Core Functions of Public Health and the 10 Essential Public Health Services

Organized public health efforts began in seventeenth-century Europe in response to the plague. Modern western public health systems, including hospitals for the ill and public sanitation services, started developing alongside scientific advances in the early nineteenth century and continue to evolve alongside science and culture today.¹

Over time, public health professionals arrived at a consensus about the essential services of public health. This post describes the evolution of The 10 Essential Public Health Services, the widely adopted U.S. framework for public health delivery developed in the late twentieth century.

In 1994, a national working group developed a framework for what is now known as the 10 Essential Public Health Services. This framework outlined the essential services of public health systems. Health departments, community partners, schools, and health programs around the nation adopted the model as the standard for public health services.²

The model divided 10 essential services of public health into three core functions of public health service, categorized as:

• Assessment
• Policy Development
• Assurance

In the original model familiar to public health professionals, nine discrete functions surround the tenth function, research. The model was a circular, iterative framework appropriate in any public health context.

After using the framework for 25 years, a new public health task force convened to update the model. The Public Health National Center for Innovations (PHNCI), with the help of the de Beaumont Foundation, took on this project and created an updated version of the 10 Essential Public Health Services. This revised version was released on September 9, 2020, and is “intended to bring the framework in line with the current and future public health practice.”³

The conception of the three core functions of public health remains the same, but the updated model shifts individual service goals from a process orientation to a goal orientation. Research was at the center of the model in the original framework, supported by system management and nine functional service areas.

In the updated model, equity is at the hub of the wheel, with research moved to one of the spokes. The recharacterized 10 essential public health services emphasize context and the human element. The primary focus is to “protect and promote the health of all people in all communities.

“To achieve equity, the Essential Public Health Services actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. Such barriers include poverty, racism, gender discrimination, ableism, and other forms of oppression.”³

Standards and goals in the 10 Essential Public Health Services framework interactively support the three core functions of public health and the central purpose of creating health equity. They can also be considered independently. A synopsis of the updated service framework and its presentation at a 2020 launch event follows.⁴

The goal for service one is to “assess and monitor population health status, factors that influence health, and community needs and assets.”³

This involves gathering and analyzing data. An example is collecting, monitoring, and analyzing data on health factors to identify threats, patterns, and potential issues. This data can then be used to determine the root causes of health disparities and help engage community members and key partners. There is an emphasis on using various methods and innovative technology to ensure the entire community is assessed.

Service two seeks to “investigate, diagnose, and address health problems and hazards affecting the population.”³

This step moves from analysis to action, using the collected data to anticipate and mitigate emerging health threats.

Service goal three uses effective communication “to inform and educate people about health, factors that influence it, and how to improve it.”³

Making health information and resources accessible could involve working with key health partners and using appropriate communication channels to disseminate important information to community audiences. Facilitation two-way communication with your audiences also builds trust in public health services.

The goal for service four is to “mobilize communities and partnerships to improve health.”³

Partnerships and coalitions are essential to promoting public health, and this service involves strengthening those partnerships. Foster and build genuine relationships with a diverse group of partners. Learn from and support these public health partners and use their expertise to improve community health.

Service goal five covers “policies, plans, and laws that impact health.”³

Policies, plans, and laws guide people’s decisions and determine the impact of your public health goals. Seeking diverse input for public health regulations improves relevance and compliance.

The goal of service six is to ensure that “laws are equitably applied to protect the public’s health.”³

Tools for ensuring equity include enforcement activities such as sanitary codes, protection of drinking water supplies, and timely follow-up on hazards, preventable injuries, and exposure-related diseases. Licensing and monitoring the quality of health-related services is also part of this service.

The goal of service seven is to enable “equitable access to the individual services and care needed to be healthy.”³

This goal requires ensuring the public has access to preventive services and cost-effective health care and social services through culturally or linguistically appropriate health delivery systems administered by a competent health care workforce.

Service goal eight aims to build “a diverse and skilled public health workforce.”³

Education and training for the public health workforce support a healthy community. This goal encompasses building a culturally competent workforce that reflects the community, is the appropriate size to meet the public’s needs and promotes a culture of lifelong learning.

In service nine, the goal is to improve “public health functions through ongoing evaluation, research, and continuous quality improvement.”³

Public health needs will continually change, and this step involves teaching public health service providers to recognize and analyze these changes from an evidence-based perspective. This perspective builds and fosters a culture of quality. Using research, evidence, practice-based insights, and other forms of innovation to inform decision-making will promote quality and prevent undue harm.

This service goal seeks to ensure that appropriate, needed resources are allocated equitably for the public’s health. It encompasses strategic and effective leadership, governance, planning, and the management of human and financial resources. The standard is to be accountable, transparent, and inclusive with all partners and the community in all aspects of practice.

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