Ensure that Federal, Tribal, State, and local health
agencies have the infrastructure to provide essential public health services effectively.
The mission of public health is to fulfill “society’s
interest in assuring conditions in which persons can be healthy.”[1] Public health engages both private
and public organizations and individuals in accomplishing this mission.
Responsibilities encompass preventing epidemics and the spread of disease, protecting against
environmental hazards, preventing injuries, encouraging healthy behavior, helping
communities to recover from disasters, and ensuring the quality and accessibility
of health services.
The Nation’s public health infrastructure is the resources
needed to deliver the essential public health services to every community—people
who work in the field of public health, information and communication systems
used to collect and disseminate accurate data, and public health organizations
at the State and local levels in the front lines of public health. The public
health infrastructure is a complex web of practices and organizations that has
been characterized as in “disarray.”1, [2]
Public health encompasses three core functions:
assessment of information on the health of the community, comprehensive
public health policy development, and assurance that public
health services are provided to the community.1 These functions have been defined further and
expanded into 10 essential public health services.2 (See chart on page 4 for full list from the Public
Health in America statement.[3])
The totality of the public health infrastructure includes all governmental and
nongovernmental entities that provide any of these services. Environmental health,
occupational health and safety, mental health, and substance abuse are integral
parts of public health. Service providers, such as managed care organizations,
hospitals, nonprofit corporations, schools, faith organizations, and
businesses, also are an integral part of the public health infrastructure in
many communities.
Various reports and evaluations have described the
continuing deterioration of the national public health system: health
departments are closing, technology and information systems are outmoded,
emerging and drug-resistant diseases threaten to overwhelm resources, and
serious training inadequacies weaken the capacity of the public health
workforce to address new threats and adapt to changes in the health care
market.1, [4]
Conversely, interest in public health has led to the development of public
health improvement plans in several States, including Illinois and Washington.
In addition, private foundations have funded major national programs to improve
health. For example, Turning Point: Collaborating for a New Century of Public
Health Initiatives, supported by the Robert Wood Johnson Foundation and the
W.K. Kellogg Foundation, helps develop more effective public health
infrastructure by providing technical assistance to health departments at State
and local levels.
All public health services depend on the presence of basic infrastructure.
Every categorical public health program—childhood immunizations, infectious
disease monitoring, cancer and asthma prevention, drinking water quality,
injury prevention, and many others—requires health professionals who are
competent in cross-cutting and technical skills, public health agencies with
the capacity to assess and respond to community health needs, and up-to-date
information systems. Federal public health agencies rely on the presence of
infrastructure systems at the local and State levels to support the
implementation of their programs.
In public health, a strong infrastructure provides the
capacity to prepare for and respond to both acute and chronic threats to the
Nation’s health, whether they are bioterrorism attacks, emerging infections,
disparities in health status, or increases in chronic disease and injury rates.
Such an infrastructure serves as the foundation for planning, delivering, and
evaluating public health. The public health infrastructure comprises the
workforce, data and information systems, and public health organizations.
Research also is a key activity of public health infrastructure in identifying
opportunities to improve health, strengthen information systems and
organizations, and make more effective and efficient use of resources.
Health data and surveillance systems provide information on
illness, disability, and death from acute and chronic conditions; injuries;
personal, environmental, and occupational risk factors; preventive and
treatment services; and costs. To be most useful, public health data must be
accessible, accurate, timely, and clearly stated and must adhere to strict
confidentiality standards. The system must be linked with other data systems
and must be linked with and integrated at the Federal, Tribal, State, and local
levels. The systematic collection, analysis, interpretation, dissemination, and
use of health data drive efforts to determine the health status of a
population, plan prevention programs, and evaluate program effectiveness.
Healthy People activities during the 1980s and 1990s have demonstrated the
central role of data, focused attention on what is important to measure, and
stimulated the development of new data systems.
Although Federal agencies take the lead in collecting
national public health data, these agencies are only some of the many necessary
partners that collect, analyze, and use public health data. Surveillance often
involves active cooperation among Federal, Tribal, State, and local agencies.
