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The three core functions of public health were first proposed in the Institute of Medicine’s (IOM) 1988 report called The Future of Public Health (Walker, 1989). This report defined the mission and core functions of governmental public health services and suggested fundamental recommendations to correct a system that was, at that time, in disarray. Building on this report, in 1994, the United States Public Health Service (PHS) released the Public Health in America statement, which provided a framework defining the goals and services of governmental health agencies. Included in the statement were the three core functions of assessment, policy development, and assurance, as well as the 10 essential services of public health (Riegelman & Kirkwood, 2023). Each function and essential public health service is described in detail in this lesson.
Assessment is a core public health function and refers to the collection and analysis of data and information regarding health problems. Public health professionals collect data and conduct research on health conditions, the potential risks of health conditions, and what resources are available to address health conditions. These assessments will address the prevention of disease and injury as well as intervention (methods or programs used to reduce the impact of disease and injury). Through the use of assessments, we can monitor the environmental, physical, mental, social, or behavioral health status of individuals and populations. Using assessments, we can also investigate environmental health problems and hazards within a community.
IN CONTEXT
Assessment Drives Informed Decisions
When you go to see your doctor, whether for an annual physical (preventing illness or injury) or because you are sick, the first things that are done are collecting data and gathering information on how you are feeling and your physical condition. You may have your blood pressure taken, you may step on a scale to assess your weight, your heart rate may be measured, and the doctor may also listen to your heart and lungs. Questions may be asked about how you are feeling and what, if any, symptoms you are experiencing. You may be asked to have blood or urine tests conducted. The results of all of these assessments (the data and information combined) will help your medical team understand the status of your individual physical health and how to respond if you need treatment.
While physicians are mainly concerned with individual health, public and community health professionals focus their assessments on the general population and populations within specific communities. Recall that communities are populations of people with shared interests, needs, experiences, and cultural ties. Epidemiology is a field of study within public health that investigates the burden of disease on populations, the distribution of disease, and the "person" and "place" of a disease to identify patterns or associations in the frequency of occurrence of a disease over a period of time. Such associations may suggest ideas about the etiology (cause) of disease.
Epidemiologists are the professionals who use the data and information from assessments to investigate the demographic and behavioral characteristics related to the “persons” experiencing the burden of disease over a period of time. These would include factors like age, sex, race, ethnicity, and gender, as well as socioeconomic factors. “Place” refers to the geographic location, such as a city or state, and could also include cyber communities (people who share the same internet site) or university communities, for example (Riegelman & Kirkwood, 2023, p. 32).
Epidemiologists play a crucial role in safeguarding public health. Their responsibilities include not only disease investigation and distribution but also surveillance (monitoring disease patterns and tracking outbreaks of disease that help to understand disease) and investigation of the prevalence rate (a measurement of the number of people who have a disease at a particular point in time) and the incidence rate (a measure of the chance of occurrence, or the number of new cases, of a disease over a period of time). Epidemiologists also conduct research and develop guidelines to promote positive health outcomes and make policy recommendations advising officials on how to control the spread of disease. They also compile reports to inform government officials and to establish or enhance public health practices.
Another core function of public health practice is Policy Development. Once the assessments are complete, the data and information are analyzed and interpreted. The results are then shared through the publication of research articles, internal and external reporting to various governments or agencies, and the communication of health messages. This function also involves community consultation and citizen participation in deciding on public health measures. Working partners or collaborators (formerly known as “stakeholders”) weigh the available data and information regarding health problems, programs, and threats to determine appropriate evidence-based interventions or policy decisions.
The process of policy development begins with setting an agenda that identifies the health issue that requires attention. Policy formulation involves developing potential solutions or strategies to address the issue. Policy adoption means that decision-makers (policymakers or other governing bodies) formally vote on or accept the proposed policy. Accepted policies then need to be put into action and evaluated for impact and effectiveness.
Evidence-based approaches to health problems (public or community health) refer to the development and delivery of services to people based upon data and scientific evidence that show that the services actually work (Seabert et al., 2022). Some key aspects of policy development include using evidence-based information to educate people about public health issues and mobilizing community partnerships to address health problems that then lead to the development of policies that support individual and community health efforts.
IN CONTEXT
Smoke-Free Policies
Years ago, 100% smoke-free public buildings and venues did not exist. You could walk into any restaurant, concert or sports venue, or office building and inhale the smoke from smokers. Over time, the data and information collected about the harms related to tobacco use and inhalation of secondhand smoke informed public health, medical professionals, and policymakers about the very serious effects of secondhand smoke on people who do not smoke. The burden of disease and associated costs to both the smoker and the bystander inhaling secondhand smoke created a demand for policy change. Over the years, the development and enforcement of 100% smoke-free policies in public buildings and venues led to a reduction of lung disease in people who did not smoke and created an environment that promotes a reduction in tobacco use and an increase in smoking cessation (World Health Organization, n.d.).
