Transcript Core Functions and Essential Services

Core Functions and
Essential Services
IDPH Education
Tom 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

Assurance
Policy Development
ASSESSMENT
*start here
Policy
Development
Assurance
*Assessment
1995 PH Functions Steering Committee
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
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.
2.
3.
Monitor health status.
Diagnose and investigate
health problems and hazards.
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 populationbased 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.
5.
6.
Develop policies and plans
Enforce laws and regulations
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
Link people to needed services
8. Assure a competent workforce
9. Inform, educate, and empower
people
10. Mobilize community partnerships
7.
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.
2.
3.
Monitor health status.
Diagnose and investigate health
problems and hazards.
Evaluate effectiveness, accessibility,
and quality.
Policy Development
4.
5.
6.
Develop policies and plans
Enforce laws and regulations
Research new insights
Assurance
Link people to needed services
8. Assure a competent workforce
9. Inform, educate, and empower
people
10. Mobilize community partnerships
7.