PLANNING FOR PUBLIC HEALTH

To "plan" means to form a scheme or method for doing or achieving something. In public health, as in most fields, planning is undertaken to determine the ways, means, and timetable by which specific goals and objectives can be achieved.

Planning in public health takes many forms. Whether within government or outside it, a planning process is employed to identify and organize the resources and actions necessary to safeguard and improve the public's health. Public health planning can occur at the municipal, state, regional, national, or international level. Goals are often defined by a specific health problem or concern (e.g., reduce heart disease, mental illness, or dental caries), and are usually coupled with specific health objectives (e.g., to reduce overall age-adjusted heart disease mortality rates by 10% over a ten-year period), service objectives (e.g., every resident of a country will be covered by health insurance for a basic set of benefits), or process objectives (e.g., develop indicators for accountability for each program area, or cut the budget by 15%).

In public health, planning can be initiated and led by a variety of public health agencies or by other health-interested organizations, although official public health agencies usually have some involvement in the planning process. Broad efforts to plan for improved population health can often benefit from involving stakeholders from other sectors whose actions influence health, such as transportation, housing, environment, economic policy, nutrition and food security, welfare, and others.

The U.S. government has established a periodic planning cycle for a comprehensive process to develop a set of national disease-prevention and health-promotion objectives. The first set of national health targets, published in 1979, was Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. Goals were set to reduce mortality among infants, children, adolescents and young adults, and adults. The broad goals for the most recent decennial planning process, completed in 1999 and incorporated into the report Healthy People 2010, are to increase quality and years of healthy life, eliminate health disparities, and achieve access to preventive services. Goals, objectives, and specific quantifiable milestones that support each goal and objective are organized into twenty-eight topic areas by health problem, and into three select populations. There are 467 separate objectives and related indicators. Similar processes and related goals and objectives are set by states and some municipalities.

Some areas of very active public health planning include manpower resources, access to health care services, and improved structures and processes to meet the needs of specified populations, such as those with HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency disease). In some circumstances, laws or regulations at the federal or state level dictate a carefully defined planning process as a condition of receipt of funds. Such is the case for the substantial funds available for care and prevention of HIV/AIDS, where an extensive community planning process with substantial participation of those affected by this condition are mandated. States and municipalities often have to submit detailed plans as a condition of receiving funds from the higher levels of government. For example, each state must submit a maternal and child health plan to receive federal block-grant money for health improvement activities for children and families.

Many tools are available to support planning. These include data and data analysis concerning the burden of disease, the distribution of available resources, and resource utilization and health outcomes. Information is also available on what interventions have been shown to be effective in practice. This information comes from a variety of sources, such as reports of the Surgeon General, the U.S. Clinical Preventive Services Task Force, and the U.S. Task Force on Community Preventive Services. Assessment of process and outcome results of planned interventions determine the effectiveness and efficiency of the plan and/or its execution.

An important movement within planning has been to involve representatives of those that will be affected by proposed plans. This participatory planning approach has significant strengths, though its influence on a specific plan and its ultimate health impact can vary.

Jonathan E. Fielding

(see also: Community Health; Community Organization; Health Goals; Healthy People 2010; Mobilization for Action through Planning and Partnerships; Regional Health Planning )

Bibliography

U.S. Department of Health, Education, and Welfare (1974). Healthy People: Surgeon General's Report on Health Promotion and Disease Prevention. Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services (2000). Healthy People 2010: Understanding and Improving Health, 2nd edition. Washington, DC: U.S. Government Printing Office.