Public health is the science and art of preventing disease, prolonging life, and promoting health through organized societal efforts. This field is dedicated to creating the conditions in which people can be healthy, addressing health at the population level rather than the individual patient level. To guide public health practice across the United States, a standardized set of core functions was developed to ensure that every community benefits from a consistent level of protection and health promotion. This framework helps clarify what public health does.
The Essential Public Health Services Framework
The activities that define public health practice are formally described by the Essential Public Health Services (EPHS) framework. Established in 1994 by a federal working group, the activities were significantly revised in 2020 to align with modern public health practice and challenges. The updated EPHS framework explicitly centers on achieving equity, actively promoting policies and systems that remove structural barriers to optimal health for all populations. The entire scope of public health work is organized under three overarching core functions: Assessment, Policy Development, and Assurance. These three domains represent a continuous cycle of gathering information, creating strategies, and ensuring that services are delivered and effective within a community.
Assessment and Monitoring Functions
The first set of functions focuses on the need for data and a comprehensive understanding of community health. The first Essential Public Health Service is to assess and monitor population health status, the factors that influence health, and community needs and assets. Ongoing surveillance involves collecting, monitoring, and analyzing data to identify health patterns, emerging issues, and the root causes of health disparities. This function requires using disaggregated data, such as data broken down by race, income, and geography, to track issues and inform equitable action.
The second Essential Public Health Service requires officials to investigate, diagnose, and address health problems and hazards affecting the population. This involves the scientific work of epidemiology, such as anticipating and mitigating emerging threats through real-time data monitoring and outbreak investigation. Public health laboratories play a significant role here, utilizing modern technology for rapid screening and high-volume testing during a health crisis. The analysis must look beyond immediate causes to consider the social, economic, and environmental root causes of poor health status.
Policy Development Functions
Once data is gathered and problems are diagnosed, public health transitions to policy and community engagement. The third service is to communicate effectively to inform and educate people about health, the factors that influence it, and how to improve it. This involves making health information accessible to the public, ensuring the materials are culturally appropriate and available in different languages to support informed decision-making.
The fourth service requires public health to strengthen, support, and mobilize communities and partnerships to improve health. Health departments work to build coalitions with local groups, non-governmental organizations, and other sectors to leverage resources and community expertise. This mobilization ensures that health interventions are grounded in the community’s own experiences and priorities.
The fifth service focuses on creating, championing, and implementing policies, plans, and laws that impact health, assuring the conditions for optimal health for all. This work establishes formal structures, such as developing comprehensive plans for addressing vector-borne illnesses or advocating for laws that promote smoke-free environments. Public health professionals provide expert input to ensure that the health impact of any proposed policy is carefully considered before it is enacted.
Assurance Functions
The final set of functions is dedicated to ensuring that services are available, effective, and accessible to everyone in the community. The sixth Essential Public Health Service is to utilize legal and regulatory actions designed to improve and protect the public’s health. This includes enforcing health and safety standards, such as conducting restaurant inspections, monitoring water quality, and ensuring compliance with sanitation regulations.
The seventh service assures an effective system that enables equitable access to the individual services and care needed to be healthy. This function involves working to link people to necessary personal health services, such as immunization campaigns or screening programs, especially for populations where access is otherwise unavailable. The goal is to address health disparities by ensuring all community members can obtain the quality care required for a healthy life.
The eighth service is to build and support a diverse and skilled public health workforce. Public health requires a workforce that is competent and reflects the diversity of the communities it serves to effectively understand and address unique health challenges. This involves continuous professional development and training to maintain high standards of practice across the field.
The ninth service requires public health to improve and innovate functions through ongoing evaluation, research, and continuous quality improvement. This involves systematically evaluating the effectiveness, accessibility, and quality of both personal and population-based health services. By linking public health research with practice, the field can contribute to the evidence base of effective interventions and continuously refine programs.
The tenth Essential Public Health Service is to build and maintain a strong organizational infrastructure for public health. This requires managing financial and human resources effectively, ensuring robust information technology systems that meet privacy standards, and exhibiting ethical governance. This foundational support ensures the entire public health system has the capacity and resilience to deliver all other services effectively, especially during times of crisis.