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Core Functions and Essential Services

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Title: Core Functions and Essential Services


1
Core Functions and Essential Services
  • IDPH Education
  • Tom Newton, Ken Sharp,
  • Joy Rueber

2
Ten Great Public Health Achievements 1900-1999
  • Published in the MMWR 1999.
  • Found that people live 30 years longer than they
    did 100 years ago and that 25 of those years can
    be attributed to Public Health

3
Public Health Successes
1. Vaccinations 2. Safer Workplaces 3. Safer
and Healthier foods 4. Motor-vehicle safety 5.
Control of infectious diseases
6. Heart disease and stroke 7. Family
Planning 8. Tobacco Use 9. Mothers and
babies 10. Fluoridation of drinking water
4
  • The Institute of Medicine (1988) defines public
    health as
  • Activities that society undertakes to assure the
    conditions in which people can be healthy. This
    includes organized community efforts to prevent,
    identify, and counter threats to the health of
    the public.

5
Another way to look at it
  • For decades, public health had been the
    stepchild clad in rags in the world of medicine,
    eclipsed by novel surgeries and the drama of the
    emergency room ..The big problem is that when
    public health is successful, nothing happens,
    because weve prevented it from happening. A
    booster shot for public health,Stephen Smith,
    Boston Globe 1/7/2003

6
One more thing to note
  • US Public Health Service has estimated that
    although US health expenditures increased by
    210 between 1981 and 1993, the proportion of
    these expenditures used for population based PH
    measures, including EH, declined by 25.

7
Public Healths Infrastructure A Status Report
  • CDC March 2001
  • In a test of e-mail capacity, only 35 of
    messages to local health departments were
    delivered successfully.
  • At least one local health department said it
    doesnt comply with reportable disease
    notification because it takes a long distance
    phone call.

8
Public Health.in the beginning
  • 6,500 years ago in ancient Sumer
  • pipes have been located indicating sewer systems
  • 5,000 years ago in Egypt
  • the priestly minister of the state had the duty
    of inspecting the water supply for the whole land
    every 10 days
  • -Sanitarians Handbook Ben Freedman 1977

9
18th and 19th Century Public Health - USA
  • Protecting the publics health was the
    responsibility of the social elite.
  • Statesmen acting in publics interest vs.
    politicians answering to a constituent group.
  • Men of property and wealth were believed to be
    independent of special interests and therefore
    capable of disinterested judgment.
  • Principles of Public Health Practice, 1997

10
18th and 19th Centuries continued.
  • Epidemic diseases were the consequence of a
    failure to obey the laws of nature and God.
  • Police function port cities
  • Quarantine caused economic problems.
  • Cause of disease unknown - health regulations
    written and revised in response to political
    influence or pressure from merchants not
    necessarily in response to shifts in scientific
    thinking.

11
The word health does not appear in the US
Constitution, therefore health became a
responsibility to be executed by the states.
  • September 17, 1787

12
The Board of Health
  • 1793, first board of health established in
    Philadelphia the national capital had to be
    shut down due to a yellow fever epidemic
  • 1850, Lemuel Shattucks Report of the Sanitary
    Commission of Massachusetts called for
    establishment of state and local health
    departments to organize public efforts aimed at
    sanitary inspections, food sanitation, vital
    stats, and services for infants and children.

13
Establishment of Iowas Local Boards of Health
  • In 1866, the Local Health Law was adopted.
  • Designated mayor and town council or township
    trustees as LBOH.
  • LBOH had authority to establish regulations for
    public health and safety, to control nuisances,
    and to regulate sources of filth and causes of
    sickness in communities.

14
State Board of Health in Iowa
  • 1880 - State Board of Health law established to
  • Collect vital statistics
  • Establish duties of local boards
  • Punish neglect of duties
  • Mostly advisory local boards had authority

15
1967 New Local Health Act
  • Chapter 137 of the Code of Iowa
  • Each county required to establish a BOH one
    member had to be a physician licensed by the
    State of Iowa.
  • BOS to appoint other members.
  • A city with a population of 25,000 could
    establish a city board of health.
  • Counties and cities were also allowed to form
    district boards of health.

16
IDPH History
  • 1924 established
  • Divisions included
  • Contagious and Infectious Disease
  • Venereal Disease
  • Housing
  • Sanitary Engineering
  • Vital statistics
  • Examinations and Licenses

17
  • Late 1920s
  • Division of Public Health Education
  • Division of Maternal and Child Health (6th in the
    nation)
  • 1931
  • Division of Public Health Nursing
  • 1948
  • Division of Hospital Licensure
  • Establishment of position classification and
    salary scale
  • 1953
  • Division of Gerontology, Health, and Chronic
    Disease

18
  • 1970
  • Environmental programs to DNR
  • 1982
  • Home care aide transferred from DHS
  • 1986
  • Health facilities regulation to DIA
  • Dept. of Substance Abuse moved to IDPH
  • 1996
  • Gambling treatment program to IDPH
  • 1999
  • State Medical Examiners Office moved to IDPH

19
Unique features of Public Health
  • Basis in social justice philosophy
  • Inherently political in nature
  • Dynamic, ever expanding agenda
  • Link with government
  • Grounded in the sciences
  • Use of prevention as a prime strategy
  • Uncommon culture

20
Institute of Medicine (IOM)
  • Private, non-governmental agency
  • Authors are unpaid volunteer experts
  • Provide objective, timely authoritative
    information and advice concerning health and
    science policy to the government, the corporate
    sector, the professions and the public.

