The Community Tool Box

Our Mission

Promoting community health and development by connecting people, ideas and resources

Table of Contents >
   Part A. Models for Promoting Community Health and Develop... >
      Chapter 2. Some Other Models for Promoting Community Health ... >
         Section 7. Ten Essential Public Health Services >
             Main Section - Introduction, what, why, when, who, and how. >

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!

1. 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:
        a. The local football team lost its game last night
        b. The front-page columnist is on vacation
        c. 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.
   
   
2. 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:
        a. The federal government has a budget surplus and is looking for a way to spend it
        b. A leading telephone company offered the state health department a great deal on
            1-800 numbers
        c. 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.
   
   
3. 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:
        a. They need to moonlight 
        b. They enjoy people watching at the mall
        c. They are public health nurses dedicated to community health promotion, including the prevention of heart disease
   
   
4. 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:
        a. The restaurant management
        b. Your local health department
        c. A joint effort of the restaurant management and your local health department
   
   
5. 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:
        a. The Department of Transportation needing to increase revenue
        b. The liquor storeowners deciding that they weren’t doing enough business and moving elsewhere.
        c. 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

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.

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

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; and
• 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:

The theme of prevention is the most powerful element in the implementation 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 #1:  Monitor 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.

Some 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 http://www.cdc.gov.  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:

Essential Service #2:  Diagnose 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 bioterrorism threats.  The Association of Public Health Laboratories (www.aphl.org) 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 #3:  Inform, 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:

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.  To learn more about National Public Health Week, please go to http://www.nphw.org/2007/home.htm.  Here you will find links to free tools and resources.  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 #4:  Mobilize 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:

This is not unlike the PATCH logic model – the Planned Approach to Community Health (See Chapter 2, Section 5 of the Community Tool Box). 

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

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

A similar process for mobilizing community partnerships to identify and solve health problems is Community Action Planning (See Chapter 1, Section 9 of the Community Tool Box). 

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 (see http://www.mchdata.net).  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:

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 initiative by visiting http://www.activelivingbydesign.org/.

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:

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:  http://cms.hhs.gov/. 

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:

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 (http://www.georgetown.edu/research/gucdc/nccc/).  The Center produces publications that teach people how to adapt health promotion materials already developed and written in English. 

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

Essential Service #8 encompasses public health activities such as:

There are many opportunities for certified education, training, and continuing education in public health.  The Association of Schools of Public Health (www.asph.org) 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 (www.ceph.org). 

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 (www.asph.org), the Centers for Disease Control and Prevention (www.cdc.gov), and representatives from state and local public health agencies, and the Association of State and Territorial Health Officials (ASTHO) (www.astho.org) and National Association of County and City Health Officials (NACCHO) (www.naccho.org). 

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 #9:  Evaluate 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:

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. 

Essential Service #10:  Research 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:

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 (http://www.phf.org/Link.htm).  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.  To view the video, please visit http://www.publichealthgrandrounds.unc.edu/misc_webcasts/10_ess_svcs.htm.

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! 

A summary of the video’s contents is provided below for your reference. 

“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.

References

American Public Health Association (June 2003).  The Guide to Implementing Model Standards. http://www.apha.org/ppp/science/theguide.htm.  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. 

American Public Health Association (2003).  The Essential Services of Public Health.  http://www.apha.org/ppp/science/10ES.htm.

Association of Schools of Public Health (2003).  The Population Approach to Public Health.  http://www.asph.org/document.cfm?page=724.

Association of Schools of Public Health (2003).  What is Public Health?  http://www.asph.org/document.cfm?page=300.

Centers for Disease Control and Prevention (2003).  Programs in Brief.  http://www.cdc.gov/programs.

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.

Public Health Foundation (2002).  Essential Public Health Services.  http://www.phf.org/essential.htm

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. 

