The Ten Essential Services A standard framework for public health

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The Ten Essential ServicesA standard framework
for public health

• Structure of the Course
• Why the Essential Services ?
• New Applications
• Performance Measurement
• Workforce Development

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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_at_uiowa.edu

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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.

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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.)

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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
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Public Health

• What we as a society, do collectively to assure
  the conditions in which people can be healthy.

Institute of Medicine The Future of Public Health
Institute of Medicine
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- How we do it -

• Public health practice is based on
• scientifically sound strategies
• for improving the quality of life and reducing
  morbidity and premature mortality.

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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.

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- 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

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Assessment

• The Process of Understanding
• Population Health Status
• Threats to Health
• Community Health Resources

Kristine Gebbe
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Policy Development

• Reduce the threats to health
• Support positive resources
• Reduce disease
• Advance overall community health

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Assurance

• The process of assuring
• Availability
• Accessibility
• Quality

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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

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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

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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
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• 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

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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

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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

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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

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4. Mobilize Community Partnerships to Solve
Health Problems

• Kinds of Activities
• coalition building
• collaboration
• community partnerships
• advocacy and budget justification
• technical assistance to communities

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5. Legal and Policy Initiatives

• Kinds of Activities
• agenda setting
• development of policies and guidelines
• legislative activities
• planning models

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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

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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

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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

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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

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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

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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

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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

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Public Policy Developments

• Performance Measurement
• Workforce Design
• New Demands on Public Health

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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

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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.

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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.

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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.

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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
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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.

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U.S. D.H.H.S. Healthy People 2010
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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. al Public Health Mgt. and
Practice May 1999
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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 Gebbe Public Health Mgt. and
Practice May 1999
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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 Workforce Development
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A working model for the Public Health Workforce
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Capacity-Process-Outcome Links
Process (Essential Public Health Services)
Capacity
Outcomes
Outputs
Key Processes
Improved organizational performance Improved
program performance
Improved Outcomes
Dr. Bernard Turnock
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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 Breslow Annu. Rev. Public Health 1994
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The Evolving Agenda of Public Health
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The Determinants of Health
Physical Environment
Social Environment
Genetic Endowment

• Individual
• Response
• Behavior
• Biology

Health and Function
Health Care
Disease
Well-Being
Prosperity
Evans and Stoddart
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Community Empowerment
Fiscal Policy Studies Institute