiveness and to provide information necessary for allocating resources and reshaping programs.

The process of evaluation helps public health professionals and their collaborators assess the success of community health initiatives. Evaluation normally requires that data be collected and analyzed.  Surveillance data from Essential Service #1 can be used for this purpose. For example, because surveillance efforts are often (but not always) annual, your community could access retrospective and current or “baseline” data before planning a public health initiative.This baseline data could then also be used to document the health behavior or health status outcome measure(s) of interest both before and after implementation of the initiative.

Evaluation plans and concepts are addressed in several chapters and sections of the Community Tool Box. These include:

Chapter 36-39, all of which fall under the broad topic,“Evaluating Community Programs and Initiatives”

Writing a Grant

Essential Service #10Research for new insights and innovative solutions to health problems.

In order to implement the 10th Essential Service, state and local health department staff might carry out health services research via many different efforts including:

  • Continuous linkage with appropriate institutes of higher learning and research;
  • An internal capacity to mount timely epidemiologic (e.g., outbreak investigations) and economic analyses (e.g., cost-benefit studies); and
  • An internal capacity to conduct needed health services research (e.g., survey design; conducting interviews and facilitating focus groups; conducting clinical trials; and accessing and using public records).

This list of research activities further illustrates the need for skills-specific training and education prescribed in Essential Service number 8. For example, anyone can create a survey and interview a group of people.  However, there are prescribed methods for creating an “instrument” that collects information that can be summarized into a coherent and even statistically significant conclusion about a population of interest.  Local health department staff may have had formal academic or on-the-job training in questionnaire design, survey methodology, or biostatistics.  Some staff may even be “specialists” who can be called upon to complete complex data analyses for research purposes. However, both generalists and specialists in the local health departments contribute to the base of knowledge and experience that are critical to maintaining an internal capacity to conduct needed health services research.

Even when local health department staff have adequate training, a strain on staffing capacity or limited resources may prompt collaboration with other “specialists.”  Within the public health community, it is not difficult to find examples of health departments working with neighboring universities to conduct research and identify solutions. One example is the Association of Schools of Public Health’s Academic Health Departments (AHD) grant program.  The AHD program fosters collaboration among local health departments across the country and 14 neighboring universities that house accredited schools of public health.  The exchange of student and other resources can enhance the capacity of local health agencies to function as “learning organizations,” thereby enhancing the success of community health efforts.

Another example of linkages with institutes of higher learning is the Council on Linkages Between Academia and Public Health Practice. Housed within the non-profit Public Health Foundation in Washington, D.C., the Council has a mission to “Improve public health practice and education by fostering, coordinating, and monitoring links between academia and the public health and healthcare community, developing and advancing innovative strategies to build and strengthen public health infrastructure, and creating a process for continuing public health education throughout one’s career.”

Research for new insights and innovative solutions to health problems can be accomplished many different ways. One way is via economic analyses to assess the “cost benefit” or the “cost effectiveness” of a program.

A cost-benefit evaluation assesses only one program, and focuses on the cost-to-outcome ratio, with the “outcome” having a dollar amount attached to it.  Example:  For a program that invests in prevention, the amount spent per client on prevention would be compared to the amount saved in averted health care costs per client (e.g., “For every $2 that we spend on diabetes management education, we save $4 in hospitalization costs.”).

A cost-effectiveness analysis can be used with one or multiple programs with the same objectives, to relate the cost of a program approach to specific measures of a program’s objectives.  Those measures may or may not have a monetary value attached to them (e.g., an outcome measure for an education program may be standardized test scores).

Inspiring, real world examples of the Ten Essential Public Health Services

The North Carolina Institute for Public Health at the University of North Carolina, Chapel Hill produced a series of CDC-funded Grand Rounds videos for public health professionals across the country.  One video was entitled, “The Ten Essential Public Health Services.” In this 12-minute selection, ten dedicated public health officials across the country tell their stories about initiatives in their states and communities.

We hope you have a few minutes more to explore the video.  If you do not have time, we hope that this section of the Tool Box has provided you with a clear understanding of the purpose and value of the Ten Essential Public Health Services.  You are now armed with the knowledge to translate the Services’ goals into practice within your community!

“The Ten Essential Public Health Services” video contents:

Interview with Lillian Shirley, RN, MPH, MPA, and Executive Director of the Multnomah County Health Department, about her experience with the implementation of Essential Service #1 in her county.
Specific topic discussed:  Needing data to back up her approach to policies that support exercise promotion within the community.

