4: Essential public health services

Essential Public Health Services
The Essential Public Health Services (EPHS) framework defines the core activities required to protect and improve community health. Established in 1994 by a U.S. federal working group and updated in 2020, this framework guides public health systems worldwide. It is structured around public health's three core functions—assessment, policy development, and assurance—and emphasizes health equity, multi-sector collaboration, and systemic barrier removal.

Assessment Functions

These services focus on data-driven understanding of health issues:

1. Monitor Health Status: Systematically collect, analyze, and disseminate data on population health, risk factors, and community assets (e.g., tracking disease rates or social determinants).
2. Investigate Health Problems: Rapidly identify and respond to acute threats (e.g., infectious outbreaks) and chronic hazards (e.g., air pollution) through surveillance and diagnostics.

Policy Development Functions

These services translate evidence into actionable strategies:
3. Inform and Educate: Disseminate accessible health information to empower individuals and communities (e.g., vaccination campaigns or nutrition guidelines).
4. Mobilize Community Partnerships: Engage diverse stakeholders—nonprofits, schools, businesses—to coordinate resources and address health priorities.
5. Develop Policies: Create evidence-based policies, laws, and plans (e.g., smoke-free ordinances or mental health initiatives).
6. Enforce Regulations: Implement legal measures to safeguard health (e.g., food safety inspections or sanitation standards).

Assurance Functions

These services ensure equitable access and system effectiveness:
7. Link to Health Services: Connect underserved populations to clinical care, preventive services, and social support systems.
8. Build Workforce: Recruit, train, and retain a culturally competent public health workforce.
9. Evaluate and Improve: Measure program effectiveness, advance practices through research, and integrate quality improvement cycles.
10. Maintain Infrastructure: Secure funding, technology, and organizational capacity to sustain public health operations.

The 2020 update explicitly prioritizes equity across all services, urging public health systems to dismantle disparities and foster inclusive community engagement. This framework enables a standardized, adaptable approach to address evolving health challenges.