2Principles of Standards and Measures Advance the collective public health practiceModerate level: not minimum, not maximumBe clear, reduce redundancy, minimize burdenBuild quality improvement into standardsApply to all sizes of HDs and all forms of governance structureEstablish same standards for Tribal, state, and local health departmentsBe reflective of emerging public health issues and opportunities; andPromote effective internal and external collaborative partnerships.
3PHAB 12 Domains Based on Core Functions of Public Health & Ten Essential Public Health Services The Essential Public Health Services provide the fundamental framework for the PHAB standards and measures, as these activities describe the full range of public health responsibilities. Using the 10 Essential Services framework assures that the PHAB standards fully cover the gamut of public health activities needed.History lesson for how the 10 Essential Services came to be: Many of you may be familiar with the core functions, which were outlined in the 1988 Institute of Medicine report - The Future of Public Health. As stated in the IOM report, the three core functions of public health are assessment, policy development and assurance. This is a good start to describing public health, but 1994, when the country was exploring issues related to health care reform, the public health sector felt that a better definition and description of public health was needed. A “Core Functions of Public Health Steering Committee” was convened to address this need. This Steering Committee involved representatives from Public Health Service Agencies (CDC, HRSA, Office of Disease Prevention and Health Promotion, etc.) and key National Public Health Organizations. The committee produced a statement called “Public Health in America.”Public Health in America – Vision and MissionThe Public Health In America statement provides a vision and mission for public health as well as the context of what public health should be prepared to do and how public health service is delivered. The vision for public health is broad, “Healthy People in Healthy Communities.” The mission identified is to “Promote Physical and Mental Health and Prevent Disease, Injury, and Disability”.The last part of the Public Health in America statement defines the “Essential Services of Public Health”. The ten essential services are shown up here on the screen and include:Monitor health status to identify and solve community health problemsDiagnose and investigate health problems and health hazards in the communityInform, educate, and empower people about health issuesMobilize community partnerships to identify and solve health problemsDevelop policies and plans that support individual and community health effortsEnforce laws and regulations that protect health and ensure safetyLink people to needed personal health services and assure the provision of health care when otherwise unavailableAssure a competent public and personal health care workforceEvaluate effectiveness, accessibility, and quality of personal and population-based health servicesResearch for new insights and innovative solutions to health problemsBasically, any public health activity can fit into one of these ten categories. So for example, Essential Service #1 includes activities such as data collection, community health assessments and the maintenance of population health registries. As another example, Essential Service #7 includes personal health care services as well as transportation and other enabling services and assuring the availability of culturally appropriate personnel and materials. Since the release of the ten Essential Services, numerous initiatives have explored the utility and feasibility of these services and have found them to be a good descriptor of public health.
4Twelve Domains of Standards Conduct assessments focused on population health status and health issues facing the communityInvestigate health problems and environmental public health hazards to protect the communityInform and educate about public health issues and functionsEngage with the community to identify and solve health problemsDevelop public health policies and plansEnforce public health laws and regulationsPromote strategies to improve access to healthcare servicesMaintain a competent public health workforceEvaluate and continuously improve processes, programs, and interventionsContribute to and apply the evidence base of public healthMaintain administrative and management capacityBuild a strong and effective relationship with governing entityThe standards are made up of domains, standards, measures and required documentation.There are 12 domains made up of standards that pertain to a broad group of public health services.Domains 1 through 10 relate to the 10 Essential ServicesDomain 11 relates to management and administrationDomain 12 relates to governance
7Comprehensive Community Health Assessment Collect and manage data Domain 1 Conduct assessments focused on population health status and health issues facing the communityComprehensive Community Health AssessmentCollect and manage dataSurveillance systemPrimary and secondary dataAnalyze data for trends in health hazards, environmental public health, and social determinants of healthUse the data to inform policy, processes, programs, and interventions.
8Domain 2 Conduct timely investigations of health problems and environmental public health hazards Conduct investigations (protocols, multiple investigations of infectious and non-infectious, manage process for reportable disease)Contain and mitigate health problems and environmental public health hazards (protocols, All Hazards Emergency Operations Plan, After Action Reports)Public health laboratory and epidemiology capacity ( 24/7 rapid detection, surge capacity, partnerships with other HDs for investigations)Plan, policies, and procedures for urgent and non-urgent communication (protocols, health alerts, coordinate responses, communicate with the public)
9Domain 3 Inform and educate about public health issues and functions Health education and health promotion (a planned approach and strategies to protect the public and provide information)Healthy behaviors, health risks, and healthy decisions for specific populations, with their input and feedbackSpecifically address factors that contribute to specific populations; higher health risks and poorer health outcomesProvide information on PH issues and PH functionsRelation with the mediaBranding strategyCommunication proceduresRisk Communications planInformation through a variety of methodsCulturally sensitive and linguistically appropriate
10Engage with the community Domain 4 Engage with the community to identify and solve health problemsEmphasis is on the process, the use of the partnership, and the mutual collaborationEngage with the communityPartnerships and coalitionsShare Models for engaging the communityCommunity policy or program change implemented through partnershipPromote community’s understanding to support policies and strategiesEngage with community membersEngage with policy makers (advisory board, elected officials)
11Domain 5 Develop public health policies and plans Be the experts for PH policy, practices, and capacityinform, track/monitor, adviseCommunity health improvement planBroad participationConsider social determinants and policy changes to address health inequitiesHealth department strategic planAll hazards emergency operations plan
12Domain 6 Enforce public health laws and regulations Laws = regulation, executive orders, statutes, and other types of lawsProcess for reviewing public health lawsInform others when changes are neededEducating the public and others on the importance and interpretation of public health lawsEnforcing public health lawsInspectionsComplianceAnalysis of compliance
13Domain 7 Promote strategies to improve access to healthcare services Assess health services and capacityCollaborative processConsider emerging issues in public health, the health care system, and health care reimbursementIdentify populations with barriersIdentify populations with barriers to health care and gaps in servicesIdentify and implement strategies to improve accessImplement strategiesCulturally competent initiatives
14Domain 8 Maintain a competent public health workforce Encourage development of sufficient number of qualified PH workersPartnerships with schools to promote public healthAssure a competent workforceWorkforce development plan and implementCompetent workforceProfessional and career developmentSupportive work environment
15Domain 9 Evaluate and continuously improve processes, programs, and interventions Performance management system (overall approach to program evaluations)Engage all staffPerformance management policy/systemImplement - analysis of progress on achievement of goals, objectives and measuresCustomer satisfaction2. Quality improvement processesQI planQI activities based on plan
16Domain 10 Contribute to and apply the evidence base of public health Use best practice availableEvidenced-based and/or promising practiceFoster innovationCommunicate research and/or best and promising practicesProtection of human subjectsExpertise to consider implications of research
17Domain 11 Maintain administrative and management capacity Operational infrastructurePolicies and proceduresEthical decision making processConfidentialityCulturally and linguistically appropriate approaches and health equityHR system and policies and proceduresInformation managementFacilities clean, safe, and accessible2. Financial managementFinancial and programmatic oversightWritten agreementsFinancial management systemSeek resources
18Operational definitions of roles, responsibilities and authorities Domain 12 Build a strong and effective relationship with governing entityOperational definitions of roles, responsibilities and authoritiesInform governing entity about PH and HDEngage governing entity in HD’s responsibilitiesCommunication