ESSENTIAL PUBLIC HEALTH SERVICES

In its 1988 book, The Future of Public Health, the Institute of Medicine proposed three "core functions" of public health: assessment, policy development, and assurance. During the five years following the release of the publication, these core functions became a de facto framework delineating the practice of public health, particularly at the state and local levels.

Stimulated in part by the potential to include public health in the then active discussions about national health care reform, and by the clear need to develop a more descriptive framework describing public health, the U.S. Public Health Service (PHS) convened a national workgroup in 1993. This group, the Public Health Functions Steering Committee, was chaired by the Surgeon General and included representatives from most PHS agencies and from a number of national public health organizations.

In the fall of 1994, the committee produced Public Health in America, a document that described a vision, a mission statement, a list of public health goals, and a list of ten public health services needed to carry out basic public health responsibilities. The ten services have subsequently been called the "Ten Essential Public Health Services." It was the committee's specific intent that these essential services represent the full range of responsibility in public health across federal, state, and local levels.

The ten essential services are:

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.
4. Mobilize community partnerships to identify and solve health problems.
5. Develop policies and plans that support individual and community health efforts.
6. Enforce laws and regulations that protect health and ensure safety.
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 workforce.
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
10. Research for new insights and innovative solutions to health problems.

By the year 2000, the ten essential services were widely recognized, although they had not displaced core functions in many states and locales. They were used as the basis for measuring performance by local and state health departments. The performance measurement tools come from the National Public Health Performance Standards Program, a voluntary program developed under the aegis of the Centers for Disease Control and Prevention and a number of national partners. The essential services are used in studies of national public health expenditures, and in the design of Mobilization for Action through Planning and Partnership (MAPP), a community assessment and planning tool used by the National Association of County and City Health Officials (NACCHO). Efforts began in the late 1990s to achieve wider consensus at state and local levels regarding their use as the principal framework for public health.

Thomas L. Milne

Carol K. Brown

(see also: Centers for Disease Control and Prevention; Director of Health; Evaluation of Public Health Programs; Mobilization for Action through Planning and Partnerships )

Bibliography

Illinois Department of Public Health (1996). Illinois Project for Local Assessment of Needs Training Program Manual, Unit 1. Springfield, IL: Illinois Department of Public Health.

Institute of Medicine, Committee on the Future of Public Health (1988). The Future of Public Health. Washington, DC: National Academy Press.

Missouri Department of Health (1997). Defining Public Health for Missouri. Jefferson City, MO: Missouri Department of Health.

Public Health Functions Steering Committee (1994). Public Health in America. Washington, DC: U.S. Public Health Services.

Washington State Department of Health, PHIP Steering Committee (1994). Public Health Improvement Plan. Olympia, WA: Washington State Department of Health.