This week’s Objectives

Understand the 3 Core Functions and 10 Essential Public Health Services Framework

Apply the 10 Essential Public Health Services to a population health problem

Compare the 10 Essential Public Health Services (CDC) to the 11 Essential Public Health Functions (WHO, PAHO)

Identify the major components of public health’s infrastructure and key dimensions of each component

Identify strategies for assessing and enhancing the infrastructure of public health

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This week’s Objectives

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Chapter 5 (Turnock, 5th ed)

Core Functions and Public Health Practice

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Understand the 3 Core Functions and 10 Essential Public Health Services Framework

Apply the 10 Essential Public Health Services to a population health problem

Compare the 10 Essential Public Health Services (CDC) to the 11 Essential Public Health Functions (WHO, PAHO)

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Learning Objectives

Essential Services of Public Health1. Monitor health status2. Diagnose and

investigate 3. Inform, educate, and

empower4. Mobilize community

partnerships5. Develop policies and

plans

6. Enforce laws and regulations

7. Link to or provide services

8. Assure a competent workforce

9. Evaluate health services

10. Research

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Governmental Role◦ “The governmental public health agency has a vital

function: to see to it that vital elements are in place and the mission is being adequately addressed.”

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IOM’s Future of Public Health

Assessment: What are the problems, needs and resources?

Policy Development: What will be done based on resources and priorities?

Assurance: How can we make sure priority problems are addressed based on scientific evidence?

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Translating Public Health Functions into Practice

How Public Health Works: Essential Services

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Statistician Community Researcher

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1. Monitor Health Status

Ongoing assessment of community health status

Identification of threats to health Determination of health service needs Attention to special high risk populations Identification of community assets &

resources Interpretation & communication Multisectoral information systems

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Monitor Health Status

http://www.countyhealthrankings.org/

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1. Monitor

“Disease Detectives” Epidemiologist Laboratorian Emergency Manager

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2. Diagnose and Investigate

Early identification of unusual event patterns

Access to public health lab capabilities Active infectious disease and environmental

surveillance activities Technical and human resource capacity for

thorough investigation

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Diagnose and Investigate

Disease Detectives - YouTube

2. Diagnose

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Health Educator Media Specialist Community Outreach Worker

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3. Inform, Educate, Empower

Community organization Social marketing and targeted

communication Access to health information Collaboration with health care providers on

health messages and programs Joint health education efforts with media,

schools, churches, work sites, etc.

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Inform, Educate, Empower

http://vimeo.com/22274847

3. Inform

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Community Organizer

Outreach Worker City Planner

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4. Mobilize Partnerships

Convening and facilitating partnerships Undertaking defined health improvement

planning efforts and projects Building coalitions to draw upon the full

range of potential human and material resources to improve community health

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Mobilizing Partnerships

YouTube - Allies for Health: Community Partnerships for Health in Public Housing

4. Mobilize

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Policy Analyst Policy Advocate Planner Economist

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5. Develop Policies and Plans

Leadership development at all levels Systematic community-wide planning for

health improvement Developing & tracking goals and objectives Joint evaluation with medical care system Development of policy and legislation to

achieve public health goals

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Develop Policies and Plans

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5. Plan

Environmental Health Specialist Industrial Hygienist Reviewer

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6. Enforce Laws & Regulations

Enforcement of sanitary codes Protection of drinking water supplies Enforcement of clean air standards Animal control Follow-up of hazard investigations Monitor quality of medical care Review of new drugs, biologics & devices

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Enforcing Laws & Regulations

YouTube - Public Health Inspector - Working in Canada

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6. Enforce

Nurse Physician Dentist Translator Case Manager

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7. Link to & Assure Medical Care

Assurance of effective access and entry Culturally appropriate materials and staff Ongoing care management Transportation services Targeted outreach & education for special

populations

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Link to & Assure Care

YouTube - Meeting the Needs of California's Diverse Patient Populations

7. Link

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Educator Trainer Regulator

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8. Assure a Competent Workforce

Education, training, assessment of personnel

Efficient processes for licensure & credentialing

Lifelong learning models Active partnerships with professional

training programs Continuing education for management and

leadership development

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Assure Competent Workforce

Public Health Training Network-Home-PHTN-CDC

8. Train

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9. Evaluate Effectiveness, Accessibility and Quality

