2. Principles of Standards and Measures
Advance the collective public health practice
Moderate level: not minimum, not maximum
Be clear, reduce redundancy, minimize burden
Build quality improvement into standards
Apply to all sizes of HDs and all forms of governance structure
Establish same standards for Tribal, state, and local health departments
Be reflective of emerging public health issues and opportunities; and
Promote effective internal and external collaborative partnerships.

3. PHAB 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 Mission
The 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 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 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
Basically, 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.

4. Twelve Domains of Standards
Conduct assessments focused on population health status and health issues facing the community
Investigate health problems and environmental public health hazards to protect the community
Inform and educate about public health issues and functions
Engage with the community to identify and solve health problems
Develop public health policies and plans
Enforce public health laws and regulations
Promote strategies to improve access to healthcare services
Maintain a competent public health workforce
Evaluate and continuously improve processes, programs, and interventions
Contribute to and apply the evidence base of public health
Maintain administrative and management capacity
Build a strong and effective relationship with governing entity
The 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 Services
Domain 11 relates to management and administration
Domain 12 relates to governance

7. Comprehensive Community Health Assessment Collect and manage data
Domain 1 Conduct assessments focused on population health status and health issues facing the community
Comprehensive Community Health Assessment
Collect and manage data
Surveillance system
Primary and secondary data
Analyze data for trends in health hazards, environmental public health, and social determinants of health
Use the data to inform policy, processes, programs, and interventions.

8. Domain 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)

9. Domain 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 feedback
Specifically address factors that contribute to specific populations; higher health risks and poorer health outcomes
Provide information on PH issues and PH functions
Relation with the media
Branding strategy
Communication procedures
Risk Communications plan
Information through a variety of methods
Culturally sensitive and linguistically appropriate

10. Engage with the community
Domain 4 Engage with the community to identify and solve health problems
Emphasis is on the process, the use of the partnership, and the mutual collaboration
Engage with the community
Partnerships and coalitions
Share Models for engaging the community
Community policy or program change implemented through partnership
Promote community’s understanding to support policies and strategies
Engage with community members
Engage with policy makers (advisory board, elected officials)

11. Domain 5 Develop public health policies and plans
Be the experts for PH policy, practices, and capacity
inform, track/monitor, advise
Community health improvement plan
Broad participation
Consider social determinants and policy changes to address health inequities
Health department strategic plan
All hazards emergency operations plan

12. Domain 6 Enforce public health laws and regulations
Laws = regulation, executive orders, statutes, and other types of laws
Process for reviewing public health laws
Inform others when changes are needed
Educating the public and others on the importance and interpretation of public health laws
Enforcing public health laws
Inspections
Compliance
Analysis of compliance

13. Domain 7 Promote strategies to improve access to healthcare services
Assess health services and capacity
Collaborative process
Consider emerging issues in public health, the health care system, and health care reimbursement
Identify populations with barriers
Identify populations with barriers to health care and gaps in services
Identify and implement strategies to improve access
Implement strategies
Culturally competent initiatives

14. Domain 8 Maintain a competent public health workforce
Encourage development of sufficient number of qualified PH workers
Partnerships with schools to promote public health
Assure a competent workforce
Workforce development plan and implement
Competent workforce
Professional and career development
Supportive work environment

15. Domain 9 Evaluate and continuously improve processes, programs, and interventions
Performance management system (overall approach to program evaluations)
Engage all staff
Performance management policy/system
Implement - analysis of progress on achievement of goals, objectives and measures
Customer satisfaction
2. Quality improvement processes
QI plan
QI activities based on plan

16. Domain 10 Contribute to and apply the evidence base of public health
Use best practice available
Evidenced-based and/or promising practice
Foster innovation
Communicate research and/or best and promising practices
Protection of human subjects
Expertise to consider implications of research

17. Domain 11 Maintain administrative and management capacity
Operational infrastructure
Policies and procedures
Ethical decision making process
Confidentiality
Culturally and linguistically appropriate approaches and health equity
HR system and policies and procedures
Information management
Facilities clean, safe, and accessible
2. Financial management
Financial and programmatic oversight
Written agreements
Financial management system
Seek resources

18. Operational definitions of roles, responsibilities and authorities
Domain 12 Build a strong and effective relationship with governing entity
Operational definitions of roles, responsibilities and authorities
Inform governing entity about PH and HD
Engage governing entity in HD’s responsibilities
Communication