Abstract
Public health practitioners in Minnesota developed and implemented a population-based public health practice model for community assessment, program planning, and evaluation. The ultimate goal of this process is improvement in population health. Major challenges to the implementation of a population-based model are addressed through the use of a theory of action; interventions at community, systems, and individual levels; and intermediate evaluation indicators. Examples of resulting changes in public health practice are described.
DURING THE LAST several decades, many public health departments moved away from preventive, population-focused programs to more illness-centered, individual-focused services. The Medicaid and Medicare legislation of the 1960s provided generous reimbursement to meet the unmet health needs of the medically indigent and older adults. The public health system responded to this trend by developing primary medical clinics for the medically indigent and community-based home care services for older adults. As a result of this emphasis on individual-level services, many public health practitioners have not had the training nor the opportunity to develop the expertise and skills necessary to implement population-based practice.
Today, population-based practice is again in the forefront of public health. The 1988 Institute of Medicine's report 1 defined the core functions that differentiate the roles and responsibilities of the public health system from those of the health care system, giving impetus to a renewed focus on population health. These core functions and their corresponding 10 essential services emphasize a population-based approach to public health practice. 2,3 Population-based practice requires a specific set of skills and expertise. An effective public health practitioner must be able to engage citizens and community partners, assess community health status, set health priorities, plan and implement effective interventions, and demonstrate the differences that public health programs make in the health of populations. This renewed emphasis on population-based practice 4 demands that public health practitioners recognize the full scope of their practice. Most of the activities that fulfill the 10 essential services occur within communities and the systems that affect health. Accountability requires public health departments to explicitly assess, plan, and evaluate at the community and systems levels as well as at the individual and family level.