For example, the Vital Statistics Cooperative Program obtains information on
births, deaths, marriages, and divorces from all 50 States, the District of
Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. Programs in each area
collect vital information from many sources in local communities, including
funeral directors, medical examiners, coroners, hospitals, religious
authorities, and justices of the peace. Other data collection systems, based on
sample surveys rather than reports, depend on the participation of thousands of
private citizens nationwide. And still other systems rely on the administrative
records of public and private health care organizations.
If data are not available or are missing, problems can
arise, especially for State and local health agencies. In particular, health
problems may not be identified in high-risk populations, or the public
intervention may not be timely enough. Information enables public health to
direct preventive services and health promotion activities toward select
populations.
The public health workforce must have up-to-date knowledge,
skills, and abilities to deliver services effectively and carry out the core
functions of assessment, policy development, and assurance of services. The
importance of organizations in making a system effective often is overlooked.
Yet, Tribal, State, and local public health agencies, in partnership with other
community organizations, are essential to an effective public health system.
Because a national data system will not be available in the
first half of the decade for tracking progress, one subject of interest
concerning the public health infrastructure is not covered in this focus area’s
objectives. This topic represents a research and data collection agenda for the
coming decade: increasing the proportion of Federal, Tribal, State, and local
public and private employers that voluntarily adopt the Standard Occupational
Classification (SOC) system to categorize public health personnel.
A major goal of Healthy People 2010 is to eliminate health
disparities. These disparities exist at all State and local levels but are not
well delineated because of differences in public health systems. A better
trained public health workforce, improved data and information systems, and
more effective public health organizations will strengthen the public health
infrastructure at all levels and help identify where disparities exist. Then
targeted interventions and programs to eliminate the disparities can be
developed.
Disparities among public health organizations and between
the public and private health sectors are also of concern. For example, a
diverse, highly skilled workforce must be recruited and trained to meet the
challenges of the 21st century. Salary structures and disparities in staffing
across jurisdictions, as well as between workers in the public and private
sectors, will affect the ability of public health agencies to recruit and
retain a high-quality workforce.
Several developments suggest opportunities to improve public
health capacity nationwide.
The 1997 report The Public Health Workforce: An Agenda
for the 21st Century recognized the need for a system to assure a stronger
public health workforce.[5]
The report identified five areas to be strengthened: national leadership, State
and local leadership, workforce composition, curriculum development, and
distance learning. Data systems are needed to track the extent to which the
workforce has the knowledge, skills, and abilities to carry out its functions.
With wide input from the public health community, the SOC system was updated in
1997 and 1998 to include an array of public health professions.[6]
SOC will continue to be used in a number of national population- and
employer-based surveys by the Bureau of Labor Statistics (U.S. Department of
Labor), the Bureau of the Census (U.S. Department of Commerce), and the Bureau
of Health Professions (U.S. Department of Health and Human Services). A
standard classification may be useful in determining minimum levels of competency
for each classification.
Healthy People 2000 did not have a specific focus area for
public health infrastructure. Two objectives, however, didaddress broad
infrastructure areas. One stated, “Increase to at least 90 percent the
proportion of persons who are served by a local health department that is
effectively carrying out the core functions of public health.” Although
selected studies have provided a snapshot of local health department
effectiveness in carrying out the core functions,[7], [8] systematic
monitoring of this objective over time has not been done. However, efforts to
define, achieve, and measure this objective have contributed to a more complete
description of infrastructure as well as a more detailed and expanded
infrastructure goal.
The second objective stated, “Increase to at least 50
percent the proportion of counties that have established culturally and
linguistically appropriate community health promotion programs for racial and
ethnic minority populations.” In 1996–97, baseline data for this objective were
obtained for local health departments serving certain racial and ethnic groups
comprising 10 percent or more of the population. Programs or interventions were
most likely to be adapted in the areas of maternal and infant health (47
percent), nutrition (44 percent), and family planning (42 percent). Adaptations
were least likely to have been made for such groups in the areas of
occupational safety and health (13 percent), mental health and mental disorders
(18 percent), and food and drug safety and health (18
percent).
Healthy People 2000 had a specific priority area on data and
surveillance. Several objectives from Healthy People 2000 have been modified
and are included in Healthy People 2010 as Public Health Infrastructure
objectives dealing with data and information systems.