1. American Public Health Association (www.apha.org)
2. Association of Schools of Public Health (www.asph.org)
3. Association of State and Territorial Health Officials (www.astho.org)
4. Environmental Council of the States (www.sso.org/ecos)
5. National Association of County and City Health Officials (www.naccho.org)
6. National Association of State Alcohol and Drug Abuse Directors (www.nasadad.org)
7. National Association of State Mental Health Program Directors (www.nasmhpd.org)
8. Public Health Foundation (www.phf.org)
9. United States Public Health Service (www.usphs.gov)

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

1. Monitor health status to identify community health problems.

Chapter 3, Section 1:  Developing a Plan for Identifying Local Needs and Resources       

Chapter 3, Section 2:  Understanding and Describing the Community

Chapter 3, Section 3:  Conducting Public Forums and Listening Sessions 

Chapter 3, Section 4:  Collecting Information About the Problem

Chapter 3, Section 5:  Analyzing Community Problems

Chapter 3, Section 6:  Conducting Focus Groups

Chapter 3, Section 7:  Conducting Needs Assessment Surveys

Chapter 3, Section 8:  Identifying Community Assets and Resources

Chapter 3, Section 9:  Developing Baseline Measures of Behavior

Chapter 3, Section 10:  Conducting Concerns Surveys

Chapter 3, Section 11:  Determining Service Utilization

Chapter 3, Section 12:  Conducting Interview

Chapter 3, Section 13:  Conducting Surveys

Toolkit: Assessing Community Needs and Resources

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

Chapter 3, Section 4:  Collecting Information About the Problem

Chapter 3, Section 5:  Section 3: Analyzing Community Problems

Chapter 3, Section 12:  Conducting Interviews

Chapter 17, Section 1:  An Introduction to the Problem Solving Process

Chapter 17, Section 3:  Defining and Analyzing the Problem

Chapter 17, Section 4:  Analyzing Root Causes of Problems: The "But Why?" Technique

Chapter 18, Section 1:  Designing Community Interventions

Chapter 18, Section 3:  Identifying Targets and Agents of Change: Who Can Benefit and Who Can Help

Chapter 19, Section 2:  Understanding Risk and Protective Factors: A First Step for Planning Community Health and Development Initiatives

Chapter 19, Section 3:  Identifying Strategies and Tactics for Reducing Risk

Chapter 19, Section 4:  Adapting Community Interventions for Different Cultures and Communities         

Chapter 19, Section 5:  Ethical Issues in Community Interventions

Toolkit: Analyzing Problems and Goals

Toolkit: Developing an Intervention

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

Chapter 1, Section 3:  Our Model of Practice: Building Capacity for Community and Systems Change

Chapter 1, Section 4:  Troubleshooting Guide: Common Problems in Community Work and How to Address

Chapter 1, Section 8:  Some Lessons Learned on Community Organizations and Change

Chapter 4, Section 2:  Communicating Information about Health and Community Development Issues

Chapter 4, Section 4:  Talking About Risk and Protective Factors Related to Health Issues

Chapter 4, Section 5:  Making Community Presentations

Chapter 6, Section 1:  Developing a Plan for Communication

Chapter 6, Section 3:  Preparing Press Releases

Chapter 6, Section 4:  Arranging News and Feature Stories

Chapter 6, Section 6:  Preparing Guest Columns and Editorials

Chapter 6, Section 7:  Preparing Public Service Announcements

Chapter 6, Section 8:  Arranging a Press Conference

Chapter 6, Section 9:  Using Paid Advertising

Chapter 6, Section 10:  Creating Newsletters

Chapter 6, Section 11:  Creating Posters and Fliers

Chapter 6, Section 12:  Developing Creative Promotions

Chapter 6, Section 13:  Creating Brochures

Chapter 6, Section 14:  Handling Crises in Communication

Chapter 6, Section 15:  Creating Fact Sheets on Local Issues

Chapter 6, Section 16:  Creating a Web Site for Your Organization

Chapter 6, Section 17:  Using E-mail Lists

Chapter 6, Section 19:  Handling Crises in Communication

Chapter 32, Section 5:  Reframing the Debate

Chapter 45, Section 2:  Conducting a Social marketing Campaign

Toolkit: Implementing a Social Marketing Effort

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

Chapter 1, Section 3:  Our Model of Practice: Building Capacity for Community and Systems Change

Chapter 1, Section 5:  Our Evaluation Model: Evaluating Comprehensive Community Initiatives

