2.3: The Core Roles of Public Health
In 1988 the Institute of Medicine defined the 3 core roles of public health: assessment, policy development, and assurance (Centers for Disease Control and Prevention (CDC), 2014, p. 28).
- Assessment includes the surveillance of diseases, collecting data on community health and making this data available to the public and researchers.
- Policy Development includes using scientific evidence to support the creation of rules, regulations, and programs, as well as the budgeting of resources.
- Assurance means making sure that policies and programs are effective at improving health, and that community members get the help that they need.
According to the Centers for Disease Control and Prevention (CDC), these three roles align with the Public Health approach outlined in Fig. \(\PageIndex{1}\).
Assessment strives to answer “what is the problem?” and “what is the cause?” Policy development identifies “what works?” and “how do you do it?” and then puts those plans into action. Assurance also answers the “what works?” question - perhaps even adding the qualifier of “what works best? ” when multiple interventions exist.
The public health response to any problem may involve primary, secondary, and tertiary prevention. Let’s pretend we are a local public health agency. If a new infectious disease is discovered, we would first want to identify the cause (a virus, bacteria or other pathogen), and how it is transmitted - from animals to humans, from one person to another, or via the food and water supply, etc. Perhaps we discover the new disease is a foodborne illness, caused by a novel (new) bacteria. We may already have primary prevention in place with safe food handling regulations in food processing plants and restaurants. With secondary prevention, we would want to identify if there was a single or multiple sources of this infectious disease; such as a particular contaminated vegetable that was purchased by several restaurants, and then subsequently consumed by those affected. We would want to ensure there were ways to prevent the spread of the infection - perhaps with quarantine measures for people already infected, or recalling contaminated foods. For tertiary prevention, we would want to make sure that those who were already infected got treatment that was proven to be effective, or evidence-based - sometimes this is much easier said than done for a disease we know little about. But our work isn’t done at this point - we would also want to ensure that measures were in place to prevent an outbreak like this from happening in the future, such as scheduling regular testing of food sources for this novel pathogen or developing better food-safety regulations. This hypothetical situation demonstrates that the roles of public health are dynamic and involve many different public and private sectors.
As shown in the figure provided by the CDC below, these 3 core roles can be further broken down into 10 essential public health services. See Fig. \(\PageIndex{2}\.
Assessment includes:
- Monitoring the health of communities to understand what health problems are the most important and who is most vulnerable. This monitoring is also referred to as surveillance.
- Diagnosing and investigating new health problems or potential hazards in the environment. For example, doctors may come across novel symptoms in a new patient or several patients and provide case reports to public health officials.
Policy Development includes:
- Informing, educating, and empowering communities and individuals about their own health. This can be done through health education in schools and community centers, and public health messaging via websites, advertising, news media, etc.
- Mobilizing community partnership to involve businesses, and non-profit organizations to address specific health issues and help solve them in a way that is meaningful to that community. There may be issues that are really important to a community, and many people who live and work there are willing to get involved.
- Developing policies that support health efforts in communities. These policies can be local, state or national level, or even global efforts.
Assurance includes:
- Enforcing laws and regulations that prevent ill health and promote safety. These could have to do with regulating food processing and handling, automobile production standards, or TB testing and vaccination requirements in school settings.
- Linking to and/or providing care to increase awareness and access to healthcare. For example: Promotores de Salud in Los Angeles County connect Spanish-speakers with mental health resources in communities where seeking mental healthcare is often stigmatized.
- Assuring a competent workforce through creating standards for public health professionals, and providing education and professional development.
- Evaluating policies, programs, and healthcare services for their efficacy and feasibility.
The 10th and final service supports all of these roles is research. Adequately funding and conducting high-quality research helps public health assess current health issues, develop strong effective policies and programs, and ensure that these policies and programs are doing what they are intended to do. Although all of the essential public health services are conducted by government agencies, nonprofit organizations and private companies also contribute to these functions.