Of the seven surveillance and data system objectives, progress
has been made on six. A set of health status indicators appropriate to Federal,
State, and local levels was developed, and all States monitor at least some
indicators. National data sources to measure progress toward each of the
Healthy People 2000 objectives were identified or created for 97 percent of
objectives. Although difficult to quantify, progress toward filling data gaps
is continuing, most recently through the Healthy People 2000 Midcourse
Review and 1995 Revisions, when considerable attention was given to
population groups at highest risk for premature death, disease, or disability.
The number of States that periodically publish data on Healthy People 2000 objectives
has increased substantially. Systems for the transfer of data have expanded considerably
in all States, with the expansion of the Internet playing a major role.
Achieving the timely release of data appears to have moved away from the
target; however, the measurement of progress for this objective is affected by
the frequency of data collection.
Note: Unless otherwise noted, data are from the Centers for
Disease Control and Prevention, National Center for Health Statistics, Healthy People 2000
Review, 1998–99.
Public Health Infrastructure
Goal: Ensure that Federal, Tribal, State, and local
health agencies have the infrastructure to provide essential public health
services effectively.
|
Number
|
Objective Short
Title
|
|
Data and Information Systems
|
|
23-1
|
Public health employee access to the
Internet
|
|
23-2
|
Public access to information and
surveillance data
|
|
23-3
|
Use of geocoding in health data
systems
|
|
23-4
|
Data for all population groups
|
|
23-5
|
Data for Leading Health Indicators,
Health Status Indicators, and Priority Data Needs at Tribal, State, and local
levels
|
|
23-6
|
National tracking of Healthy People
2010 objectives
|
|
23-7
|
Timely release of data on objectives
|
|
Workforce
|
|
23-8
|
Competencies for public health
workers
|
|
23-9
|
Training in essential public health
services
|
|
23-10
|
Continuing education and training by
public health agencies
|
|
Public Health Organizations
|
|
23-11
|
Performance standards for essential
public health services
|
|
23-12
|
Health improvement plans
|
|
23-13
|
Access to public health laboratory
services
|
|
23-14
|
Access to epidemiology services
|
|
23-15
|
Model statutes related to essential
public health services
|
|
Resources
|
|
23-16
|
Data on public health expenditures
|
|
Prevention Research
|
|
23-17
|
Population-based prevention research
|
Potential data
sources: National Association of County and City Health Officials (NACCHO);
Association of State and Territorial Health Officials (ASTHO); National Public Health Performance Standards Program, CDC, PHPPO; IHS.
Unpublished
data from a 1999 survey of the National Association of County and City Health
Officials showed 49 percent of local health department directors had
continuous, high-speed access to the Internet at work. Further, 83 percent of
local health departments had staff members who can search for and access public
information on the Internet. The Bioterrorism Initiative, which began in 1999,
is expected to generate information on Internet and e-mail capacity at State
and local levels for responding to terrorist events; this information could be
used in monitoring this objective.
All
workers within a State or local public health agency need access to the Internet
or other electronic information systems appropriate to their job functions. Access
requires hardware (for example, computers, modems, CD-ROM drives), software
that can browse the Internet and can be used to analyze health information databases,
and training on the effective use of the Internet and database systems. Adequate
capacity in public health informatics—the systematic application of information
and computer science and technology to public health practice, research, and
learning—is key to this objective. Public health agencies need to provide
appropriate training on data sources and how to transform the data retrieved
from these systems into information that can be used to develop public health policy.
Potential data
sources: CDC, NCHS; National Association of County and City Health
Officials (NACCHO); Association of State and Territorial Health Officials
(ASTHO); National Public Health Performance Standards Program, CDC, PHPPO; IHS.
Leading
Health Indicators are defined elsewhere in Healthy People 2010. (See
Understanding and Improving Health.) Health Status Indicators and Priority Data
Needs are those generated from objective 22.1 in Healthy People 2000[9], [10] This objective seeks to ensure that
data collected at the national, Tribal, State, and local levels are
electronically aggregated and available toand accessible by individuals
and organizations. The objective includes publicly accessible communication
through media (for example, print, television, and radio) or online systems,
such as the Internet. In addition to data on Leading Health Indicators, Health
Status Indicators, and Priority Data Needs, many other kinds of public health
data need to be accessible to the public. These data include health outcomes;
utilization statistics, such as the Health Plan Employer Data and Information
Set (HEDIS) or similar measures from managed care organizations; infrastructure
data; health risk data; and community report cards that provide a snapshot of a
community’s health. Efforts should be made to include other sources of data not
widely used for public health assessment (for example, sources of
socioeconomic, expenditure, and quality of life data).