Chapter 1, Section 7:  Working Together for Healthier Communities: A Framework for Collaboration Among Community Partnerships, Support Organizations, and Funders

Chapter 4, Section 1:  Developing a Plan for Communication Chapter

Chapter 5, Section 2:  Systems Advocacy and Community Organizing

Chapter 8, Section 1:  VMOSA (Vision, Mission, Objectives, Strategies, Action Plan): An Overview

Chapter 8, Section 2:  Proclaiming Your Dream: Developing Vision and Mission Statements

Chapter 8, Section 3:  Creating Objectives

Chapter 8, Section 4:  Developing Successful Strategies: Planning to Win

Chapter 8, Section 5:  Developing an Action Plan

Chapter 8, Section 6:  Obtaining Feedback from Constituents: What Changes Are Important and Feasible

Chapter 8, Section 7:  Identifying Action Steps in Bringing About Community and Systems Change

Chapter 9, Section 1:  Organizational Structure

Chapter 9, Section 4:  Developing an Ongoing Board of Directors

Chapter 9, Section 5:  Welcoming and Training New Members to a Board of Directors

Chapter 9, Section 6:  Maintaining a Board of Directors

Chapter 24, Section 3:  Promoting Coordination, Cooperative Agreements, and Collaborative Agreements Among Agencies

Chapter 25, Section 5:  Increasing Funding for Community Health and Development Initiatives

Chapter 46, Section 1:  Planning for the Institutionalization of an Initiative

Chapter 46, Section 2:  Strategies for Sustaining the Initiative

Chapter 46, Section 3:  Promoting Adoption of the Initiative's Mission and Objectives

Chapter 46, Section 4:  Attracting Support for Specific Programs

Chapter 46, Section 5:  Marketing the Initiative to Secure Financial Support

Toolkit: Developing Strategic and Action Plans

Toolkit: Sustaining the Work or Initiative

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

Chapter 30, Section 1:  Overview: Getting an Advocacy Campaign Off the Ground

Chapter 30, Section 2:  Survival Skills for Advocates

Chapter 30, Section 3:  Understanding the Issue

Chapter 30, Section 4:  Recognizing Allies

Chapter 30, Section 5:  Identifying Opponents

Chapter 30, Section 6:  Encouraging Involvement of Potential Opponents as well as Allies

Chapter 30, Section 7:  Developing a Plan for Advocacy

Chapter 33, Section 1:  Writing Letters to Elected Officials

Chapter 33, Section 2:  Reaching a Broad Audience Easily and Quickly: Writing Letters to the Editor

Chapter 33, Section 4:  Filing a Complaint

Chapter 33, Section 6:  Using Personal Testimony to Change Policies

Chapter 33, Section 7:  Lobbying Decisionmakers

Chapter 33, Section 9:  Conducting a Petition Drive 

Chapter 33, Section 10:  General Rules for Organizing for Legislative Advocacy

Chapter 33, Section 13:  Conducting a Public Hearing

Toolkit: Advocating for a Change

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

Chapter 5, Section 1:  Strategies for Community Change and Improvement: An Overview

Chapter 5, Section 4:  Systems Advocacy and Community Organizing

Chapter 5, Section 5:  Coalition Building I: Starting a Coalition

Chapter 6, Section 2:  Using Principles of Persuasion

Chapter 7, Section 1:  Developing a Plan for Increasing Participation in Community Action

Chapter 7, Section 2:  Promoting Participation Among Diverse Groups

Chapter 7, Section 3:  Methods of Contacting Potential Participants

Chapter 7, Section 4:  Writing Letters to Potential Participants

Chapter 7, Section 5:  Making Personal Contact with Potential Participants

Chapter 7, Section 6:  Involving Influential People in the Initiative

Chapter 7, Section 7:  Involving People Most Affected by the Problem

Chapter 11, Section 1:  Developing a Plan for Involving Volunteers

Chapter 11, Section 2:  Recruiting Volunteers

Chapter 11, Section 3:  Developing Volunteer Orientation Programs

Chapter 11, Section 4:  Developing Training Programs for Volunteers

Chapter 13, Section 1:  Developing a Plan for Building Leadership

Chapter 13, Section 2:  Servant Leadership:  Accepting and Maintaining the Call of Service

