What Are the 10 Essential Public Health Services?

If you've ever seen the 2011 movie "Contagion," you know it's a real nail-biter. In it, you follow a devastating epidemic making its way across the globe as public health officials race to stop it. The movie is, at times, terrifying. It's also entirely plausible.

Public health professionals track epidemics every day, and while the job isn't always as glamorous as Hollywood would suggest, it is an essential public health service—one of 10 essential services, in fact.

History

Medicine and public health are often intertwined, but they approach health from two very different perspectives. While medical practitioners are often focused on diagnosing, treating, and caring for the individual patient in front of them, public health takes a wider view — that of an entire community. When done well, public health can achieve something remarkable: nothing. No outbreaks. No health concerns. No lives lost prematurely. It's a lofty — and likely unachievable — goal, but it encompasses the most important aspect of public health. That is, prevention. 

The 10 essential services arose in the early 90s along with debate over healthcare reform. At the time only three "core functions" for public health were widely recognized: assessment, policy development, and assurance. While great guiding principles, they were too broad to be of practical use. Public health leaders wanted to provide more specific guidance to health departments and policymakers tasked with protecting the health of their communities. The result was a consensus statement that outlined key services everyone working in public health should strive for. 

Here is what they came up with.

Monitor Health Status to Identify and Solve Community Health Problems

Scientists conducting scientific experiment in laboratory
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A critical component necessary for all public health services is data. Without it, communities don't know what is needed, where priorities should lie, or how to allocate resources effectively. In "Contagion," public health agencies like the Centers for Disease Control and Prevention and the World Health Organization were already hot on the trail of the outbreak before most people knew it was happening because of surveillance processes in place.

There are systems all over the world to help sound alarms if things are amiss. While traditionally they have relied heavily on things like reporting by medical practitioners, conducting surveys, or testing lab samples, the internet has provided new ways to track epidemics in the early stages, or even before they begin. A new field called digital disease detection has emerged to help public health professionals and researchers spot outbreaks quickly by tracking key phrases on social media or combing online news reports. These systems don't just look for infectious diseases. Monitoring the heath status of a community means also looking at things like injuries, chronic diseases, and birth outcomes to see what trends—if any—exist.

This service is critical. After all, before public health officials can do anything to improve the health of a community, they must first figure out what needs to be done.

Diagnose and Investigate Health Problems and Health Hazards in the Community

Once alarms have been raised, public health officials then work to figure out who is most impacted and why. A whole scientific field is actually dedicated to investigating these health trends. It's called epidemiology.

Epidemiologists collect and analyze data to figure out how diseases or health conditions are distributed in a given population, what key factors those cases have in common, and—most importantly—how that information could be applied to prevent future cases. When there's a salmonella outbreak, epidemiologists are the ones talking to those who got sick, collecting information on what they ate, and pinpointing what food is the likely culprit so that it can be pulled from the shelves.

Inform, Educate, and Empower People About Health Issues

Once public health professionals know what's going on, who it's impacting, and—if possible—how to prevent it, they then spread the word to the population at large.

One of the most successful examples of this essential service in action was the Back to Sleep campaign. When epidemiologists around the world started to identify sleep position as a risk factor for sudden infant death syndrome, the American Academy of Pediatrics and other heath officials in the United States launched an educational campaign urging parents to place their babies down to sleep on their backs, rather than on their stomachs or sides. Pediatricians talked about it with their patients' families, pamphlets were passed out, and experts went on television to spread the word.

And it looks like it worked. SIDS rates dropped by over 50 percent in the years immediately following the launch of the campaign. 

Mobilize Community Partnerships and Action to Identify and Solve Health Problems

Rarely is disease prevention and health promotion done by a single entity in a vacuum. Public health relies on the cooperation and support of a wide variety of stakeholders to investigate, resolve, and prevent health issues. That includes individuals and organizations who may not be involved in health directly, but whose support is crucial to gathering accurate information and empowering individuals to adopt certain behavior changes.