Target: 90
percent.
Baseline: 45
percent of major national, State, and local health data systems geocoded records to street address or latitude and longitude in 2000.
Target setting
method: 100 percent improvement.
Data source: CDC,
NCHS.
Public
health rests on information. The information technology revolution, including
online systems, the Internet, and other electronic information systems, continues
to expand both the volume and the accessibility of information. Increased use
of geocoding in health data systems will provide the basis for more
cost-effective disease surveillance and intervention. At the same time,
challenges arise in synthesizing and disseminating the huge amount of available
information as well as ensuring that the data are scientifically accurate and
have appropriate safeguards for confidentiality.
The
capacity to achieve national goals is related to the ability to target
strategies to geographic areas.[11]
Extension of geocoding capacities throughout health data systems will
facilitate this ability. A GIS is a powerful tool combining geography, data,
and computer mapping. With GIS, digital maps and databases are stored with
linked georeferenced identifiers to facilitate rapid computer manipulation,
analysis, and spatial display of information. Geocoding (street address
matching or assignment of latitude and longitude) will be the basis for data
linkage and analysis in the 21st century. The versatility of GIS supports the
exploration of spatial relationships, patterns, and trends that otherwise would
go unnoticed.[12] In 1999, 10
of 22 major health data systems, defined as data systems responsible for
tracking five or more Healthy People 2010 objectives, geocoded data. However,
public access to data below the county level is prohibited or severely
restricted because of confidentiality and privacy issues. A major challenge in
the coming decade will be to increase public access to GIS information without
compromising confidentiality.[13]
(See Tracking Healthy People 2010 for a discussion of these major health data
systems.)
Target: 100
percent.
Baseline: 11
percent of the population-based objectives had national data for all select
population groups in 2000.
Target setting
method: Total coverage.
Data source:
CDC, NCHS.
The
capacity of the public health system to measure the health of all individuals
requires special attention to groups that may not be identifiable in statewide
or national databases. Lack of data for these groups can be the result of
relatively small numbers of cases for rare events, small population groups, or
other special circumstances. Better data-gathering systems are needed to track
health objectives for such populations as racial and ethnic groups, persons
with disabilities, specific Tribes, homeless persons, institutionalized persons
(for example, in nursing homes and prisons), low-income persons, and students
in special education.
National
data indicate that some racial and ethnic groups often face higher rates of
illness, disability, death, or other risk factors than the general population.
Other groups, such as persons with low incomes, limited education, or
disabilities, also have relatively poor health. Females and males also
experience the burden of poor health in different ways. One of the overarching
goals of Healthy People 2010 is to eliminate these health disparities. To
assess progress toward this goal, data on population groups must be available.
Potential data sources: CDC, NCHS; IHS.
In
1997, 37 of 47 States and the District of Columbia had their own Healthy People
2000 plans.[14] The average number of objectives in
the State plans was 113 but ranged from 20 to 308.14 On average, baseline data were available for
76 percent of the States’ objectives by 1997, although more than half of the
data were 3 or more years old.14
Because
of the lack of comparability between States, a set of Leading Health Indicators
has been developed from the Healthy People 2010 objectives. (See Understanding
and Improving Health.) These indicators can be monitored at the national,
State, and local levels. They can be used in conjunction with States’ objectives
to evaluate the progress of Healthy People 2010 in communities.