• Systems Analyst• Quality Improvement Specialist• Administrator

Assessing program effectiveness Understanding why interventions work or

don’t work in a specific setting Providing information necessary for

allocating resources and reshaping programs

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Evaluate Effectiveness, Accessibility and Quality

Medicare Hospital Compare Quality of Care

9. Evaluate

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Community Researcher Lab Researcher Behavioral Researcher

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10. Research and Innovation

Participation in and support for full continuum of innovation

Ongoing linkage with institutions of higher learning

Internal capacity to mount timely epidemiologic & economic analyses and conduct health services research

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Research and Innovation

YouTube - Youth Violence: A Community Solution

10. Research

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World Health Organization CDC

1. Monitoring, evaluation, and analysis of health status

2. Surveillance, research, and control of the risks and threats to public health

3. Health promotion4. Social participation in health5. Development of policies and

institutional capacity for public health planning and management

6. Strengthening of public health regulation and enforcement capacity

7. Evaluation and promotion of equitable access to necessary health services

8. Human resources development and training in public health

9. Quality assurance in personal and population-based health services

10. Research in public health11. Reduction of the impact of

emergencies and disasters on health

1. Monitor health status to identify and solve 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 and action 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 competent public 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.

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Apply the 10 Essential Public Health Services to a population health problem.

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Your turn

identify the major components of public health’s infrastructure and key dimensions of each component

identify strategies for assessing and enhancing the infrastructure of public health

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Chapter 6 Will Help You To:

Public health infrastructure: the resources and relationships necessary to carry out public health’s core functions and essential services in the community

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Infrastructure, Ingredients,and Inputs

Resources and relationships necessary to carry out the core functions and essential services of public health

Human Information Financial Organizational

◦ Statutes◦ Leadership◦ Partnerships

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Public Health Infrastructure

Impact of Public Health Infrastructure

Public Health Infrastructure--the resources needed to deliver essential public health services to every community

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Public Health Response

EpidemicInvestigation

Surveillance

LaboratoryPractice

Workforce Capacity & Competency

Information& Data

Systems

Organizational& SystemsCapacity

BasicInfrastructure

Essential Capabilities

SOURCE: Public Health Foundation

Infrastructure = Inputs

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Public Health System: Simple Logic Model

Inputs Processes Outputs Outcomes

PublicPrivateIndividualsAssociationsWorkforce InfrastructureInformation Technology$$$$

Core Functions

Essential Services

VaccinationsInformation Screenings Partnerships Education ProgramsAlertsPlansStudies

• Years of Healthy Life

• Life Expectancy

• Infant survival

• Disease rates

• Disaster recovery

Human Resources in Public Health

•People = Key

•“public health worker”???

•Best guess = 600,000 workers

•Distribution

•Composition

•Skills/competencies47

All those providing essential public health services, regardless of the nature of the employing organization

The Public Health Workforce

Public Health Physician Public Health Nurse Public Health Dentist Public Health Dental