For example, many public health initiatives have turned to local groups and individuals to help combat HIV in marginalized populations. Instead of using authority figures to disseminate key information, programs work within peer networks to reach those most at risk for infection. After all, who better to help influence positive change in a community than the people who are already a part of it?

Develop Policies and Plans that Support Individual and Community Health Efforts

Some of the greatest public health achievements of the past century were not actually due to one-on-one education or small, local efforts. They were a result of policy changes. Workplace safety guidelines, seat belt laws, and minimum quality standards for drinking water, for example, all led to significant improvements to our health and safety.

School immunization requirements, for example, made big strides in increasing vaccination rates and, in turn, combatting vaccine-preventable diseases like measles and chickenpox. Not only did requirements work to protect individual children, but the resulting high immunization rates made it harder for diseases to circulate—a process known as herd immunity—thus helping to protect an even greater number of people in the community.

Enforce Laws and Regulations that Protect Health and Ensure Safety

Health codes help prevent food-borne illness by requiring restaurants to adhere to certain standards, but would they be as effective if health officials never came out to inspect the kitchens? The same can be said for pharmaceuticals. Inspections of manufacturing facilities by the Food and Drug Administration help minimize the risk that medical products become contaminated. Policies can lead to population-level health improvements, but only if they are enforced.

Link People to Needed Personal Health Services

Health care in the United States is a fragmented and highly complicated system. Whether or not you are able to see a doctor when you need to can vary based on a wide range of factors, including your age, location, financial situation, health condition, and employment status. Public health agencies help ensure some of the most vulnerable populations in a community are able to access health care—and access doesn't just mean getting in to see a doctor. It can also mean having transportation to and from medical services, affordability of the care provided, and culturally appropriate translation of materials.

One of the biggest ways public health departments help link people to services is through public health centers. While often these centers provide direct medical care for low-income and uninsured individuals, they also often provide things like health education, counseling, and referral services. For example, the Special Supplemental Nutrition Program for Women, Infants, and Children—commonly called WIC—is often run by local health departments in an effort to ensure that all kids regardless of income have access to good nutrition in the first few years of life.

Assure Competent Public and Personal Health Care Workforce

Medicine is always changing to adapt to the latest research and available technologies. That's why medical professionals in the United States are required to take classes to stay up-to-date. Public health agencies like the Centers for Disease Control and Prevention, as well as local health departments, collaborate with medical associations to offer continuing education classes on a wide range of topics, including on things like bioterrorism and emergency preparedness—yes, even responding to natural disasters falls under public health, too.

Evaluate Effectiveness, Accessibility, and Quality of Health Services

As effective as public health efforts have been to save lives and improve the health of communities, there is always more that could be done. Health initiatives are under near constant monitoring and evaluation to verify they actually work, and programs that require funding are also assessed to ensure that resources are being used efficiently and effectively.

To do this, agencies look at a wide range of factors and involve a host of different specialties. Health economists, for example, can help estimate the cost effectiveness of a given policy change. Epidemiologists look at disease trends among participants of a particular health initiative to see if they've improved. Biostatisticians analyze data from surveys and medical records to determine whether certain health indicators in a given population have changed. Not only do the results from these evaluations help to improve programs, but insight gathered can also often be used for the first essential service list above.

Research for New Insights and Innovative Solutions to Health Problems

One of the most important ways public health works to protect the health and safety of a community is through asking questions, gathering data, and finding new and better ways to solve problems. Public health research done on vehicular crashes brought us safer cars and seat belts. Persistent investigations of a dental anomaly led to the inclusion of fluoride in drinking water. A better understanding of our immune system resulted in developing vaccines that have saved millions of lives and billions of dollars.

So no, public health isn't exactly glamorous. But it is pretty amazing.

Sources:

Centers for Disease Control and Prevention. The Public Health System and the 10 Essential Public Health Services.

The Community Toolbox. Chapter 2: Section 7. Ten Essential Public Health Services. Center for Community Health and Development at the University of Kansas.  

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