Health
Status Indicators and Priority Data Needs are those generated from objective
22.1 in Healthy People 2000.9, 10 Select populations are those identified for
each indicator that make up at least 10 percent of the population for the
Tribal, State, or local area. State and local data are essential for the
managers and providers who must assess health status and services and plan,
carry out, and evaluate health programs. However, data were not available for
all objectives at all State and local levels to evaluate the majority of
Healthy People 2000 objectives. Therefore, a consensus process identified a
small set of indicators that would be understandable, acceptable, outcome
oriented, and measurable with available data and would imply specific
interventions that compel action.9 This process resulted in the set of Health
Status Indicators. National data for these indicators are published regularly
in the Healthy People 2000 Review 1998–99.[15]
An
additional set of measures was considered that had important public health
significance but could not be included because of insufficient data at the
State and local levels. This set, known as Priority Data Needs, has been used
to measure these additional indicators.10
(State data are available for both the Health Status Indicators and Priority Data Needs at http://www.cdc.gov/nchswww/datawh)
An important function of these different sets of health
indicators is to monitor progress toward the second goal of Healthy People
2010: to eliminate health disparities among population groups. Data for these
indicators need to be available at the national, Tribal, State, and local
levels. The objective’s intent is to ensure the availability of sufficient and
accurate data to evaluate these indicator sets at all geographic levels and for
all select population groups.
Target: 100
percent.
Baseline: 82
percent of measurable objectives, including their subobjectives, were tracked
at least every 3 years in 2000.
Target setting
method: Total coverage for measurable objectives, including their
subobjectives.
Data source:
CDC, NCHS.
Frequent, regular feedback is needed to tailor strategies
to achieve national objectives during a decade. Past efforts have been hampered
by infrequent tracking of objectives. For adequate tracking of the objectives
during the next decade, at least three data points (baseline, midpoint, final)
are desirable to assess progress. Hence, objectives need to be measured at
least every 3 years. In 2000, 66 percent of the measurable objectives,
including their subobjectives, were tracked annually.
Healthy People 2010 contains more than 150 developmental
objectives that lacked baseline data at initial publication but that were
expected to have data points by 2004 to facilitate setting 2010 targets in the
mid-decade review. Developmental objectives that do not have a baseline by the
midcourse review will be dropped. Healthy People will succeed and lead to
action only to the extent that regularly collected data can be used to track
its objectives.
Target: 100 percent.
Baseline: 36
percent of the objectives, including their subobjectives, measured by major
data systems were tracked with data released within 1 year of the end of data
collection in 2000.
Target setting
method: Total coverage (as measured by major data systems).
Data source: CDC,
NCHS.
The utility of data depends on both the periodicity of data
collection (see objective 23-6) and the timeliness of data release. In past
years, a number of electronic data collection systems have been put in place in
national, Tribal, State, and local data collection agencies (for example,
electronic birth and death certificates, computer-assisted personal interview
questionnaires, and computer-assisted telephone interview questionnaires). Some
of these innovations, such as vital statistics data from electronic birth and
death certificates, already are showing results in the more timely release of
data. For others, the benefits of faster turnaround are still a few years away.
The purpose of this objective is to ensure that health information is available
to policymakers and the public shortly after data collection.
Potential data
sources: National Association of County and City Health Officials (NACCHO);
Association of State and Territorial Health Officials (ASTHO); HRSA; IHS.
In addition to a basic knowledge of public health, all
public health workers should have specific competencies in their areas of
specialty, interest, and responsibility. Competent leaders, policy developers,
planners, epidemiologists, funders, evaluators, laboratory staff, and others
are necessary for a strong public health infrastructure. The workforce needs to
know how to use information technology effectively for networking,
communication, and access to information. A skilled workforce must be
culturally and linguistically competent to understand the needs of and deliver
services to select populations and to have sensitivity to diverse populations.
Finally, technical competency in such areas as biostatistics, environmental and
occupational health, the social and behavioral aspects of health and disease,
and the practice of prevention in clinical medicine should be developed in the
workforce.
Although the disciplines in a particular agency will vary
according to the resources, policies, needs, and populations served, individual
public health employees must have certain competencies or levels of expertise.
Their combined areas of expertise enable the organization to provide essential
public health services. Failure to include references to these competencies in
the formal personnel system makes achieving standards difficult. Position
descriptions or performance evaluations are likely sources of data for this
objective.
National licensing and certification programs that measure
competency already exist for nurses, physicians, dietitians, health educators,
laboratory technicians, sanitarians, environmental health specialists, and many
allied health professionals. Coordination with these national programs will be
important to ensure that new certification efforts cover essential public
health service concerns. At least one State, New Jersey, has licensing
requirements for all local health officers.
