Accumulated experience in the application of essential public health functions

Understanding of the different settings

Public health practitioners are expected to be effective in different environments.

Effective public health practitioners have to work with many different partners and paradigms.

Who employs the public health professionals and what are their agendas? What is the performance of essential public health functions?

Essential public health functions“The indispensable set of actions, under the primary responsibility of the state,

that are fundamental for achieving the goal of public health, which is to improve, promote, protect, and restore the health of the population through collective action.”

PAHO/WHO. Public Health in the Americas: Conceptual Renewal, Performance Assessment, and Bases for Action. Washington, DC: PAHO/WHO, 2002.

a set of fundamental actions that address determinants of health, maintain and protect population health through organized efforts of society.

- Public health functions represent public goods, and in this respect governments would need to ensure the provision of essential functions, but would not necessarily have to implement and finance them.

- They prevent and manage the major contributors to the burden of disease by using effective

technical, legislative, administrative, and behaviour-modifying interventions, and thereby provide an approach for intersectoral action for health.

- There are several models of PH functions, and services, which are regional or country specific.

Models of PH Functions ....

PAHO/WHOWHO Western Pacific RegionUSAUKCanadaAustraliaOther Countries

USA, 1988

Essential Public Health Functions

EPHF 1. Monitoring, evaluation, and analysis of health status

EPHF 2. Surveillance, research, and control of the risks and threats to public health

EPHF 3. Health promotionEPHF 4. Social participation in healthEPHF 5. Development of policies and institutional capacity

for public health planningand managementEPHF 6. Strengthening of public health regulation and

enforcement capacityEPHF 7. Evaluation and promotion of equitable access to

necessary health servicesEPHF 8. Human resources development and training in

public healthEPHF 9. Quality assurance in personal and population-

based health servicesEPHF 10. Research in public healthEPHF 11. Reduction of the impact of emergencies and

disasters on healthPAHO/WHO, 2002

USA (CDC), 1994Essential PH Services

1. Monitor health status to identify community health problems.

2. Diagnose & investigate health problems & health hazards in the community.

3. Inform, educate, & empower people about health issues.4. Mobilize community partnerships to identify & solve

health problems.5. Develop policies & plans that support individual &

community health efforts.6. Enforce laws & regulations that protect health & ensure

safety.7. Link people to needed personal health services & assure

the provision of health care when otherwise unavailable.8. Assure a competent public health & personal health

workforce.9. Evaluate effectiveness, accessibility, & quality of personal

& population-based health services.10. Research for new insights & innovative solutions to health

problems.

USA, 1988

Australia, 2000Public Health Core Functions

1. Assess, analyse & communicate population health needs & community expectations2. Prevent & control communicable & noncommunicable diseases & injuries through risk

factor reduction, education, screening, immunisation & other interventions3. Promote & support healthy lifestyles & behaviours through action with individuals,

families, communities & wider society4. Promote, develop & support healthy public policy, including legislation, regulation &

fiscal measures5. Plan, fund, manage & evaluate health gain & capacity building programmes designed to

achieve measurable improvements in health status, & to strengthen skills, competencies, systems & infrastructure

6. Strengthen communities & build social capital through consultation, participation & empowerment

7. Promote, develop, support & initiate actions which ensure safe & healthy environments8. 8Promote, develop & support healthy growth & development throughout all life stages9. Promote, develop & support actions to improve the health status of Aboriginal & Torres

Strait Islander people & other vulnerable groups

Canada, 2003Essential Public Health Functions

Population health assessment; Health surveillance; Health promotion; Disease and injury prevention; Health protection.

National Working Group

Estonia, 2008Essential Public Health Operations

1. surveillance and assessment of the population’s health and well-being;

2. identifying health problems and health hazards in the community;

3. health protection;4. preparedness and planning of public health

emergencies;5. disease prevention;6. health promotion;7. evaluation of quality and effectiveness of personal

and community health services;8. leadership, governance and the initiation,

development and planning of public health policy;9. ensuring a competent public health workforce; and10. public-health-related research.

WHO Europe, 2011Essential Public Health Operations

1. Surveillance and assessment of the population’s health and well-being;

2. Identification of health problems and health hazards in the community;

3. Preparedness for and planning of public health emergencies;

4. Health protection services (environment, occup., food safety);

5. Disease prevention; 6. Health promotion; 7. Assurance of a competent public health and personal

health care workforce; 8. Governance, financing and evaluation of quality and

effectiveness of PHS; 9. Communication for PH; and 10. Health-related research.

Comparison of WHO-EURO’s Essential Public Health Operations, the Pacific Essential Public Health Functions, the CDC’s Essential Public

Health Services and PAHO’s Essential Public Health Functions

WFPHA Survey, 2012

Simple model of public health performance

?