Interview with Ken Dahl, Commissioner of Health in the city of Minneapolis, about his experience with the implementation of Essential Service #2.
Specific topic discussed:  Public health laboratory surveillance at the local level.

Interview with John M. Auerbach, MBA, and Executive Director of the Boston Public Health Commission, about his experience with the implementation of Essential Service #3.
Specific topic discussed:  Using hotlines at the state or local level; this one was for allaying fears about West Nile virus.

Interview with Susan M. Allan, MD, JD, MPH, and Director of the Arlington County Department of Human Services, about her experience with the implementation of Essential Service #4 in her community.
Specific topic discussed:  Post-9/11 (2001) in Northern Virginia, and the team work of public health staff as they confronted mass hysteria over several months; training to date had prepared staff to deal with similar situations for only several days.

Interview with Fernando A. Guerra, MD, MPH, and Director of Health for the San Antonio Metropolitan Health District, about his experience with the implementation of Essential Service #5.
Specific topic discussed:  Community-wide obesity prevention within cultural norms.

Interview with Sherri McDonald, RN, MPA, Director of the Thurston County Public Health and Social Services Department, about her experience with the implementation of Essential Service #6.
Specific topic discussed:  The Health Insurance Portability and Accountability Act (HIPAA).

Interview with Nancy Humbert, MSN, ARNP, and Acting Administrator of the Miami-Dade County Health Department, about her experience with the implementation of Essential Service #7.
Specific topic discussed:  Outreach and education, and assuring a medical home.

Interview with Jody Henry Hershey, MD, MPH, and Director of the New River Health District, about his experience with the implementation of Essential Service #8 in his community.
Specific topic discussed:  The need for adequate access to Internet Technology and related resources before on the job training can even take place.

Interview with Jean Marie Malecki, MD, MPH, FACPM, and Director of the Palm Beach County Health Department, about her experience with the implementation of Essential Service #9.
Specific topic discussed:  Leadership theory, and monitoring and modifying systems “for the best interests of the community.”

Interview with Eduardo J. Sanchez, MD, MPH, and Commissioner of the Texas Department of Health, about his experience with the implementation of Essential Service #10 in his state.
Specific topic discussed:  Health behavior change, specifically obesity prevention.

Print Resources

American Public Health Association (June 2003).  The Guide to Implementing Model Standards.  This resource includes discussion of PATCH implementation along with other model standards for community health development, such as the Assessment Protocol for Excellence in Public Health.

United States Department of Health and Human Services (1989). Making Health Communication Programs Work: A Planner’s Guide. Bethesda, MD: United States Department of Health and Human Services, Public Health Service, National Institutes of Health, Office of Cancer Communications, National Cancer Institute.

Wholey, J., Hatry, H., and Newcomer, K. (Eds.) (1994). Handbook of Practical Program Evaluation. San Francisco: Jossey-Bass.

The remaining nine links will take you to the web pages of organizations that served on the Public Health Functions Steering Committee, which adopted the Ten Essential Public Health Services in 1994.

Centers for Disease Control and Prevention (1999). Ten Great Public Health Achievements—United States, 1900 – 1999. Morbidity and Mortality Weekly Report, April 02, 1999: 48(12); 241-243.

Association of Schools of Public Health (2003). The Population Approach to Public Health.

Online Resources

American Public Health Association (2003).  The Essential Services of Public Health.

Association of Schools of Public Health (2003).  What is Public Health?

Centers for Disease Control and Prevention (2003).  Programs in Brief.

Public Health Foundation (2002).  Essential Public Health Services.

Guide for Enhancing Core Functions and Essential Services for Public Health Improvement

1. Monitor health status to identify community health problems.

2. Diagnose and investigate health problems and health hazards in the community.

3. Inform, educate, and empower people about health issues.

Our Model of Practice: Building Capacity for Community and System Change

Some Lessons Learned on Community Organization and Change

Communicating Information about Community Health and Development Issues

Talking About Risk and Protective Factors Related to Community Issues

Making Community Presentations

Developing a Plan for Communication

Preparing Press Releases

4. Develop policies and plans that support individual and community health efforts.

5. Enforce laws and regulations that protect health and ensure safety.

6. Mobilize community partnerships to identify and solve health problems.

7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

8. Assure a competent public health and personal health care work force.

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.