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core business of public health, public health finance, public health systems, systems thinking



  1. Smith, Tina Anderson MPH
  2. Minyard, Karen J. PhD
  3. Parker, Christopher A. MBBS, MPH
  4. Van Valkenburg, Rachel Ferencik MPA
  5. Shoemaker, John A. MPH


In 1994, the Public Health Functions Steering Committee proffered a description of the Essential Public Health Services (Essential Services). Questions remain, however, about the relationship between the roles defined therein and current public health practice at state and local levels. This case study describes the core business of public health in Georgia relative to the theoretical ideal and elucidates the primary drivers of the core business, thus providing data to inform future efforts to strengthen practice in the state. The principal finding was that public health in Georgia is not aligned with the Essential Services. Further analysis revealed that the primary drivers or determinants of public health practice are finance-related rather than based in need or strategy, precluding an integrated and intentional focus on health improvement. This case study provides a systems context for public health financing discussions, suggests leverage points for public health system change, and furthers the examination of applications for systems thinking relative to public health finance, practice, and policy.