1. Novick, Lloyd F.

Article Content

IN 1988, THE PIVOTAL REPORT, The Future of Public Health,1 set out recommendations for a new categorization of public health functions. These functions, categorized as assessment, policy development, and assurance, were recommended to counter the attrition of public health vigilance in protecting the public. Specific public health activities have been identified for each of these functions, and a number of states have adopted this format to organize their public health systems.2 For example, Washington State used the core public health functions to develop its Public Health Improvement Plan (PHIP). By grouping public health functions into an overall population-based health improvement mission, plans can address specific activities to improve community health status.3


A difficulty of using this format is that public health activities are described in general categories using terms-assessment, policy development, and assurance-that may not be readily identifiable, especially to those not in the public health field, such as legislators and the public.2 This potential shortcoming also is associated with the ten essential health services, now the most common taxonomy used to describe public health activities. This essential service categorization is a further development of the initial three core functions, providing a common vocabulary expressing the mission of public health in terms of communitywide health improvement. Again, this framework groups activities into abstract categories that may not be meaningful for the public (a comprehensive discussion of this issue can be found elsewhere2).


This January-February 2003 issue of the Journal of Public Health Management and Practice (9:1) focuses on the status of core functions some 15 years after they were first described. Articles in this issue demonstrate their ongoing utility in improving public health practice and provide graphic examples in both local and state public health, illustrating the terms assessment, process, and assurance in action. These examples help to remedy the deficit of abstractness associated with these terms as discussed above.


The lead article by Fielding and coworkers, "Reinvigorating Public Health Core Functions: Restructuring Los Angeles County's Public Health System," describes efforts to revitalize public health in Los Angeles County after a series of funding reductions and unsuccessful reorganizations. They describe a vision of reinvigorating the public health function to "ensure conditions that maximize the health of all Los Angeles County residents." This vision, with an emphasis on public health core functions, also is evident in the second article by Avila and Smith (also from the Los Angeles County Department of Health Services) titled "The Reinvigoration of Public Health Nursing."


Zahner and Vandermause describe a study of local health department performance in Wisconsin based on compliance with state statutes and using a variety of performance measures including the core public health functions and essential services. Measuring health department performance is an example of the core function of assurance.


A number of additional articles in this issue provide interesting examples of the assurance function. First, Barthell and coauthors describe their experience in ensuring community emergency care in Milwaukee using available technology. Then, "Systems Analysis of a Clinical Error," authored by Denison and Pierce, analyzes a clinical error that occurred in public health practice, identifying the multiple factors contributing to its occurrence in an immunization program. Next, Saarlas and associates employ quantitative performance indicators to monitor registry progress of 16 All Kids Count grantees. Last, Safran and colleagues emphasize assurance and accountability for population health in their article on the progress of the National Diabetes Control Program.


Other articles in the issue provide illustrations of core functions and essential services in operation. They include a description of a statewide mammography database by Jazieh (essential service 1: monitor health status to identify community health problems); a media campaign to reduce tobacco use by Carver and coworkers (essential service 3: inform, educate, and empower people about health issues); and a look at the public health workforce by Gebbie and colleagues (essential service 8: ensure a competent public health and personal workforce).




1. Institute of Medicine, The Future of Public Health (Washington, DC: National Academy Press, 1988). [Context Link]


2. L.F Novick, "A Framework for Public Health Administration and Practice," in Public Health Administration: Principles for Population-Based Management, eds. L.F. Novick and G. Mays (Gaithersburg, MD: Aspen Publishers, Inc., 2000), 34-62. [Context Link]


3. National Association of County and City Health Officials, 1992-93 National Profile of Local Health Departments (Washington, DC: NACCHO, 1995). [Context Link]