Performance of EPHFs

PH professio

nals

SDPHs

PH employe

rs

Searching for interfaces and synergies:… from Core PH Functions to

Core Competencies, Teaching Curricula and PH Performance

CORE PUBLIC HEALTH FUNCTIONS

CORE PUBLIC HEALTH COMPETENCIES

COMPETENCY BASED EDUCATION AND TRANING

EFFICIENT AND ACCOUNTABLE PERFORMANCE

EPHF 1:Monitoring, evaluation, and analysis of health status

• Evaluating the country’s current health status, trends, and determinants, with a focus on identifying inequalities in risks, threats, and access to health services.

• Identifying the population’s health needs, which includes evaluating the health risks and assessing demand for services.

• Managing important statistics and the situation of high-risk and/or specific groups.

• Producing information pertinent to the evaluation of health services performance.

• Identifying resources from outside the sector that can improve health promotion and the quality of life.

• Developing technology and methods to manage, interpret, and communicate information to public health’s decision makers, external actors, suppliers, and citizens.

• Defining and developing agencies to evaluate the quality of the collected data.

http://www.paho.org/english/dpm/shd/hp/EPHF_01.htm

UK. 2002, 2012Standards for organisations with a public health function

LEVEL FOR ASSESSMENT AND IMPROVEMENT OF QUALITY OF THE PUBLIC HEALTH FUNCTION :

1. The individual public health practitioner 2. Departments of public health and other similar groups of public

health professionals 3. Employing organisations 4. Partner organisations

CHECKLIST :Effective health programmes in place Explicit professional standards laid out Risk management programme in place – including emergency plans Critical incident reporting procedure in place Complaints procedure set out Performance appraisal system in place and recognised as the employing organisation's responsibility CPD programme for all staff

Links forged with performance management Regular departmental meetings to - review procedures audit department’s work develop annual work programmes/business plans ensure adequate resources and infrastructure Mechanisms in place to deal with poor performance External appraisal (including peer review) Induction of new staff Health and safety policy

ASPHER Survey, 2011 – 2012The Association of Schools of Public Health in the European Region

To enable ASPHER to contribute efficiently to the worldwide discussion on harmonising essential public health functions, core competencies, and performance standards

Current and desired level of EPHOs performance as determined by employers in comparison to the

estimate of the training output by SDPHsEPHO 1. Surveillance of diseases and assessment of the population’s health

EPHO 2. Identification of priority health problems and health hazards in the community

EPHO 3. Preparedness and planning for public health emergences

EPHO 4. Health protection operations (environmental, occupational, food safety and others)

EPHO 5. Disease prevention

EPHO 6. Health promotion

EPHO 7. Assuring a competent public health and personal health care workforce

EPHO 8. Core governance, financing and quality assurance for public health

EPHO 9. Core communication for public health

EPHO 10.Health-related research

Current Desired SPH's Output

The rays in the spider web indicate the ranks of the 5 point Likert Scale

Example from pilot: MoH department for planning and organization in Serbia

EPHO 1: Surveillance of diseases and assessment of the population’s health

analyse prevalence and incidence.

do regression analyses

interpret the Gini-coefficient

apply the concept of Salutogenesis (Antonovski)

contribute to a health impact assessment

contribute to a health report

prepare an option appraisal

contribute to a health needs assessment

0

1

2

3

4

5

What is the current level of performance displayed by public health professionals in your job environment for this competence?What is the desired level of performance for public health professionals in your job environment for this competence?

A principal recommendation is that governments need to ensure equitable access to essential EPHFs and that the delivery of EPHFs should be tailored to different national and local circumstances.

Bettcher DW, Sapirie S, Goon EH. Essential public health functions: results of the international

Delphi study. World Health Stat Q. 1998; 51:44–54.

Group Work:Essential Public Health Functions

Individual and Group WorkPlease consider the following dimensions:

- Population health- Public Health systems development- Public Health Workforce- The Public Health labour market- The most important stakeholders- The role of NGOs community- Other aspects

Attitudes ValuesExperience

KnowledgeSkills

Group Work

Aims:- to list the benefits and disadvantages of adopting a framework of

essential public health functions- to discuss the feasibility of creating a global framework of essential

public health functions- to discuss how to move forward with developing a global framework

Group Work

Questions:- Is there a need for a framework of public health functions that would

define and measure any endeavor in public health? - Based on the groups’ experience and opinions, what are the benefits

and disadvantages of defining and implementing essential public health functions at a national or regional level?

- Do the members of the group agree on the need for, and feasibility of, developing a global set of public health functions? Why, or why not?

- If yes, how would the group suggest moving forward with the development of a global framework? What do they see as the challenges?