21
The Future of Public Health
  • Institute of Medicine (IOM) report 1988
  • Found a fragmented system not able to fulfill
    necessary functions
  • Stated 1/3 of the US population is effectively
    served by public health
  • Identified the 3 core functions of public health

22
The Future of the Publics Health in the 21st
Century - IOM, 2003
  • Recommended 6 areas of action and change
  • 1. Adopting a population health approach that
    considers the multiple determinants of health.
  • 2. Strengthening the governmental public health
    infrastructure, which forms the backbone of the
    public health system.

23
  • 3. Building a new generation of intersectoral
    partnerships that also draw on the perspectives
    and resources of diverse communities and actively
    engage them in health action.
  • 4. Developing systems of accountability to
    assure the quality and availability of public
    health services.

24
  • 5. Making evidence the foundation of decision
    making and the measure of success.
  • 6. Enhancing and facilitating communication
    within the public health system (e.g., among all
    levels of the governmental public health
    infrastructure, between public health
    professionals and community members.)
  • www.nap.edu

25
The Core Functions
  • Assessment
  • Policy Development
  • Assurance

26
Assessment
  • Ensures limited resources are used effectively

27
Policy Development
  • Pay attention to quality of process and decisions
    made
  • Raise questions other people wont or cant ask
  • Include the public
  • Build bridges

28
Assurance
  • Maintain service
  • Have intended impact
  • Make sure health services are available

29
Assurance
Policy Development
ASSESSMENT
30
start here
Policy Development
Assurance
Assessment
31
1995 PH Functions Steering Committee
  •                                                 
                                              
  • Vision
  • Healthy People in Healthy Communities
  • Mission
  • Promote Physical and Mental Health and Prevent
    Disease, Injury, and Disability
  • Public Health
  • Prevents epidemics and the spread of disease
  • Protects against environmental hazards
  • Prevents injuries
  • Promotes and encourages healthy behaviors
  • Responds to disasters and assists communities in
    recovery
  • Assures the quality and accessibility of health
    services

32
  • Essential Public Health Services
  • Monitor health status to identify community
    health problems
  • Diagnose and investigate health problems and
    health hazards in the community
  • 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
    and assure the provision of health care when
    otherwise unavailable
  • 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

33
IAC 641.77
  • Roles and responsibilities of local boards of
    health.

34
Assessment
  • Monitor health status.
  • Diagnose and investigate health problems and
    hazards.
  • Evaluate effectiveness, accessibility, and
    quality.

35
1. Monitor health status to identify and solve
community health problems
  • Make an accurate diagnosis
  • Identification of threats
  • Assessment of health needs
  • Timely collection, analysis, and publication of
    information
  • Pay attention to vital stats and health status of
    populations who may need more services
  • Collaborate

36
2. Diagnose and investigate health problems and
health hazards in the community
- Identify epidemiolgic emerging health
threats - Have access to a quality public health
laboratory - Have the capability to use modern
technology, conduct rapid screening, and high
volume testing if needed - Have active
epidemiology programs - Have the capacity for
investigation of outbreaks and patterns of
chronic disease and injury
37
3. Evaluate effectiveness, accessibility, and
quality of personal and population-based health
services
- Provide ongoing evaluation of health
programs - Complete an analysis of health status
and utilization data - Provide information
necessary to allocate resources and reshape funds
38
Policy Development
  • Develop policies and plans
  • Enforce laws and regulations
  • Research new insights

39
4. Develop policies and plans that support
individual and community health efforts
  • Provide leadership development
  • Plan at the local and state level
  • Develop and track measurable health objectives
  • Conduct joint evaluations with the medical system
  • Develop codes, regulations, and legislation

40
5. Enforce laws and regulations that protect
health and ensure safety
  • Enforce sanitary codes
  • Protect drinking water
  • Enforce clean air standards
  • Provide timely follow-up
  • Monitor quality of medical services
  • Conduct a timely review of new applications

41
6. Research for new insights and innovative
solutions to health problems
-Link with institutions of higher learning and
research -Develop an internal capacity to mount
timely epidemiologic and economic analyses and
conduct needed health care services research
42
Assurance
  • Link people to needed services
  • Assure a competent workforce
  • Inform, educate, and empower people
  • Mobilize community partnerships

43
7. Link people to needed personal health
services and assure the provision of health care
when otherwise available
  • Assure effective entry for socially disadvantaged
    people into system
  • Provide culturally and linguistically appropriate
    materials and staff
  • Provide ongoing care management
  • Provide or refer to transportation services
  • Provide targeted health information to high risk
    groups
  • Provide technical assistance for worksite health
    promotion/disease prevention programs

44
8. Assure a competent public and personal health
care workforce
  • Attend/provide education and training
  • Provide an efficient process for licensure or
    certification
  • CQI and CEU
  • Partner with professional training organizations

45
9. Inform, educate, and empower people about
issues
  • Provide social marketing and targeted media
    communication
  • Provide accessible resources at community levels
  • Collaborate with personal providers of health
    care
  • Provide joint health education programs

46
10. Mobilize community partnerships and action
to identify and solve health problems
  • Convene and facilitate community groups
  • Develop defined preventive,screening,
    rehabilitation, and support programs
  • Have ability to draw on potential human and
    material resources

47
Conclusions, Examples, and Practice
  • How IDPH activities fit within the framework of
    the essential services.
  • How Iowas local public health departments are
    using the framework of the essential services.
  • How your program fits with the essential services.

48
Assessment
  • Monitor health status.
  • Diagnose and investigate health problems and
    hazards.
  • Evaluate effectiveness, accessibility, and
    quality.

49
Policy Development
  • Develop policies and plans
  • Enforce laws and regulations
  • Research new insights

50
Assurance
  • Link people to needed services
  • Assure a competent workforce
  • Inform, educate, and empower people
  • Mobilize community partnerships
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