The Ten Essential Services A standard framework for

The Ten Essential Services A standard framework for public health è Structure of the Course è Why the Essential Services ? è New Applications Performance Measurement Workforce Development

Examining the Ten Essential Services è A developmental course - i. e. We need your participation and comments ! è Ten three hours sessions to examine the ten essential services. è Each session conducted by University faculty and IDPH practitioners è Concludes with individual reports è E-mail connection - chris-atchison@uiowa. edu

Individual Reports At the final class each participant will have 10 minutes to explain: è How the 10 essential services fits into their work situation è Identify at least one other unit or agency which would share responsibility for each of the 10 services. è Evaluate how effective each service is being implemented.

What is Health? è The absence of Disease or Disability è The “complete physical, mental and social well being and not merely the absence of disease or infirmity”. (W. H. O. )

What is Public Health ? è Governmental Services (Especially Medical Care for the Poor) è The Methods (Knowledge and Techniques) è The Profession è The System and Social Enterprise è The Health of the Public Bernard J. Turnock

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

- 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. MMWR - APRIL 24, 1992

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. Robert D. Behn 1987

- In the Beginning Core Functions and a Division of Responsibility è è 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

Assessment The Process of Understanding Population Health Status Threats to Health Community Health Resources Kristine Gebbe

Policy Development è Reduce threats to health è Support positive resources è Reduce disease è Advance overall community health

Assurance The process of assuring: è Availability è Accessibility Quality è

IOM Report - Federal Responsibilities è Support knowledge development and dissemination è Establish national health objectives and priorities è Provide technical assistance è Provide funding for capacity development è Assure the public interest, nationally

IOM Report - State Responsibilities - è Assess needs based on statewide data è Assure a statutory base è Establish state health objectives è Assure appropriate services è Support local service capacity

IOM Report - Local Responsibilities è Assess and monitor for local health problems and solutions è Provide leadership for local involvement è Assure high quality services The Future of Public Health

Public Health in America Vision: Healthy People in Healthy Communities Essential Public Health Services è è è è è 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

1. Monitor Health Status Kinds of Activities è è è è 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

2. Investigate Health Problems and Health Hazards Kinds of Activities è communicable disease, chronic disease and injury detection è outbreak investigation and control è contact tracing è population-based screening services è HIV/AIDS prevention è environmental risk assessment and sampling è investigation of toxic substances è diagnostic and environmental laboratory services

3. Education Kinds of Activities è school health education è school campaigns è population-wide health promotion/risk reduction programs è nutrition education è substance abuse prevention è worksite health promotion è HIV education è education related to enforcement of laws and regulations

4. Mobilize Community Partnerships to Solve Health Problems Kinds of Activities è coalition building è collaboration è community partnerships è advocacy and budget justification è technical assistance to communities

5. Legal and Policy Initiatives Kinds of Activities è agenda setting è development of policies and guidelines è legislative activities è planning models

6. Enforce Laws and Regulations Kinds of Activities è air quality è sanitation è housing è substance control/product safety è vector/rodent control è fluoridation services è hazardous materials management è occupational health and safety è environmental hazards è waste management è water quality control è emergency response è toxicology and forensic medicine è youth access to tobacco è enforcement of quarantine and mandated supervision of medication

7. Manage and Coordinate Health Care Kinds of Activities è è è è case management/care coordination services outreach services transportation and other enabling services development of primary care services in underserved communities personal health services clinical preventive services school-based clinical services management of client-based data systems

8. The Public Health and Personal Health Care Workforce Kinds of Activities è professional education and training è recruitment and retention of health professionals è continuing education è licensing of health and environmental professionals è leadership training/programs

9. Evaluate Personal and Population-Based Health Services Kinds of Activities è è è è è facilities licensing health care systems monitoring personal health services monitoring program evaluation data systems laboratory regulation of EMS personnel/services quality improvement programs evaluation of outcomes data

10. Research Initiatives Kinds of Activities è biomedical, preventive, and clinical investigations è health services research and research grants è research and monitoring about the effects of the changing healthcare environment è demonstration programs è methods development è innovative technologies

The Essential Services reflect public health practice The Washington E-Coli Example è Physician notes HUS è ER reports of bloody diarrhea è Labs id cause as E. coli è State epidemiologists locate source è New lab tests confirm case links è 250, 000 hamburger patties recalled è Media campaign alerts public

Why make the use of the Ten Essential Services Routine? è By Definition - Public Health requires collective action è From our Strategic Plan - We must not be in disarray è Our base - Public Policy new levels of organization and integration

Public Policy Developments è Performance Measurement è Workforce Design è New Demands on Public Health

Government-wide Forces for Change è Budgets will continue to shrink substantially è Demands and requirements will continue to grow è Diminishing public confidence in government's ability to deliver services

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.

Benefits of Performance Measurement QUALITY IMPROVEMENT è Objective performance measures will define performance expectations, provide data for benchmarking, and become an impetus for action. ACCOUNTABILITY è 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 è Performance measurement data will provide a scientific basis for better decision-making, useful comparative data for evaluation, and will strengthen external leverage in partnership.

Why Measure Public Health Performance? è The need to effectively measure public health performance is urgent. è 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. è 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.

Performance Measures National Purpose The National Public Health Performance Standards Program (NPHPSP) is a partnership effort to: è Develop performance standards for public health practice as defined by the Essential Services of Public Health, è collect and analyze performance data, and è improve system-wide performance. PHPPO

Performance Measurement National 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.

U. S. D. H. H. S. Healthy People 2010

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

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

Cross Cutting Competencies for The Public Health Workforce è Analytic è Communication è Policy Development è Cultural è Basic P. H. Science è Leadership and Systems Thinking è Management and Information Management Task Force on Public Health Workforce Development

A working model for the Public Health Workforce Competencies Essential Services Monitor Investigate Educate Mobilize Develop Policy Enforcement Personal Care Workforce Evaluation Research Analysis Communication Policy and Program Cultural Basic Science Finance/ Mgt Organization

Capacity-Process-Outcome Links Process Capacity Outcomes (Essential Public Health Services) Outputs Key Processes System Inputs è Workforce Information Organization & Relationships Facilities Funding è Assess Develop Policy Assure Programs and Services consistent with mandates and community priorities è Improved organizational performance Improved program performance Improved Outcomes Dr. Bernard Turnock

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

The Evolving Agenda of Public Health Determinants of Health Chronic Disease Infections Hygiene

The Determinants of Health Social Environment Physical Environment Genetic Endowment Individual Response • Behavior • Biology Health and Function Disease Health Care Well-Being Prosperity Evans and Stoddart

Executive Strategies Healthy Iowans Results Budgets Program Infrastructure Staff and other Professional Services Legislative Community Empowerment Tactics Essential Services Indicators Performance Measures Fiscal Policy Studies Institute