If you’ve been following this article series, you know we’ve been discussing the September 9, 2020 live reveal of the newly revised 10 Essential Public Health Services. In this article, we’ll explore how the revised EPHS compare to other public health frameworks, as described by the committee who revealed the revised essential services during the live webinar.

Why it Matters

As you’ll read below, these public health frameworks are all inter-related and complementary, as well as serving distinct purposes to provide public health goals and objectives and inform public health practice. Understanding how these frameworks fit together will help public health workers apply the revised essential services, and that application is where the true value lies.

As Brian C. Castrucci, DRPH, MA, President & Chief Executive Officer of the de Beaumont Foundation said during the revised 10 EPHS reveal webinar, “We need to have a reckoning right now in this country about what public health is and what we want it to be, and we now have to make some decisions to ensure that we are never here again, with a public health infrastructure that was not adequately supported to do the job that they’re trying to do… I hope this work with the ten essential services, following up with our staffing ratios work, is part of an ongoing effort to ensure that public health is woven into the basic fabric of our country…”

“We need to have a reckoning right now in this country about what public health is and what we want it to be, and we now have to make some decisions to ensure that we are never here again…” — Brian C. Castrucci, DRPH, MA

We’ll take a look at several public health frameworks:

PHAB Accreditation Standards and Measures and the Revised 10 EPHS

History:

Individual states used to manage accreditation for health departments, until 2004 when the CDC’s Future Initiative determined that accreditation was an essential piece to strengthening public health infrastructure. As a result, in 2005, the Exploring Accreditation project was launched to investigate the potential for a national accreditation standard. The Public Health Accreditation Board (PHAB) was formed to oversee health department accreditation and, over the next few years, developed and tested a set of national accreditation standards and process, which was launched in 2011. In 2013, PHAB began accrediting health departments.

As Paul Kuehnert, DNP, RN, FAAN, President & CEO, PHAB shared during the revised essential services reveal, that over 10 years ago when PHAB was formed, there was a need to find a way to organize the standards and measures and the 10 Essential Public Health Services were a natural fit.

How the frameworks fit together:

The revision of the 10 essential services is very timely and PHAB will be using the revised essential services to update the PHAB accreditation standards and measures (those measures are expected to be released for public comment at the end of 2021).

During the reveal webinar, Kuehnert also emphasized that the process of accreditation and actually applying the essential services framework is one way this becomes a living, breathing thing for the field of public health.

Liza Corso, Senior Public Health Advisor, CDC agreed, saying it is through application in practice that the essential services become more than just a framework; this is how they are institutionalized and recognized and threaded into the daily life of what public health does.

Public Health 3.0 and the Revised 10 EPHS

History:

The term “Public Health 3.0” was coined in 2016 by Karen B. DeSalvo, MD, MPH, MSc, then Acting Assistant Secretary for the US Department of Health and Human Services (HHS). That same year, the Office of the Assistant Secretary for Health (OASH) released a whitepaper entitled, “Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure” which really defines the entire thrust of Public Health 3.0.

The core recommendations or goals of Public Health 3.0 outline practices that public health can implement in order to address social determinants of health and further health equity. Public Health 3.0 is a term meant to describe a progression or “modernization” of public health goals and missions.

How the frameworks fit together:

John Auerbach, MBA, President and CEO, Trust for America’s Health, who worked with Karen B. DeSalvo, MD, MPH, MSc on the concept of Public Health 3.0, pointed out that the concept of a Chief Health Strategist, among other Public Health 3.0 ideas, are “beautifully represented” in the revised essential services:

  • Public Health needs real-time accurate data from multiple sources
  • There must be multi-sector partnerships (e.g. housing, transportation, education, economic development, etc.)
  • Public Health must work on upstream interventions; a primary example is in combatting racism
  • Public Health needs to listen to the community and understand that public health is fundamentally local

Foundational Public Health Services (FPHS) and the Revised 10 EPHS

History:

In the spring of 2013, instigated by a 2012 IOM report, the Public Health Leadershp Forum developed a, “conceptual framework describing both the foundation and programs that each health department should possess” at a minimum. The result was a model later inherited and updated by the Public Health National Center for Innovations (PHNCI) and termed the Foundational Public Health Services.

How the frameworks fit together:

Jessica Fischer, MCP, Public Health National Center for Innovations (at PHAB) shared that, the EPHS and the FPHS are definitely complementary concepts, but they exist for different reasons and there are important distinctions between them. According to Fischer, those are:

FPHS:

  • Specifically address the governmental public health system
  • Exist to define a minimum package of services that must be available everywhere for public health to work anywhere
  • Are meant to make the case for public health funding and so they are developed in a manner that allow them to be costed out
  • Do not describe every aspect of public health or every aspect of public health practice, but rather the foundational pieces of what government must do

EPHS:

  • Address the entire scope of public health services as done by the system
  • Are measurable; PHAB developed tools to measure their implementation and the quality of that implementation
  • As accredited by PHAB, incorporate everything in the FPHS but also go a step further in terms of standards and measures

Healthy People 2030 and the Revised 10 EPHS

History:

Healthy People 2030 is the fifth and most recent iteration of a set of evidenced-based objectives released by the US Department of Health and Human Services and designed to, “help individuals, organizations, and communities across the United States improve health and well-being.” In 1979, the Surgeon General’s Report, “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention,” laid out a list of objectives for health promotion and disease prevention in the United States.

Every 10 years since then, a new report has been released, with a new set of goals and objectives. As you may have read in our blog article, “10 Basic Things You Need to Know About Public Health 3.0,” the Public Health 3.0 encompasses the Healthy People objectives and provides recommendations on how public health can achieve them.

How the frameworks fit together:

Healthy People 2030 and the revised essential services have consistent vision and clear conceptual alignment. Liza Corso laid out the conceptual alignment both frameworks share. For example:

  • An attention to social determinants of health, health equity, and multi-sectoral partnerships
  • A clear connection in content and objectives related to public health infrastructure as well as objectives related to accreditation and the workforce
  • A high prioritization of being data-driven: the revised EPHS includes a lot of language about being data-driven which is the core of what Healthy People is about.

In Conclusion

As you can see, the revised 10 Essential Public Health Services have a strong connection and value alignment with other public health frameworks. Public health frameworks are meant to guide public health practice as well as provide a means of communicating what public health does. The value in these frameworks lies in the use and implementation of the frameworks in public health practice.

Read Next

We will be publishing a series of articles about the revised Essential Public Health Services. Once published, links will be posted below, as well as on our social media. You can access the revised EPHS toolkit on the Public Health National Center for Innovations (PHNCI) website.