In its 1988 “Future of Public Health” report, the U.S. Institute of Medicine described public health in terms of its mission, substance and organizational framework, as well as its role in such important and interrelated topics as prevention, community approach, health as a public good and the contributions made by various partners. The same report defined the mission of public health, at that time, as “fulfilling society’s interest in assuring conditions in which people can be healthy.”
A much earlier definition was provided by Charles-Edward Amory Winslow in a 1923 paper, titled “The Evolution and Significance of the Modern Public Health Campaign,” in which he described public health as “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities, and individuals.”
Core functions
The core functions of public health agencies, as defined in the 1988 IOM report mentioned above, are assessment, policy development and assurance. In 1994, the Core Public Health Functions Steering Committee, a panel composed of representatives from U.S. Public Health Service agencies and other major public health organizations of the U.S. Centers for Disease Control and Prevention, went into much greater detail by defining the “public health essential services” role as, among other things:
- monitoring health status;
- diagnosing and investigating health problems and health hazards;
- informing, educating and empowering people about health issues;
- mobilizing community partnerships to identify and solve health problems;
- developing policies and plans that support individual and community health;
- enforcing laws and regulations that protect health and ensure safety;
- linking people to needed personal health services and ensuring the provision of health care when otherwise unavailable;
- ensuring the availability of a competent public health and personal health care workforce;
- evaluating the effectiveness, accessibility and quality of personal and population-based health services; and
- conducting research leading to new insights and innovative solutions to health problems.
Traditional tasks
No matter which definition of public health, core function or essential service is the principal focus, most U.S. public health agencies—be they municipal, county, regional or even state—organize themselves around functional operational divisions or units. These divisions traditionally include, but are not limited to, specialized fields, such as maternal and child health, surveillance/epidemiology, administration, environmental health and behavioral health.
However, since the terrorist attacks of Sept. 11, 2001, considerable funding has been provided to local, state and federal public health agencies and organizations to orient them toward the more comprehensive state of public health preparedness necessary to cope with the changed and more dangerous realities of today’s world. One of the more obvious utilizations of said funding has been the development of public health preparedness units within these various health agencies—but what exactly is public health preparedness? One of the more expansive definitions comes from the Harvard School of Public Health’s Center for Public Health Preparedness Web site (www.hsph.harvard.edu/hcphp), which states that the “key elements” of public health preparedness now include “regularly exercised plans, timely access to information, clear knowledge of individual and agency roles and responsibilities, reliable communications systems and connectivity between and among responding agencies.”
Another updated definition of public health emergency preparedness, provided by the RAND Corporation in a 2007 report titled, “Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” goes into greater detail with the assertion that, “The capability of “¦ public health and health care systems, communities, and individuals to prevent, protect against, quickly respond to, and recover from health emergencies “¦ threatens to overwhelm routine capabilities.”
The threat is greater, the report also says, during emergencies “whose scale, timing, or unpredictability” is uncertain. “Preparedness involves a coordinated and continuous process of planning and implementation,” the report continues, “that relies on measuring performance and taking corrective action.”
A tip-of-the-spear summary
Today’s post-9/11 public health preparedness units have numerous responsibilities, including:
- Establishing an Incident Command System (ICS) structure for the Health Department; most of the emergency management continuum—which consists primarily of mitigation, preparedness, response and recovery operations—is best handled by the entire department within the ICS.
- Assuring National Incident Management System (NIMS) compliance within the Health Department; Homeland Security Presidential Directive 5 mandates that local and state government agencies adopt NIMS as the preferred model for their own emergency response policies, procedures and protocol-development and practice;
- Overseeing the mass dispensing of medications. Traditionally, this responsibility was related primarily to a prophylaxis medication distribution to the public following a bioterrorism incident, and was carried out in cooperation with the CDC’s Strategic National Stockpile (SNS) or a state’s pre-designated RSS (receipt, store and stage) site. However, as recent H1N1 events proved, this “dispensing” task can also include vaccinations; and
- Developing, analyzing, testing, exercising and revising various emergency and contingency plans, including and involving (but not limited to) pandemic preparedness, SNS distribution and both medical surge and continuity of operations requirements.
Whether preparing and planning for, or responding to, public health emergencies, it is imperative that EMS agencies understand the function, makeup and overall capabilities of their public health departments. It’s far better to become acquainted with your local public health agency prior to a large-scale public health event. In addition, with health-care reform emphasizing prevention, there may be opportunities for collaboration (and related funding) that further public health goals while alleviating inappropriate use of the EMS system.