Laws and regulations in public health often start with policies. Laws are formal rules established by Congress or at the state level. Laws have legal authority and are also enforceable. Smoke-free air laws were developed as a policy response to protect the public from secondhand smoke. Essentially, they regulate smoking in public places. Mandatory seat belt laws are another example of enforceable laws that protect public health. Later in this course, you will explore more about public health policies, laws, and regulations.
Assurance is the third and final core function of public health practice. Assurance refers to the responsibility and oversight by governmental and nongovernmental public health agencies to ensure that the key parts of a health care system or public health system are in place and effective in providing access, equity, and quality.
The core function of assurance actively promotes community health by ensuring accessible, high-quality services. It underscores the responsibility of public health services to protect population health and reduce inequities. State and local health departments are government agencies that implement this core function.
IN CONTEXT
Assurance through Vaccination Clinics
Vaccination clinics are examples of a program that a health department would implement under the core function of assurance. If a community is experiencing an outbreak of a vaccine-preventable disease, like measles, which poses a significant health risk to vulnerable populations, the public health department will engage with local health care providers, schools, community organizations, and religious organizations to help mobilize the community to promote vaccine awareness. Vaccination clinics established throughout the community in schools, public places, and mobile clinics can assure access to vaccinations. This includes those in underserved communities, thereby increasing vaccination rates, reducing disease transmission, and enhancing community protection.
The core functions of public health, while useful in providing a framework for governmental public health practice, were not tangible enough for the daily work of public health agencies. Thus, in their statement that promoted the core functions, PHS offered a series of 10 essential services in public health to guide daily responsibilities in public health practice and provide a mechanism for evaluating whether the core functions were fulfilled.
The Essential Public Health Services (EPHS) was revised in 2020 to bring the practice of public health in line with current and future practice. The revised services below are each mapped to one of the three core functions.
| Essential Service | Core Function | Purpose |
|---|---|---|
| Assessing and monitoring population health | Assessment | Understanding health status, community needs, and assets |
| Investigating, diagnosing, and addressing health problems | Assessment | Identifying and solving health issues and hazards affecting the population |
| Communicating effectively to inform and educate | Policy development | Informing people about influencing factors on health and improvement strategies for the health status of individuals, populations, and/or communities |
| Creating, championing, and implementing policies, plans, and laws | Policy development | Impacting health through policy changes |
| Utilizing legal and regulatory actions designed to improve and protect public health | Policy development | Enforcing health-related laws and regulations |
| Strengthening, supporting, and mobilizing communities and partnerships | Assurance | Improving health outcomes through collaboration with others |
| Assuring an effective system for equitable access to services and care | Assurance | Ensuring that everyone has access to needed services |
| Building and supporting a diverse and skilled public health workforce | Assurance | Strengthening and growing the public health workforce to deliver effective public health services |
| Improving and innovating public health functions through ongoing evaluation, research, and continuous quality improvement | Assurance | Enhancing public health practice |
| Building and maintaining a strong organizational infrastructure for public health | Assurance | Ensuring a strong foundation for public health efforts |
Both the core functions and EPHS actively promote equity and aim to remove systemic barriers like lack of insurance; financial disadvantage; health care staff shortages; limited access; stigma; bias related to race, gender, or ethnicity; lack of transportation; and more. Overall, the three core functions and the EPHS are frameworks that are meant to promote the health of all people in all communities (Office of Disease Prevention and Health Promotion, n.d.).
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REFERENCES
Office of Disease Prevention and Health Promotion. (n.d.). Healthy people 2030: Access to health services. U.S. Department of Health and Human Services. health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-health-services
Riegelman, R. & Kirkwood, B. (2023). Social and behavioral sciences and public health. In Public health 101: Improving community health (4th ed.). Jones & Bartlett Learning.
Seabert, D. M., McKenzie, J. F., & Pinger, R. R. (2022). Community organizing/Building and health promotion. In An introduction to community & public health (10th ed.). Jones & Bartlett Learning.
Walker, B., Jr. (1989). The future of public health: The Institute of Medicine's 1988 report. Journal of Public Health Policy, 10(1), 19–31.
World Health Organization. (n.d.). Driving the creation of smoke-free public places. www.who.int/europe/activities/driving-the-creation-of-smoke-free-public-places
