The Ten Essential ServicesA standard framework for public health

Structure of the Course

Why the Essential Services ?

New Applications

Performance Measurement

Workforce Development

Examining the Ten Essential Services

A developmental course - i.e. We need your

participation and comments !

Ten three hours sessions to examine the ten essential

services.

Each session conducted by University faculty and

IDPH practitioners

Concludes with individual reports

E-mail connection - chris-atchison@uiowa.edu

Individual Reports

At the final class each participant will have 10 minutes to explain:

How the 10 essential services fits into their

work situation

Identify at least one other unit or agency

which would share responsibility for each

of the 10 services.

Evaluate how effective each service is

being implemented.

What is Health?

The absence of Disease or Disability

The “complete physical, mental and

social well being and not merely the

absence of disease or infirmity”.

(W.H.O.)

What is Public Health ?

Governmental Services (Especially

Medical Care for the Poor)

The Methods (Knowledge and Techniques)

The Profession

The System and Social Enterprise

The Health of the Public

Bernard J. Turnock

Institute of MedicineThe Future of Public Health

Public Health

What we as a society, do collectively to

assure the conditions in which people can

be healthy.

Institute of Medicine

Public health practice is based on

scientifically sound strategies

for improving the quality of life and

reducing morbidity and premature

mortality.

- How we do it -

Organizational Strategy

The pattern of major

objectives, purposes, or goals,

and essential policies and plans for achieving those goals,

stated in such a way as to

define what business the organization is in or is to be in and

the kind of organization it is or is to be.

- In the Beginning -Core Functions and a Division of

Responsibility

The Institute of Medicine - The Future of Public Health

Assessment, Policy Development and Assurance

The Roles of State, Local and National Government

The Emergence of Non-Governmental Public Health e.g. Managed Care

Assessment

The Process of Understanding

Population Health Status

Threats to Health

Community Health Resources

Kristine Gebbe

Policy Development

Reduce the threats to health

Support positive resources

Reduce disease

Advance overall community health

Assurance

The process of assuring:

Availability Accessibility Quality

IOM Report- Federal Responsibilities

Support knowledge development and

dissemination

Establish national health objectives and

priorities

Provide technical assistance

Provide funding for capacity development

Assure the public interest, nationally

IOM Report- State Responsibilities -

Assess needs based on statewide data

Assure a statutory base

Establish state health objectives

Assure appropriate services

Support local service capacity

IOM Report- Local Responsibilities

Assess and monitor for local health

problems and solutions

Provide leadership for local involvement

Assure high quality services

The Future of Public Health

Public Health in AmericaVision:

Healthy People in Healthy Communities

Essential Public Health Services

Monitor health status Diagnose and investigate health problems and health hazards Inform, educate, and empower people about health issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health

efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and

population-based health services Research for new insights and innovative solutions to health problems

1. Monitor Health Status

Kinds of Activities

disease and injury registries epidemiology - surveillance, disease reporting,

sentinel events population-based/community health needs

assessments state/community report cards/development of health

status indicators vital statistics environmental epidemiology immunization status tracking data sets

2. Investigate Health Problems and Health Hazards

Kinds of Activities

communicable disease, chronic disease and injury detection

outbreak investigation and control contact tracing population-based screening services HIV/AIDS prevention environmental risk assessment and sampling investigation of toxic substances diagnostic and environmental laboratory services

3. Education

Kinds of Activities

school health education school campaigns population-wide health promotion/risk reduction

programs nutrition education substance abuse prevention worksite health promotion HIV education education related to enforcement of laws and

regulations

4. Mobilize Community Partnerships to Solve Health Problems

Kinds of Activities

coalition building

collaboration

community partnerships

advocacy and budget justification

technical assistance to communities

5. Legal and Policy Initiatives

Kinds of Activities

agenda setting

development of policies and guidelines

legislative activities

planning models

6. Enforce Laws and Regulations

Kinds of Activities

air quality sanitation housing substance control/product safety vector/rodent control fluoridation services hazardous materials management occupational health and safety environmental hazards

waste management water quality control emergency response toxicology and forensic

medicine youth access to tobacco enforcement of

quarantine and mandated supervision of medication

7. Manage and Coordinate Health Care

Kinds of Activities

case management/care coordination services outreach services transportation and other enabling services development of primary care services in under-

served communities personal health services clinical preventive services school-based clinical services management of client-based data systems

8. The Public Health and Personal Health Care Workforce

Kinds of Activities

professional education and training

recruitment and retention of health professionals

continuing education

licensing of health and environmental

professionals

leadership training/programs

9. Evaluate Personal and Population-Based Health Services

Kinds of Activities

facilities licensing health care systems monitoring personal health services monitoring program evaluation data systems laboratory regulation regulation of EMS personnel/services quality improvement programs evaluation of outcomes data

10. Research Initiatives

Kinds of Activities

biomedical, preventive, and clinical investigations health services research and research grants research and monitoring about the effects of the

changing healthcare environment demonstration programs methods development innovative technologies

The Essential Services reflect public health practice

The Washington E-Coli Example

Physician notes HUS ER reports of bloody diarrhea Labs id cause as E.coli State epidemiologists locate source New lab tests confirm case links 250,000 hamburger patties recalled

Media campaign alerts public

Why make the use of the Ten Essential Services Routine?

