This year marks the 25th anniversary of the 10 Essential Services of Public Health – an opportunity to both commemorate the progress of the public health field and ask how well the framework continues to work for our current and future public health needs.
The Essential Services are based on a document created in 1994 by a federal working group under the leadership of the Centers for Disease Control and Prevention. Its purpose was to translate the complex language of the Institute of Medicine’s 1988 assessment of the U.S. public health system titled The Future of Public Health, which identified three core functions – assessment, policy development, and assurance.
At the de Beaumont Foundation, we want to celebrate what public health has achieved over the last 25 years, appreciate how the 10 Essential Services framework has been applied, and consider what kind of framework will be needed for the next 25 years. Much has changed in the practice of public health, shaped by the field itself and many external developments, including:
- Obesity, diabetes, cancer and heart disease led an epidemiologic transition from acute infections to chronic diseases. The rapid and pervasive spread of obesity showed us we can’t tackle chronic disease alone, and need to work with multi-sector partners to use policy to make the healthy choice the easy choice.
- At the same time, the increase in globalization created a world where borders provide no protection from germs. Emerging infectious diseases like SARS, Ebola, and Zika have irreversibly changed how we respond to potential pandemics.
- Many new vaccines have been developed, and there are now several available for adults. Unfortunately, we’ve also developed an epidemic of anti-vaccine sentiment.
- Activists demanded a robust response to HIV/AIDS from public health, clinical medicine, and basic science. We have been rewarded with a decreasing rate of new infections and AIDS deaths, but the number of people living with AIDS continues to rise. The epidemic illuminated the ways culture and politics can inhibit public health progress.
- Terrorism and large-scale natural disasters transformed the field of emergency preparedness and response, compelling different sectors to work together for the public good. Hurricane Katrina showed the world how starkly different the experiences of haves and have-nots can be in this country.
- We experienced a great deal of success in tobacco control and prevention, partly because of the master settlement agreement, which shaped the way we think about corporate responsibility and ways we can fight against harmful products.
- School shootings and gun violence have increased attention to violence prevention, pointing to a desperate need for more research and effective policy solutions.
- LGBTQ advocates showed us how the interrelationships between culture, law, stigma, and health can cause sweeping change.
- Marijuana legalization is giving us the opportunity to demonstrate what lessons we learned from the past decades of alcohol and tobacco control, while the opioid epidemic has shown how far we have to go in addressing substance abuse challenges.
- Sweeping changes in technology were both disruptive and transformative. The advent of informatics, smartphones, and the popularization of the internet have contributed to sedentary lifestyles and social isolation, while also democratizing information, making telemedicine and electronic health records possible, and creating profound opportunities to harness big data to improve health.
While all of these sweeping changes were unfolding, the field of public health used the 10 Essential Services as an organizing framework to communicate the role of the field, to develop performance standards, to build an accreditations system, and to assist other nations as they built capacity in their own public health systems. We’ve also seen the emergence of new frameworks that serve similar but distinct purposes, such as the Culture of Health, Foundational Public Health Services, and Public Health 3.0.
I recently had the opportunity to solicit feedback about the Essential Services at the first-ever Public Health Innovation Summit & Showcase, hosted by the Public Health National Center for Innovations (PHNCI), a division of the Public Health Accreditation Board. The two-day event brought together leaders from across the nation to explore ways to advance innovation in governmental public health.
The audience quickly reached consensus that it is time to conduct a systematic review of the framework and consider at least minor if not major changes to it. Public health leaders suggested that we should pay particular attention to health equity, preparedness, management & governance, informatics, assurance, research, and evaluation among many other suggestions. These thoughtful responses and passionate energy led me to want to hear more from public health professionals about their perspectives on the future of public health.
We will be reaching out soon to gather feedback about the role the 10 Essential Services have played and the framework we need for the next 25 years. (If you’re not already getting our newsletter, sign up now to be part of this opportunity.) We look forward to engaging other organizations and leaders to explore the future of public health.
The 10 Essential Public Health Services
Assessment
- Monitor and evaluate health status to identify community health problems.
- Diagnose and investigate health problems and health hazards in the community.
Policy Development
- 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.
Assurance
- Enforce laws and regulations that protect and ensure public health and 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.
