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HEALTHY COMMUNITIES
<br />The report defined the three core functions of public health as:
<br />1. Assessment "Every public health agency [should] regularly and
<br />systematically collect, assemble, analyze, and make available information on the
<br />health of the community, including statistics on health status, community health
<br />needs, and epidemiologic and other studies of health problems. Not every agency
<br />is large enough to conduct these activities directly; intergovernmental and
<br />interagency cooperation is essential. Nevertheless each agency bears the
<br />responsibility for seeing that the assessment function is fulfilled. This basic
<br />function of public health cannot be delegated."
<br />2. Policy development "Every public health agency [should] exercise its
<br />responsibility to serve the public interest in the development of comprehensive
<br />public health policies by promoting use of the scientific. knowledge base in
<br />decision - making about public health and by leading in developing public health
<br />policy. Agencies must take a strategic approach, developed on the basis of a
<br />positive appreciation for the democratic political process."
<br />3. Assurance — "Public health agencies [should] assure their constituents that
<br />services necessary to achieve agreed upon goals are provided, by either
<br />encouraging actions by other entities (private or public sector), by requiring such
<br />action through regulation, or by providing services directly.... Public health
<br />agencies should] involve key policymakers and the general public in determining
<br />a set of high - priority personal and communitywide health services that
<br />governments will guarantee to every member of the community. This guarantee
<br />should include subsidization or direct provision of high - priority personal health
<br />services for those unable to afford them" (IOM, 1988).
<br />In the eight years since this report was released, there has been a significant
<br />strengthening of practice in governmental public health agencies and other
<br />settings. Substantial social, demographic, and technological changes in recent
<br />years (Brownson and Kreuter, in press), however, have made it necessary to
<br />reexamine governmental- public health agencies' efforts to improve the public's
<br />health.
<br />Building upon the conc6pts of assessment, assurance, and policy development
<br />contained in The Future of Public Health, a group of leading public health
<br />organizations (Public Health Functions Steering Committee, 1994) adopted a
<br />1 Members of the Public Health Functions Steering Committee include: American
<br />Public Health Association; Association of State and Territorial Health Officials; National
<br />Association of County and City Health Officials; Institute of Medicine, National
<br />Academy of Sciences; Association of Schools of Public Health; Public Health
<br />Foundation; National Association of State Alcohol and Drug Abuse Directors; and the
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<br />INTRODUCTION 9
<br />vision of public health as "healthy people in healthy communities," six public
<br />health goals, and ten essential public health services. The six public health goals
<br />are to: (1) prevent epidemics and the spread of disease, (2) protect against
<br />environmental hazards, (3) prevent injuries, (4) promote and encourage healthy
<br />behaviors, (5) respond to disasters and assist communities in recovery, and (6)
<br />assure the quality and accessibility of health services.
<br />The ten essential public health services are to:
<br />1. monitor health status to identify community health problems;
<br />2. diagnose and investigate health problems and health hazards in the
<br />community;
<br />3. inform, educate, and empower people about health issues;
<br />4. mobilize community partnerships to identify and solve health problems;
<br />5. develop policies and plans that support individual and community health
<br />efforts;
<br />6. enforce laws and regulations that protect health and ensure safety;
<br />7. link people to needed personal health services and ensure the provision of
<br />health care when it is otherwise unavailable;
<br />S. ensure the availability of a competent public health and personal health
<br />care workforce;
<br />9. evaluate , effectiveness, accessibility, and quality of personal and
<br />population -based health services; and
<br />10. research new insights and innovative solutions to health problems.
<br />These essential public health services were used to describe public health more
<br />readily to external audiences and constituencies and played an important role in
<br />defining public health during the 1993 -1994 health care reform debate (Turnock
<br />and Handler, 1995).
<br />FACTORS AFFECTING PUBLIC HEALTH
<br />We live in a complexly, interconnected global society in which there are
<br />many threats to, and opportunities to improve, the public's health. In recent years,
<br />we have witnessed the emergence or reemergence of infectious diseases such as
<br />hanta virus, cryptosporidiosis, Fscherichia coli 0157, and Ebola virus (Gordon et
<br />U.S. Public Health Service (Centers for Disease Control and Prevention, Health
<br />Resources and Services Administration, Office of the Assistant Secretary for Health,
<br />Substance Abuse and Mental Health Services Administration, Agency for Health Care
<br />Policy and Research, Indian Health Services, and Food and Drug Administration).
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