Worker Public Health

Veterinarian Public Health Nutritionist Public Health Pharmacist Public Health

Administrator

Public Health Laboratory Scientist

Public Health Attorney Health Information

System/Computer Specialist

Public Relations/Public Information/Health Communications/Media Specialist

Biostatistician

Job Titles

Epidemiologist Environmental

Engineer Environmental

Engineering Technician and Technologist

Environmental Scientist and Specialist

Environmental Scientist Technician and Technologist

Occupational Safety and Health Technician and Technologist

Health Educator Public Health Policy

Analyst Health Service

Manager/Health Service Administrator

Public Health and Community Social Worker

Job Titles

Mental Health and Substance Abuse Social Worker

Psychologist, Mental Health Provider

Alcohol and Substance Abuse Counselor, including Addiction Counselor

Mental Health Counselor

Outreach Worker Program Manager Program Planner

Job Titles

Percent of Responding LHDs

Race/Ethnicity of Top Executive 2005 1992-93

White 92.7% 96.2%

Black 4.7% 1.9%

American Indian/Alaska Native 1.6% 0.2%

Asian or Pacific Islander 1.2% 0.8%

Some other race 0.6% 1.0%

Hispanic ethnicity 1.5% 1.7%

Race and Ethnicity of LHD Top Executives: 1993 and 2005

Source: 2005 National Profile of LHDs

Composition of the Public Health Workforce

Percent of Responding LHDs

Race/Ethnicity of Top Executive 2005 1992-93

White 92.7% 96.2%

Black 4.7% 1.9%

American Indian/Alaska Native 1.6% 0.2%

Asian or Pacific Islander 1.2% 0.8%

Some other race 0.6% 1.0%

Hispanic ethnicity 1.5% 1.7%

Race and Ethnicity of LHD Top Executives: 1993 and 2005

Source: 2005 National Profile of LHDs

Race or Ethnicity Percentage of LHD Staff

Percentage of U.S. Population*

White 74.0% 80.2%

Black 14.7% 12.8%

American Indian 0.3% 1.0%

Asian 2.7% 4.3%

Pacific Islander 0.1% 0.2%

Two or more 0.5% 1.5%

Some other 6.3% Not included

Hispanic ethnicity 11.2% 14.4%

Race and Ethnicity Estimates for the LHD Workforce

*Based on U.S. Census Bureau estimates for 2005.

Source: 2005 National Profile of LHDs

http://www.rwjf.or/en/research-publications/find-rwjf-research/2007/11/graphical-portrait-of-frontline-health-and-health-care-workforce.html

Distribution of Health Educators (Bachelor’s degree) per 100,000 population

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at

• Analytical and assessment• Policy and program• Communications• Cultural• Community practice• Basic Public Health• Management• Leadership

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Core Professional Public Health Competencies

Vital Statistics National Health Interview Survey National Ambulatory Medical Care Survey National Health and Nutrition Survey National Hospital Discharge Survey Behavioral Risk Factor Surveillance Survey

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Information Resources

BRFSShttp://www.cdc.gov/brfss/

Total health expenditures = $2.0 trillion Public health expenditures within total

health expenditures = about $60-70 billion◦ 1/3 from federal sources◦ 2/3 from state and local sources

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Financial Resources

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Organizations Leadership Coalitions and Consortia Community Health Partnerships

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Organizational Resources

Relationshipshttp://www.youtube.com/watch?v=fy8BA8X4Kwo

Putting Prevention to Work ($74 million). Support federal, state and community initiatives to use evidence-based interventions to address tobacco control, obesity prevention, HIV-related health disparities, and better nutrition and physical activity.

Primary and Behavioral Health Integration ($20 million). Assist communities with the coordination and integration of primary care services into publicly-funded community mental health and other community-based behavioral health settings.

Obesity Prevention and Fitness ($16 million). Advance activities to improve nutrition and increase physical activity to promote healthy lifestyles and reduce obesity related conditions and costs. These activities will support the First Lady’s “Let’s Move!” initiative and help implement recommendations of the President’s Childhood Obesity Task Force.

Tobacco Cessation ($16 million). Implement anti-tobacco media campaigns showing the negative health consequences of tobacco use, telephone-based tobacco cessation services, and outreach programs targeting vulnerable populations.

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Community and Clinical Prevention ($126 million)

Affordable Care Act, 2010

Public Health Infrastructure ($70 million)The allocation strengthens state and local capacity to prepare health departments to meet 21st century challenges.

Public Health Infrastructure ($50 million). Support state, local, and tribal public health infrastructure to advance health promotion and disease prevention through improved information technology, workforce training, and regulation and policy development.

Epidemiology and Laboratory Capacity Grants ($20 million). Build state and local capacity to prevent, detect, and respond to infectious disease outbreaks.

Affordable Care Act, 2010

Research and Tracking ($31 million)

The initiative supports the Affordable Care Act’s expansion of coverage for community and clinical preventive services by increasing resources for guidance and evaluation of preventive services.

Surveillance ($21 million). Fund data collection and analysis to measure the impact of health reform and support strategic planning.

Community Preventive Services Task Force ($5 million). Strengthen CDC’s Community Guide by supporting the Task Force on Community Preventive Services’ efforts to identify and disseminate additional evidence-based recommendations on important public health decisions to inform policymakers, practitioners, and other decision makers.

Clinical Preventive Services Task Force ($5 million). Expand the development of recommendations for clinical preventive services, with enhanced transparency and public involvement in the processes of the Task Force.

Affordable Care Act, 2010

Public Health Training ($23 million)These funds support the training of existing and next generation public health professionals.

Public Health Workforce ($8 million). Expand CDC public health workforce programs to increase the number of fellows trained and placed in public health positions.

Public Health Training Centers ($15 million). Support training of public health providers to advance preventive medicine, health promotion and disease prevention, and improve the access and quality of health services in medically underserved communities.

Affordable Care Act, 2010