Potential data
sources: Association of Schools of Public Health; American Association of Medical Colleges; HRSA’s Bureau of Health Professions; American Association of Colleges of Nursing.
Potential data
sources: National Association of County and City Health Officials (NACCHO);
Association of State and Territorial Health Officials (ASTHO); IHS.
The above two objectives address training for both the
current and future public health workforce. Tomorrow’s public health workforce
is being educated today by schools of public health, programs in public health
accredited by the Council on Education for Public Health, and other graduate
programs. These emerging leaders must be grounded in the areas of expertise
needed to deliver essential public health services. This objective may be
accomplished either by developing specific courses or by incorporating
essential public health services into existing offerings, depending on the
school or program.
There is an ongoing need to train and educate people who
are currently employed in public health as new areas, problems, threats, and
potential disasters emerge. For example, the threat of bioterrorism or the
increased impact of any natural and technological disaster will require
different training and areas of expertise so that public health workers can
detect problems early, communicate rapidly, and respond effectively. A system
for enabling career-long learning opportunities is desirable.
Although several disciplines have continuing education
requirements as part of the licensing or certification process, this objective
extends to all workers. Federal, Tribal, State, and local public health
agencies do not necessarily have to provide the education, but they need to
ensure its availability to employees. Employees in organizations that are not
formally part of the public health system but that deliver health services also
should have continuing education. Once an effective source of data is developed
for this objective, a percentage of employees should be targeted annually for
continuing education.
Potential data
source: National Public Health Performance Standards Program, CDC, PHPPO.
Experts in quality improvement have long asserted that
“what gets measured gets done.”[16] The measurement of performance is not new, nor is the
concept foreign to most health departments. What is not being done, however, is
comprehensive, systematic performance evaluation. Without standard performance
indicators and systematic comparisons, public health lacks useful benchmarks
for improvement. National performance standards could be used to improve
quality, increase accountability for dollars invested, and create credibility
with internal and external constituents. National organizations, such as the
Joint Commission on Accreditation of Healthcare Organizations and the National
Commission on Quality Assurance, that work with performance measures in health
care have models that can be followed.
A number of States have or are developing State-specific
performance standards for local public health agencies. The Centers for Disease
Control and Prevention (CDC), in conjunction with national, State, and local
public health organizations, is developing national performance standards for
State and local health departments.[17] These national standards, expected to be operational in
2000, are based on the essential public health services.
Target and
baseline:
|
Objective
|
Jurisdiction
|
1997 Baseline
(unless noted)
|
2010 Target
|
|
|
|
Percent
|
|
23-12a.
|
Tribes
|
Developmental
|
|
23-12b.
|
States and the District
of Columbia
|
78
|
100
|
|
23-12c.
|
Local jurisdictions
|
32 (1992–93)
|
80
|
|
|
|
|
|
|
|
Researchers and research organizations now recognize the
value of including diverse populations and communities in their studies.
Population-based prevention and clinical research must continue to include
specific population groups, such as females, racial and ethnic groups, and
persons who are either not served or are underserved. Research should be
responsive to National, State, and local public health priorities and needs.
(A listing of abbreviations and acronyms used in this
publication appears in Appendix H.)
Distance learning: A system and a process that
connects learners with distributed learning resources characterized by (1)
separation of place or time between instructor and learner, among learners, or
between learners and learning resource and (2) interaction between the learner
and the instructor, among learners, or between learners and learning resources
conducted through one or more media. Use of electronic media is not required.
Epidemiology: Branch of medical science dealing with
the distribution and determinants of health-related events in specified
populations and the application of this study to the control of health
problems.
Essential public health services: The services identified
in Public Health in America (defined below): monitoring health status;
diagnosing and investigating health problems; informing, educating, and
empowering people; mobilizing community partnerships; developing policies and
plans; enforcing laws and regulations; linking people to needed services;
assuring a competent workforce; conducting evaluations; and conducting
research.
Federal, State, or local public health agency: A
government or nongovernment entity authorized to provide one or more essential
public health services. Included are health, mental health, substance abuse,
environmental health, occupational health, educational, and public health agencies.
Geocoding: The process of address matching and assignment
of a street address to a corresponding latitude and longitude.