Chapter 13, Section 5:  Developing a Community Leadership Corps

Chapter 16, Section 1:  Conducting Effective Meetings

Chapter 16, Section 2:  Developing Facilitation Skills

Chapter 16, Section 3:  Capturing What People Say:  Tips for Recording a Meeting

Chapter 18, Section 1:  Designing Community Interventions

Chapter 18, Section 3:  Identifying Targets and Agents of Change:  Who Can Benefit and Who Can Help

Chapter 19, Section 2:  Understanding Risk and Protective Factors:  A Tool for Selecting Ingredients for Community Health and Development Initiatives

Chapter 19, Section 3:  Identifying Strategies and Tactics for Reducing Risks

Chapter 19, Section 4:  Adapting Community Interventions for Different Cultures and Communities

Chapter 19, Section 5:  Ethical Issues in Community Interventions

Chapter 20, Section 6:  Training for Conflict Resolution

Chapter 26, Section 12:  Promoting Neighborhood Action

Chapter 44, Section 2:  Establishing Micro-grant Programs

Toolkit: Creating and Maintaining Coalitions and Partnerships

Toolkit: Building Leadership

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

Chapter 3, Section 11:  Understanding and Describing the Community

Chapter 24, Section 3:  Promoting Coordination, Cooperative Agreements, and Collaborative Agreements Among Agencies

Chapter 24, Section 4:  Developing Multisector Collaborations

Chapter 30, Section 1:  Overview:  Getting an Advocacy Campaign Off the Ground

Chapter 30, Section 2:  Survival Skills for Advocates

Chapter 30, Section 3:  Understanding the Issue

Chapter 30, Section 4:  Recognizing Allies

Chapter 30, Section 5:  Identifying Opponents

Chapter 42, Section 1:  Developing a Plan for Financial Sustainability

Chapter 42, Section 2:  Creating a Business Plan

Chapter 42, Section 3:  Developing a Committee to Help with Financial Sustainability

Chapter 42, Section 4:  Applying for a Grant:  The General Approach

Toolkit: Increasing Participation and Membership

Toolkit: Writing a Grant Application for Funding

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

Chapter 3, Section 4:  Collecting Information About the Problem

Chapter 3, Section 7:  Conducting Needs Assessment Surveys

Chapter 3, Section 13:  Conducting Surveys

Chapter 10, Section 1:  Developing a Plan for Staff Hiring, Orientation, and Training

Chapter 12, Section 2:  Designing a Training Session

Chapter 12, Section 3:  Delivering a Training Session

Chapter 12, Section 4:  Conducting a Workshop

Chapter 13, Section 1:  Developing a Plan for Building Leadership

Chapter 13, Section 2:  Servant Leadership:  Accepting and Maintaining the Call of Service

Chapter 13, Section 5:  Developing a Community Leadership Corps

Chapter 14, Section 1:  Learning How to Be a Community Leader

Chapter 14, Section 2:  Developing and Communicating a Vision

Chapter 14, Section 3:  Promoting Coordination, Cooperative Agreements, and Collaborative Arrangements Among Agencies

Chapter 14, Section 4:  Understanding People’s Needs

Chapter 14, Section 5:  Building and Sustaining Commitment

Chapter 14, Section 6:  Influencing People

Chapter 14, Section 7:  Building and Sustaining Relationships

Chapter 14, Section 8:  Learning From and Contributing to Constituents

Chapter 14, Section 9:  Making Decisions

Chapter 15, Section 1:  Developing a Management Plan

Chapter 15, Section 2:  Providing Supervision for Staff and Volunteers

Chapter 15, Section 3:  Providing Support for Staff and Volunteers

Chapter 16, Section 1:  An Introduction to the Problem Solving Process

Chapter 16, Section 2:  Conducting Effective Meetings

Chapter 16, Section 3:  Developing Facilitation Skills

Chapter 16, Section 4:  Capturing What People Say: Tips for Recording a Meeting

Chapter 16, Section 5:  Defining and Analyzing the Problem

Chapter 16, Section 6:  Generating and Choosing Solutions

Chapter 16, Section 7:  Putting Your Solution into Practice

Chapter 24, Section 3:  Promoting Coordination, Cooperative Agreements, and Collaborative Agreements Among Agencies.

