Core Functions of Public Health

Key Concepts

• Core Functions of Public Health: Assessment, Policy Development, Assurance
• 10 Essential Public Health Services
• Stakeholders in Public Health: Community, Clinical Care System, Employers/Businesses, Media, Academia, Government
• Non-Governmental Organizations (NGOs) in Public Health
• Health Determinants: Genes/Biology, Individual Health Behaviors, Social/Societal Characteristics, Health Services/Medical Care
• Social Determinants of Health
• Health Impact Pyramid

Core Functions and Essential Services

The core functions of public health are:

1. Assessment: Collecting, analyzing, and making available information on the health of a community. This includes monitoring health and diagnosing/investigating diseases.
2. Policy Development: Creating laws and policies to support public health. This involves informing, educating, and empowering people about health issues.
3. Assurance: Ensuring that essential health services are available to everyone and that laws are enforced. This includes enforcing laws, linking people to care, and evaluating the effectiveness of interventions.

Example: E-Vaping Crisis

• Assessment: Hospitals and urgent care centers noticed an increase in patients with damaged lungs, leading to an investigation into the cause.
• Policy Development: Public health officials informed and educated the public about the dangers of e-vaping, particularly the harmful chemicals involved. Policies were developed to prevent the targeting of teenagers and young adults by e-cigarette companies like Juul.
• Assurance: Law enforcement agencies fined retailers selling e-cigarettes to underage individuals. Efforts were made to link addicted individuals to cessation programs.

The core functions are a continuous cycle of research, policy adjustment, and evaluation. Public health is a constantly evolving field, adapting to new information and changing circumstances.

Federal, State, and Local Examples:

• Federal: Tobacco health surveillance (assessment), ban on smoking on flights (policy development), federal grants for anti-smoking research (assurance).
• State: Monitoring tobacco use (assessment), tobacco taxes (policy development), funding anti-tobacco campaigns (assurance).
• Local: Enforcing tobacco use ordinances, fining non-compliant bars, providing resources for smoking cessation (assurance).

Question: Which of the following is not a core function of public health? Answer: Authority. Public health partners with law enforcement for policing.

Question: Monitoring health and diagnosing/investigating disease relate to which core function? Answer: Assessment.

Stakeholders and Roles in Public Health

Public health requires collaboration with various stakeholders:

• Community: Engaging community members in health initiatives.
• Clinical Care System: Providing personal health services, diagnostic treatments, and clinical services.
• Employers and Businesses: Implementing wellness initiatives and benefits for employees.
• Media: Serving as a vehicle for public discourse on health issues.
• Academia: Conducting education, training, and research.
• Government: Developing health in all policies.

Non-Governmental Organizations (NGOs):

• Professional membership organizations (e.g., American Public Health Association).
• Organizations focused on specific health concerns (e.g., American Cancer Society).
• Citizen organizations (e.g., Americans for Non-Smokers' Rights).
• Foundations (e.g., Bill & Melinda Gates Foundation).

Examples of Stakeholder Roles:

• Media: Vehicle for public discourse.
• Government: Health in all policies.
• Academia: Education and training.
• Employers/Businesses: Wellness initiatives and benefits.

Determinants of Health and the Health Impact Pyramid

The four determinants of health are:

1. Genes and Biology: Genetic predispositions and biological factors.
2. Individual Health Behaviors: Lifestyle choices and habits.
3. Social/Societal Characteristics: Social and economic factors, including where people live, work, and play.
4. Health Services/Medical Care: Access to and quality of healthcare.

Social determinants of health have the greatest impact on overall health. Where people live, work, and play significantly influences their health outcomes.

Health Impact Pyramid:

• Bottom (Greatest Public Health Impact): Socioeconomic factors (e.g., poverty reduction, education).
• Second Level: Changing the Context to Make Individuals' Default Decisions Healthy (e.g., seatbelt laws, smoking restrictions).
• Third Level: Long-lasting Protective Interventions (e.g., vaccinations, cholesterol screenings).
• Fourth Level: Clinical Interventions (e.g., treatment of diseases).
• Top (Greatest Individual Effort): Counseling and Education (e.g., healthy eating education).

As you move down the pyramid, the public health impact increases. As you move up the pyramid, the individual effort increases.

Question: List the four determinants of health. Answer: Genes/biology, health behaviors, social/societal characteristics, health services/medical care.

Question: Which determinant influences our health the most? Answer: Social/societal characteristics (where you live, work, and play).

Question: As we move ____ the health impact pyramid, the public health impact grows greater, and as we move ____ the health impact for an individual increases. Answer: Down, Up.

Synthesis/Conclusion

Public health is a multifaceted field that relies on the core functions of assessment, policy development, and assurance. Effective public health interventions require collaboration with diverse stakeholders, including communities, healthcare providers, businesses, media, academia, and government agencies. Addressing the social determinants of health, such as poverty and lack of access to education, is crucial for improving population health outcomes. The Health Impact Pyramid illustrates that interventions targeting socioeconomic factors have the greatest potential for population-wide impact, while individual-level interventions require more effort from individuals. By understanding and addressing these key concepts, public health professionals can work towards creating healthier communities for all.