If you read our previous article, “What is the value of the revised EPHS for Public Health, Tribal Health, and State Health Departments?” you know that we’ve been discussing the September 9, 2020 live reveal of the newly revised 10 Essential Public Health Services. The webinar reveal included a thorough presentation of the need for revision as well as the changes made.

Below, we’ll review the history of the 10 Essential Public Health Services, including how they came to be created, as well as take a broad look at the revisions made and why those revisions were needed and what can be expected of changes to the essential services going forward.

History:

1988:

In 1988, the Institute of Medicine (IOM), now the National Academy of Medicine (NAM), released a report entitled, “The Future of Public Health.” The report was motivated by the committee’s feeling that public health had become too focused on providing clinical care and was unprepared to face a new era marked by a rise in chronic diseases such as the HIV/AIDS epidemic. As a result, the committee defined a core set of functions for public health: assessment, policy development, and assurance.

1993-1994:

In 1993, the Clinton administration’s public health reform initiative sought to clarify and define the concepts introduced in the IOM report by creating a public health framework.

In 1994, the Department of Health and Human Services (DHHS) convened a committee representing health departments across the country, the Public Health Functions Working Group, tackled this initiative, introducing and defining the original 10 Essential Public Health Services (EPHS).

1994 – 2020

The 10 Essential Public Health Services framework has been a guide for public health practice for the past 25 years. The framework has given public health a common set of goals as well as provided public health with a means of communicating what public health is all about.

However, an update was needed because, “… public health is always changing, and our frameworks need to reflect that. The 10 essential services don’t lose the fact that they’ve always been essential. It’s just, what they are today is better reflective of the challenges and opportunities that we have to improve the health of all Americans.” – Brian C. Castrucci, DRPH, MA, President and CEO, deBeaumont Foundation

“The 10 essential services don’t lose the fact that they’ve always been essential. It’s just, what they are today is better reflective of the challenges and opportunities that we have to improve the health of all Americans.” – Brian C. Castrucci, DRPH, MA

How have the essential services changed with the revision?

Here you can see a side by side comparison graphic of the old 10 Essential Public Health Services compared to the 2020 revision:

Original EPHS vs Revised EPHS

Some of the key changes include:

  • A shift in focus:
    • The old essential services focused on: Public health solving community problems
    • The new essential services focus on: engaging the community in a partnership and co-creating solutions
  • Being a little more actionable and practical for practice, through an increased focus on:
    • The language of creating, championing, and implementing policies and laws
    • Building a strong infrastructure for public health
  • The centering of equity to consider the health of every member of every community

Why does centering the essential services around equity matter?

Our article discussing Public Health 3.0 delves further into this topic, but the key takeaway is that addressing health equity is a vital component of public health and affects all other areas of public health.

“Despite public health’s increasing focus on how environments impact health, our ZIP codes remain a more accurate determinant of health than our genetic codes. As a society, we have a collective responsibility to create conditions that allow all members of our communities to make healthy choices. And yet public health initiatives often exist in silos, resulting in missed opportunities to leverage the critical knowledge of communities to improve health at the local level.” (Healthy People.gov)

To understand more about how inequity can affect public health, you can view this excellent video produced by The California Endowment to encourage building healthy communities in the state of California. The principles apply nationwide.

How often will new updates occur?

The 10 Essential Public Health Services had not been updated in 25 years prior to this revision. Going forward, the deBeaumont Foundation plans to convene leaders and stakeholders in about 5 years to deliberate over whether any changes are needed and continue meeting about once every 5 years.

The goal is to only make changes if they are critical since so much other public health work builds on the essential services, including efforts towards accreditation and the incorporation of the essential services into legislation.

“As we thought about all the things that had changed over the last 25 years and, honestly, over the last six months, it became clear that 25 years is really too long to wait. On the other hand, we don’t want to change the framework frequently because a lot of other work rests on it and builds on it, and that other work takes time. So, we don’t want to change it again right in the middle of when people are adapting to the new framework.” Katie Sellers, DrPH, CPH, Vice President for Impact, de Beaumont Foundation

CDC support for new EPHS

The Centers for Disease Control and Prevention (CDC) representatives were involved in the revision process from the very beginning and throughout the process. The CDC also has the revised essential services available on their website here.

“…this has been a really nice partnership right from the beginning.” – Liza Corso, Senior Public Health Advisor, Centers for Disease Control and Prevention

Additional Resources

You can access the recording of the live reveal as well as a toolkit created for public health departments on the Public Health National Center for Innovations (PHNCI) website here.

You may also be interested in our other articles in this series (Links will be included as each article is published):