Chapter 27, Section 1:  Understanding Culture and Diversity in Building Communities

Chapter 27, Section 2:  Building Relationships with People from Different Cultures

Chapter 27, Section 3:  Healing from the Effects of Internalized Oppression

Chapter 27, Section 5:  Learning to be an Ally for People from Diverse Groups and Backgrounds

Chapter 27, Section 8:  Multicultural Collaboration

Chapter 27, Section 9:  Using Diversity and Conflict as Resources in Building Consensus

Toolkit: Building Leadership

Toolkit: Enhancing Cultural Competence

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

Chapter 1, Section 5:  Our Evaluation Model:  Evaluating Comprehensive Community Initiatives

Chapter 31, Section 1:  Understanding Community Leadership, Evaluators, Grantmakers: What Are Their Interests?

Chapter 31, Section 3:  Developing an Evaluation Plan

Chapter 32, Section 3:  Communicating Information about the Initiative to Gain Support from Key Audiences

Chapter 36, Section 1:  A Framework for Program Evaluation:  A Gateway to Tools

Chapter 36, Section 3:  Understanding Community Leadership, Evaluators, and Funders:  What Are Their Interests?

Chapter 36, Section 4:  Choosing Evaluators

Chapter 36, Section 5:  Developing an Evaluation Plan

Chapter 38, Section 1:  Measuring Success: Evaluating Community Health Initiatives

Chapter 38, Section 2:  Gathering Information: Monitoring Your Progress

Chapter 38, Section 3:  Rating Community Goals

Chapter 38, Section 4:  Rating Member Satisfaction

Chapter 38, Section 5:  Constituent Survey of Outcomes: Ratings of Importance

Chapter 38, Section 6:  Reaching Your Goals: The Goal Attainment Report

Chapter 38, Section 7:  Behavioral Surveys

Chapter 38, Section 8:  Interviews with Key Participants: Analysis of Critical Events

Chapter 38, Section 9:  Gathering and Using Community-Level Indicators

Chapter 39, Section 2:  Providing Feedback to Improve the Initiative

Chapter 39, Section 4:  Communicating Information about the Initiatives to Gain Support from Key Audiences

Toolkit: Evaluating the Initiative

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

Chapter 3, Section 1:  Developing a Plan for Identifying Local Needs and Resources

Chapter 3, Section 2:  Understanding and Describing the Community

Chapter 3, Section 3:  Conducting Public Forums and Listening Sessions

Chapter 3, Section 4:  Collecting Information About the Problem

Chapter 3, Section 5:  Analyzing Community Problems

Chapter 3, Section 6:  Conducting Focus Groups

Chapter 3, Section 7:  Conducting Needs Assessment Surveys

Chapter 3, Section 8:  Identifying Community Assets and Resources

Chapter 3, Section 9:  Developing Baseline Measures of Behavior

Chapter 3, Section 10:  Conducting Concerns Surveys

Chapter 3, Section 11:  Determining Service Utilization

Chapter 3, Section 12:  Conducting Interviews

Chapter 3, Section 13:  Conducting Surveys

Chapter 18, Section 1:  Designing Community Interventions

Chapter 18, Section 3:  Identifying Targets and Agents of Change: Who Can Benefit and Who Can Help

Chapter 18, Section 10:  Promoting Coordination, Cooperative Agreements, and Collaborative Arrangements Among Agencies  

Chapter 18, Section 11:  Developing Multisector Collaborations

Chapter 19, Section 2:  Understanding Risk and Protective Factors: A First Step for Planning Community Health and Development Initiatives

Chapter 19, Section 3:  Identifying Strategies and Tactics for Reducing Health Risks

Chapter 19, Section 4:  Adapting Programs for Different Cultures and Communities

Toolkit: Assessing Community Needs and Resources

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