Public Health Core Functions -- Alabama, Maryland, Mississippi, New Jersey, South Carolina, and Wisconsin, 1993 (2024)

The three core functions of public health are assessment,policy development, and assurance (1,2). Within these corefunctions, CDC has identified 10 basic public health practices thatare integral to the operation of state and local health agencies(Table_1) (3). As a part of assessing the core functions of publichealth, public health officials at local health departments in sixstates (Alabama, Maryland, Mississippi, New Jersey, South Carolina,and Wisconsin) were surveyed in 1993 by the state local liaisonaffiliates of the Association of State and Territorial Local HealthLiaison Officials, the School of Public Health at the University ofNorth Carolina at Chapel Hill, and CDC. This report summarizes thefindings from this survey.

The questionnaire included 26 questions about the three corefunctions of public health; these questions were derived fromprevious surveys (4). Respondents were asked to 1) evaluate whethereach of the 10 public health practices existed in theirjurisdiction and 2) assess the adequacy of the performance of thepractice by the entire community. A total of 395 jurisdictions wassurveyed, with respondents being either the local health departmentdirector or the district health officer. The office of the statelocal liaison affiliates received and analyzed completedquestionnaires.

Overall, completed surveys were received from 370 (94%) of the395 jurisdictions surveyed. Of these 370, 313 (85%) served areaswith populations of less than 100,000; those jurisdictionsaccounted for 39% of the population for all six states. The surveyrepresented approximately 11% of the U.S. population and 12% of allU.S. local health departments.

For all respondents, the mean percentage score for performanceby the community was 56%. For the presence of the three corefunctions, the mean percentage scores were 46% for assessment, 53%for policy development, and 68% for assurance. The mean percentagescores for the presence of the 10 specific practices ranged from38% for planning to 91% for informing and educating (Table_1).

The mean percentage score for the perceived adequacy ofperformance by the community was 32%. For the adequacy of the threecore functions, the mean percentage scores were 27% for assessment,29% for policy development, and 40% for assurance. The meanpercentage score for the adequacy of the 10 basic public healthpractices ranged from 19% for assessing to 51% for informing andeducating (Table_1).Reported by: C Barganier, DrPH, Alabama Dept of Public Health. CDevadason, MD, Maryland State Dept of Health and Mental Hygiene. RCaperton, Mississippi State Dept of Health. D McDonough, MPH, ADMiller, MD, New Jersey State Dept of Health. FH Young, Jr, MD,South Carolina Dept of Health and Environmental Control. LGilbertson, MS, Wisconsin Dept of Health and Social Svcs. CAMiller, MD, KS Moore, School of Public Health, Univ of NorthCarolina at Chapel Hill. Association of State and Territorial LocalHealth Liaison Officials. Div of Public Health Systems, PublicHealth Practice Program Office, CDC.

Editorial Note

Editorial Note: An assessment by the Institute of Medicine in 1988highlighted the need to improve essential public health functionsin the United States (1). In 1989, a survey of state healthofficers documented a wide range in the presence of the three corefunctions at the state level: the function of assessment was beingperformed in 82% of states; policy development, in 72%; andassurance, in 56% (5). Although the findings in this reportcontrast with previous findings, they extend understanding of thepresence and adequacy of core public health functions to the locallevel.

The results of this survey are subject to at least twolimitations: 1) because this survey was designed as a pilot, thefindings cannot be generalized; and 2) the diversity in theorganization and activities of the different public health agenciesrestrict the comparability of the findings. Despite theselimitations, refinement of this approach will assist in monitoringefforts to achieve the national health objective to "increase to atleast 90 percent the proportion of people who are served by a localhealth department that is effectively carrying out the corefunctions of public health" (objective 8.14) (2).

References

1. Institute of Medicine. The future of public health. Washington, DC: National Academy Press, 1988.

2. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

3. Roper WL, Baker EL, Dyal WW, Nicola RM. Strengthening the public health system. Public Health Rep 1992;107:609-15.

4. Miller CA, Moore KS, Richards TB, Kotelchuck M, Kaluzny AD. Longitudinal observations on a selected group of local health departments. J Public Health Policy 1993;14:34-50.

5. Scott HD, Tierney JT, Waters WJ. The future of public health: a survey of the states. J Public Health Policy 1990;11:296-304.

Table_1
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TABLE 1. Mean summary scores for the percentage performance of a public healthpractice in a community and the percentage perceived adequacy of performance ofthe practice -- Alabama, Maryland, Mississippi, New Jersey, South Carolina, andWisconsin, 1993*================================================================================================= Perceived adequacyFunction and practice Performance of performance------------------------------------------------------------------------------Assessment 46% 27% Assess the health needs 42% 19% Investigate the occurrence of health effects and health hazards 40% 25% Analyze the determinants of identified health needs 63% 41%Policy development 53% 29% Advocate for public health, build constituencies, and identify resources 69% 38% Set priorities among health needs 46% 26% Develop plans and policies to address priority health needs 38% 21%Assurance 68% 40% Manage resources and develop organizational structures 70% 49% Implement programs 67% 37% Evaluate programs and provide quality assurance 46% 22% Inform and educate 91% 51%------------------------------------------------------------------------------* Of 395 jurisdictions surveyed, 370 (94%) local health department directors or district health officers completed surveys.=================================================================================================

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