Core Functions and Essential Services

IDPH EducationTom Newton, Ken Sharp,

Joy Rueber

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

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

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.

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 we’ve prevented it from happening.” – A booster shot for public health,Stephen Smith, Boston Globe 1/7/2003

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%.

Public Health’s 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 doesn’t comply with reportable disease notification because it takes a long distance phone call.

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

-Sanitarian’s Handbook – Ben Freedman 1977

18th and 19th Century Public Health - USA Protecting the public’s health was the

responsibility of the social elite. Statesmen acting in public’s 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

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.

The word “health” does not appear in the US Constitution, therefore health became a responsibility to be executed by the states.

September 17, 1787

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 Shattuck’s 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.

Establishment of Iowa’s 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.

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

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.

IDPH History

1924 established• Divisions included:

– Contagious and Infectious Disease– Venereal Disease– Housing– Sanitary Engineering– Vital statistics– Examinations and Licenses

Late 1920’s– 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

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 Examiner’s Office moved to IDPH

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

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.

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

The Future of the Public’s 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.

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.

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

The Core Functions

Assessment

Policy Development

Assurance

Assessment

Ensures limited resources are used effectively

Policy Development

Pay attention to quality of process and decisions made

Raise questions other people won’t or can’t ask

Include the public Build bridges

Assurance

Maintain service Have intended impact Make sure health services are available

ASSESSMENT

Policy Development

Assurance

*Assessment

Policy Development

Assurance

*start here

                                                                                          

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

1995 PH Functions Steering Committee

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

IAC 641.77

Roles and responsibilities of local boards of health.

Assessment

1. Monitor health status.

2. Diagnose and investigate health problems and hazards.

3. Evaluate effectiveness, accessibility, and quality.

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

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

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

Policy Development

4. Develop policies and plans

5. Enforce laws and regulations

6. Research new insights

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

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

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

Assurance

7. Link people to needed services

8. Assure a competent workforce

9. Inform, educate, and empower people

10. Mobilize community partnerships

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

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

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

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

Conclusions, Examples, and Practice How IDPH activities fit within the

framework of the essential services. How Iowa’s local public health

departments are using the framework of the essential services.

How your program fits with the essential services.

Assessment

1. Monitor health status.

2. Diagnose and investigate health problems and hazards.

3. Evaluate effectiveness, accessibility, and quality.

Policy Development

4. Develop policies and plans

5. Enforce laws and regulations

6. Research new insights

Assurance

7. Link people to needed services

8. Assure a competent workforce

9. Inform, educate, and empower people

10. Mobilize community partnerships