Community Health Needs

PHE 500 Module Two 1

Public Health Core Functions

Public health engages in many activities, but there are three core functions that define public

health’s role: assessment, assurance, and policy development. Assessment includes tasks

such as monitoring a community’s health status in order to identify public health issues and

needs, investigating potential health hazards, and evaluating public health programs for their

effectiveness. Examples of specific assessment tasks include conducting a community

health needs assessment and performing workplace inspections (by an agency such as the

Occupational Safety and Health Administration, or OSHA). Assurance includes tasks such

as ensuring appropriate healthcare services provision, ensuring that a competent healthcare

workforce is in place, and educating the community about health issues. Specific assurance

tasks include ensuring emergency healthcare is available during a disaster and bringing

together various community partners to hold a health fair. Policy development includes

tasks such as drafting plans and policies that support and engage community health efforts,

enforcing laws that protect the public’s health and researching for new solutions to

developing health problems. Specific policy development tasks include quarantining those

who have come in contact with a highly infectious disease (such as tuberculosis or Ebola)

and researching a proposed new transportation policy that will encourage additional physical

activity (The University of California, Irvine, n.d.).

These three core functions support public health’s overarching goals, which include the

following:

 Prevent the spread of disease and epidemic outbreaks

 Protect against environmental hazards

 Prevent injuries

 Actively promote and encourage healthy behaviors

 Ensure a timely and appropriate response to disasters and assist in recovery and

rebuilding

 Assure service quality and accessibility (CDC, 2014)

2 PHE 500 Module Two

Theoretical Frameworks and Models in Public Health

Public health operates from a variety of theoretical frameworks and perspectives. Together,

they inform the way in which public health issues are viewed and how problems are

approached. A few of the dominant frameworks and models include the following:

 Life course framework: This framework views a person’s health as a result of a

variety of factors, but emphasizes a temporal and social perspective (World Health

Organization, 2000). This framework sees health as being affected by events and

experiences that take place over the span of a person’s lifetime. It looks for indicators

for a person’s current health state by looking back at that person’s lifetime

experiences, while at the same time recognizing that those experiences are shaped

by the wider social, economic, and cultural context (WHO, 2000). The multiple

determinants of a person’s health are nested in biological, genetic, social, behavioral,

and economic contexts that often change over time as a person develops (Halfon &

Hochstein, 2002).

 Social determinants of health: The social determinants of health are “the conditions

in which people are born, grow, work, live, and age,” (WHO, 2015, para. 1) and also

take into account wider forces that shape a person’s life. These forces include

development agendas, social norms, economic policies and systems, political

systems, and social policies (WHO, 2015). The social determinants of health

framework recognizes that all of these forces combine to determine one’s health. The

SDH framework recognizes stress as being an important and contributing factor to

lower life spans. The social determinants of health also recognize the presence of a

social gradient in health. This means that in all societies, the health of individuals runs

across a spectrum, from top to bottom. Those with the worst health are almost always

in the lower socioeconomic classes, and those with the best health are almost always

in the higher socioeconomic classes. For example, when looking at infant mortality

rates, rates are highest among the poorest, and those in the second highest wealth

quintile have higher infant mortality rates than those in the highest wealth quintile.

This means that mortality rates run across a spectrum, creating what is termed the

social gradient. Those with the worst health outcomes (and subsequently those that

also are in the lowest socioeconomic class) are at the bottom of the spectrum, and

those with the best health outcomes (and subsequently those who are in the highest

socioeconomic class) are at the top of the spectrum.

 Ecological model: Also termed the “social ecological model,” this model is based on

the belief that health and disease patterns are strongly shaped by social and physical

environments and responses to these environments (Fielding, Teutsch, & Breslow,

PHE 500 Module Two 3

2010). The Institute of Medicine defines the ecological model as one that

“emphasizes the linkages and relationships among multiple factors (or determinants)

affecting health” (2003, p. 5). These factors include individual behavior, social and

community networks, working and living conditions, and broad social, cultural,

economic, health, and environmental conditions (IOM, 2003).

There are other models and frameworks that are currently in use in public health, but these

are the three that are most commonly used. It is important to note that the similarity among

all three is that health is not influenced by one single factor. Instead, it is the result of a

myriad of factors that combine to create the state of a person’s health. It is vitally important

to understand the range of complex factors that determines a person’s health when

designing effective public health interventions, which will be discussed in a later module.

4 PHE 500 Module Two

References

Centers for Disease Control and Prevention. (2014). The 10 essential public health services. Retrieved from

http://www.cdc.gov/nphpsp/documents/essential-phs.pdf.

Fielding, J. E., Teutsch, S., and Breslow, L. (2010) A framework for public health in the United States. Public

Health Reviews, 32, 174–189.

Halfon, N., and Hochstein, M. (2002). Life course health development: An integrated framework for developing

health, policy and research. Milbank Quarterly, 20(3), 433–479.

Institute of Medicine. (2003). Who will keep the public healthy? Educating public health professionals for the

21 st century. Washington, D.C.: The National Academies Press.

The University of California, Irvine. (n.d.). The three core public health functions and ten essential public health

services. Retrieved from http://ocw.uci.edu/opencourses/09f/89300/core_functions.pdf

World Health Organization. (2000). The implications for training of embracing a life course approach to health.

Retrieved from http://www.who.int/ageing/publications/lifecourse/alc_lifecourse_training en.pdf

World Health Organization. (2015). Social determinants of health. Retrieved from

http://www.who.int/social_determinants/en/