Public Health Services and Systems Kristine M. Gebbie, DrPH, RN Columbia University School of Nursing Center for Health Policy 630 West 168 th Street, Mail Box 6 New York, NY (212)

Developed as part of an Enhanced AHEC Community Partnership for Health Professions Workforce and Educational Reform project funded by the Health Resource and Service Administration (HRSA)

OBJECTIVES l Identify essential services l Describe core functions l Describe future trends

Report on the Future of Public Health Institute of Medicine, 1988 l Impact on public health practice and practitioners included s stimulus for public health system research s stimulus to strengthen the system s new vocabulary for describing the system

IOM 1988 Report, Continued l Mission of Public Health s Assuring healthy conditions s Focus on community-wide concerns s Organize efforts to address health concerns

IOM 1988 Report, Continued l Core Functions of Public Health s Assessment s Policy development s Assurance

Public Health in America l The IOM core functions paradigm is helpful but does not communicate well outside the public health world l Public health and interest in the health of populations were almost lost during the health reform debates l Public Health in America was written to provide a statement for general use

Public Health in America l The Vision s Healthy People in Healthy Communities l The Mission s Prevent disease and injury s Promote physical and mental health

Responsibilities of Public Health l Prevent epidemics and the spread of disease l Protect against environmental hazards l Prevent injury l Promote and encourage healthy behavior l Respond to disasters and assist in recovery l Assure quality and accessibility of health services

Public health is a continuous process that is supported by management & developed by research

Essential Services of Public Health l Monitor health status l Investigate outbreaks l Inform the public l Support coalitions l Develop policy l Enforce regulations

Essential Services of Public Health l Link people to care or provide care l Prepare the workforce l Assure quality, accessible, effective services l Research for new solutions

Core Functions and Essential Services l Assessment s Monitor health s Diagnose problems

Did you know that... l To diagnose diseases, the SC public health laboratory was established in 1909? l South Carolina got its first epidemiologist, Dr GE McDaniel, in 1935?

Core Functions and Essential Services l Policy Development s Inform and educate the public s Mobilize community partnerships s Develop policies and plans

Did you know that... l 1950’s pollution control policies were developed in partnership with the Development Board and the Textile Manufacturers Association? l Public health boards designing public health budgets and programs are carrying out a process similar to an individual giving informed consent for a medical procedure?

Core Functions and Essential Services l Assurance s Enforce laws and regulations s Link people to needed care and assure care when otherwise unavailable s Evaluate effectiveness, accessibility and quality of health services

Did you know that... l To assure services, the first public health nurse was hired in 1903? l To limit health hazards in the 1940’s, privies were built for $18.20? l The WIC program brought 16 nutritionists to the state in 1973?

Discussion Time l How can practicing health professionals participate in assessment, policy development or assurance at the local level?

Core Functions and Essential Services l Research is an essential service that supports all of the core functions l Leadership and management of the system transcend the functions and services

Did you know that... l Healthy People is our national visionary planning process for improving the nation’s health? l The goals of HP2010 are to increase years of healthy life and eliminate disparities in health? l Turning Point is SC’s state-wide, interactive process for transforming public health in the new century?

Forces Shaping Public Health l Public attitude toward government l Federalism and devolution of responsibility l The economy l Environmental policy l Changes in personal care and financing systems

Discussion Time l How can a public health perspective strengthen the perspectives dominant in your profession?

Summary l The vision of public health is healthy people in healthy communities. l The mission of public health is to prevent disease and injury and promote physical and mental health. l The core functions of public health are assessment, policy development and assurance.

Module Author Kristine M. Gebbie, DrPH, RN Elizabeth Standish Gill Associate Professor in Nursing Columbia University School of Nursing Director Center for Health Policy