By Definition - Public Health requires

collective action

From our Strategic Plan - We must not be

in disarray

Our base - Public Policy new levels of

organization and integration

Public Policy Developments

Performance Measurement

Workforce Design

New Demands on Public Health

Government-wide Forces for Change

Budgets will continue to shrink substantially

Demands and requirements will continue to

grow

Diminishing public confidence in

government's ability to deliver services

Performance Measurement

The selection and use of quantitative

measures of capacities, processes, and

outcomes to develop information about

critical aspects of activities, including their

effects on the public and other customers.

Benefits of Performance Measurement

QUALITY IMPROVEMENT Objective performance measures will define performance

expectations, provide data for benchmarking, and become an impetus for action.

ACCOUNTABILITY Performance measures will provide objective data for defining the

value of public health, initiating community action, and highlighting best practices.

INCREASED SCIENCE BASE FOR PUBLIC HEALTH PRACTICE Performance measurement data will provide a scientific basis for

better decision-making, useful comparative data for evaluation, and will strengthen external leverage in partnership.

Why Measure Public Health Performance?

The need to effectively measure public health performance is urgent.

The lack of focus on population based services which prevent disease and disability has led to outbreaks of infectious and chronic diseases that weaken the health of communities.

A performance measurement system will provide information to advocate for public health at state and local levels, shape policy decisions, and target resources to ultimately improve the health of the public.

Performance MeasuresNational Purpose

The National Public Health Performance Standards Program (NPHPSP) is a partnership effort to:

Develop performance standards for public

health practice as defined by the Essential

Services of Public Health,

collect and analyze performance data, and

improve system-wide performance.

PHPPO

Performance MeasurementNational Activities

Comprehensive performance measurement tools for the

assessment of public health practice at both the state

and local levels are being designed in partnership with

other national public health organizations.

Additionally, a surveillance instrument has been

prepared as a rapid assessment tool to provide local,

state, and federal public health officials with a snapshot

of local public health capacity and performance.

U.S. D.H.H.S.

Healthy People 2010

Examining the Public Health Workforce

“The objective of sound health workforce

policy is to assure that there is an

adequate, affordable supply of competent

personnel to provide needed health

services to a given population.”

Virginia Kennedy et. alPublic Health Mgt. and PracticeMay 1999

Why Understanding the Workforce is important?

“The challenges facing public health today

are enormous and require a workforce in

governmental, voluntary, and interested

private health agencies that is skilled not

only in the technology of public health but

also in its philosophy and framework.”

Kristine GebbePublic Health Mgt. and PracticeMay 1999

Cross Cutting Competencies for The Public Health Workforce

Analytic Communication Policy Development Cultural Basic P.H. Science Leadership and Systems Thinking Management and Information

Management

Task Force on Public Health WorkforceDevelopment

A working model for the Public Health Workforce

CompetenciesEssentialServices

Monitor

Investigate

Educate

Mobilize

Develop Policy

Enforcement

Personal Care

Workforce

Evaluation

Research

AnalysisCommun-

icationPolicy andProgram Cultural

BasicScience

Finance/Mgt

Organi-zation

DevelopPolicyAssess

Capacity-Process-Outcome Links

CapacityProcess

(Essential Public Health Services)

Outputs

Outcomes

System Inputs

Workforce

Information

Organization & Relationships

Facilities

Funding

Improved organizational performance

Improved program performance

Assure

Programs and Services consistent with mandates and community priorities

Key Processes

ImprovedOutcomes

Dr. Bernard Turnock

The Dynamic Nature of Public Health

The fact that health problems emerge mainly in

response to conditions of life requires that

public health remain highly adaptive, especially

when living conditions are changing rapidly.

Afifi and BreslowAnnu. Rev. Public Health1994

The Evolving Agenda of Public Health

Hygiene

Infections

Chronic Disease

Determinants of Health

The Determinants of Health

Evans and Stoddart

SocialEnvironment

PhysicalEnvironment

GeneticEndowment

IndividualResponse

•Behavior•Biology

Disease Health

Care

Well-Being Prosperity

Health

and Function

StrategiesHealthyIowans

TacticsEssentialServices

Legislative

Results

Indicators

PerformanceMeasures

Executive

ProgramInfrastructure

Staff and otherProfessional Services

Budgets

Fiscal Policy Studies Institute

CommunityEmpowerment