Geographic information system (GIS): Combines modern
computer and supercomputing digital technology with data management systems to
provide tools for the capture, storage, manipulation, analysis, and
visualization of spatial data. Spatial data contain information, usually in the
form of a geographic coordinate system, that gives the data location relative
to the earth’s surface. These spatial attributes enable previously disparate
data sets to be integrated into a digital mapping environment.
Graduate program in public health: Any academic
postbachelor’s degree program that specifically trains public health workers. Included,
for example, are programs in schools of public health, nursing, environmental
health, medicine and dentistry, and veterinary medicine.
Health improvement plan (HIP): A plan made up of
action steps to guide providers of essential public health services in
addressing problems and gaps that have been identified in a needs assessment. A
local plan should be linked to its State plan. Both plans should mobilize a
variety of organizations to reduce health problems and improve the community’s
capacity to respond to public health needs. All providers of public health
services—such as health
departments, hospitals, schools, managed care providers under Medicaid,
environmental health agencies, and medical and nursing organizations—should be included in a HIP.
Health departments should play an especially active role in developing and implementing
plans.
Health Status Indicators: Eighteen measures of health
status defined in 1991 that represent a broad overview of a community’s health
and that can be used by various levels of government. Health Status Indicators
include infant mortality, death rates for selected diseases, incidence rates of
selected infectious diseases, measures regarding pregnancy and birth, childhood
poverty, and air quality.
Leading Health Indicators: A set of 10 key determinants
that influence health and can serve as a barometer for evaluating the health of
the Nation. Leading Health Indicators include individual behaviors, the social
and physical environment, and community health programs and address areas that
most influence the health of individuals, communities, and the Nation. (See
Understanding and Improving Health.)
Major health data systems: Data systems that provide
tracking data for five or more national Healthy People 2010 objectives,
including the Vital Statistics Cooperative Program, National Health Interview
Survey, National Health and Nutrition Examination Survey, National Hospital
Discharge Survey, and Behavioral Risk Factor Surveillance System.
Needs assessment: A formal process—which is the first step in a community
health improvement process—of
identifying problems and assessing the community’s capacity to address health
and social service needs. Examples include Assessment Protocol for Excellence
in Public Health, Planned Approach to Community Health, Healthy Cities, and Model
Standards.
Population-based prevention research: Research to
identify effective public health prevention practices for particular
populations.
Priority Data Needs: Sixteen measures of health
status and risk behaviors of public health significance that were not included
in the 1991 list of Health Status Indicators because of insufficient data at
all levels of government. Subsequent to 1991, data sources have been developed
for most of the Priority Data Needs. Priority Data Needs include indicators of
selected chronic diseases, access to medical care, environmental exposures, and
behavioral risks.
Public health and environmental health laboratory
services: Laboratory services that include health and environmental
assessment, surveillance, quality assurance, training, and consultation. These
services also include a core set of tests in pathology, hematology, chemistry,
microbiology, and environmental science.
Public Health in America: Statement that defines
the public health vision and mission and describes the essential public health
services. It was adopted in 1994 by the Public Health Functions Steering
Committee, which included representatives of the U.S. Public Health Service
agencies, American Public Health Association, Association of Schools of Public
Health, Association of State and Territorial Health Officials, Environmental
Council of the States, National Association of County and City Health
Officials, National Association of State Alcohol and Drug Abuse Directors,
National Association of State Mental Health Program Directors, and Public
Health Foundation.
Public health informatics: The systematic application
of information and computer science and technology to public health practice, research,
and learning.
Public health infrastructure: The resources needed to
deliver the essential public health services to every community—people who work
in the field of public health, information and communication systems used to
collect and disseminate accurate data, and public health organizations at the
State and local levels in the front lines of public health.
Public health workers:
Individuals who are responsible for providing the essential public health
services whether or not they work in an official health agency. At the State
level, many workers have public health responsibilities even though they may
work for nonpublic health agencies, such as environmental, agricultural, and
education departments. This definition does not include those workers who
occasionally contribute to the public health effort while fulfilling other
responsibilities. Public health workers also are defined in the SOC system used
by the Bureau of Labor Statistics, Bureau of the Census, and Bureau of Health
Professions. This system has been updated and expanded to include additional
categories of public health workers.
