The 10 Essential Public Health Services (EPHS) serve as a framework to guide the field of public health, describing the activities that public health systems should undertake in all communities in the United States.
The original framework was developed in 1994, and in 2020 a revised framework was released that brought the EPHS up-to-date with current and emerging practice. The field has begun updating and adopting the revised framework making equity at the center of the model. Public health practices recognize that in order to build strong, healthy communities, fair and just access must be establishedThe Futures Initiative: How the 10 Essential Public Health Services Framework Was Updated in 2020. 2020. Available at: http://phnci.org/national-frameworks/10-ephs .
Purposes The 10 Essential Public Health Services (EPHS) provide a framework for public health to protect and promote the health of all people in all communities.10 Essential Public Health Services Futures Initiative Task Force. 10 Essential Public Health Services. September 9, 2020. https://phnci.org/uploads/resource-files/EPHS-English.pdf In recognition of public health's commitment to provide a fair and just opportunity for everyone to achieve optimal health and well-being, the framework now contains an equity statement, centers equity in the graphic, and incorporates equity throughout each Essential Service.Jarrah S, Khaldun J, Sellers K, Rich N. Bringing the essential public health services to life. J Public Health Manag Pract. 2021; 27(1):97-98.
The EPHS are organized according to the "three fundamental purposes of public health" (i.e., the three core functions of public health) — assessment, policy development, and assurance:
Assessment Assess and monitor population health status, factors that influence health, and community needs and assets. Investigate, diagnose, and address health problems and hazards affecting the population.
Policy development Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it. Strengthen, support, and mobilize communities and partnerships to improve health. Create, champion, and implement policies, plans, and laws that impact health. Utilize legal and regulatory actions designed to improve and protect the public's health.
Assurance Assure an effective system that enables equitable access to the individual services and care needed to be healthy. Build and support a diverse and skilled public health workforce. Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement. Build and maintain a strong organizational infrastructure for public health.
List of services The revised framework includes an updated graphic, which includes an equity statement.Public Health National Center for Innovations. 10 Essential Public Health Services Toolkit. September 9, 2020. http://ephs.phnci.org/toolkit
Equity Statement: To protect and promote the health of all people in all communities
The 10 Essential Public Health Services provide a framework for public health to protect and promote the health of all people in all communities. To achieve equity, the Essential Public Health Services actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. Such barriers include poverty, racism, gender discrimination, ableism, and other forms of oppression. Everyone should have a fair and just opportunity to achieve optimal health and well-being.
EPHS #1: Assess and monitor population health status, factors that influence health, and community needs and assets This service includes: Maintaining an ongoing understanding of health in the jurisdiction by collecting, monitoring, and analyzing data on health and factors that influence health to identify threats, patterns, and emerging issues, with a particular emphasis on disproportionately affected populations Using data and information to determine the root causes of health disparities and inequities Working with the community to understand health status, needs, assets, key influences, and narrative Collaborating and facilitating data sharing with partners, including multisector partners Using innovative technologies, data collection methods, and data sets Utilizing various methods and technology to interpret and communicate data to diverse audiences Analyzing and using disaggregated data (e.g., by race) to track issues and inform equitable action Engaging community members as experts and key partners
EPHS #2: Investigate, diagnose, and address health problems and hazards affecting the population This service includes: Anticipating, preventing, and mitigating emerging health threats through epidemiologic identification Monitoring real-time health status and identifying patterns to develop strategies to address chronic diseases and injuries Using real-time data to identify and respond to acute outbreaks, emergencies, and other health hazards Using public health laboratory capabilities and modern technology to conduct rapid screening and high-volume testing Analyzing and utilizing inputs from multiple sectors and sources to consider social, economic, and environmental root causes of health status Identifying, analyzing, and distributing information from new, big, and real-time data sources
EPHS #3: Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it This service includes: Developing and disseminating accessible health information and resources, including through collaboration with multi-sector partners Communicating with accuracy and necessary speed Using appropriate communications channels (e.g., social media, peer-to-peer networks, mass media, and other channels) to effectively reach the intended populations Developing and deploying culturally and linguistically appropriate and relevant communications and educational resources, which includes working with stakeholders and influencers in the community to create effective and culturally resonant materials Employing the principles of risk communication, health literacy, and health education to inform the public, when appropriate Actively engaging in two-way communication to build trust with populations served and ensure accuracy and effectiveness of prevention and health promotion strategies Ensuring public health communications and education efforts are asset based when appropriate and do not reinforce narratives that are damaging to disproportionately affected populations
EPHS #4: Strengthen, support, and mobilize communities and partnerships to improve health This service includes: Convening and facilitating multisector partnerships and coalitions that include sectors that influence health (e.g., planning, transportation, housing, education, etc.) Fostering and building genuine, strengths-based relationships with a diverse group of partners that reflect the community and the population Authentically engaging with community members and organizations to develop public health solutions Learning from, and supporting, existing community partnerships and contributing public health expertise
EPHS #5: Create, champion, and implement policies, plans, and laws that impact health This service includes: Developing and championing policies, plans, and laws that guide the practice of public health Examining and improving existing policies, plans, and laws to correct historical injustices Ensuring that policies, plans, and laws provide a fair and just opportunity for all to achieve optimal health Providing input into policies, plans, and laws to ensure that health impact is considered Continuously monitoring and developing policies, plans, and laws that improve public health and preparedness and strengthen community resilience Collaborating with all partners, including multi-sector partners, to develop and support policies, plans, and laws Working across partners and with the community to systematically and continuously develop and implement health improvement strategies and plans, and evaluate and improve those plans
EPHS #6: Utilize legal and regulatory actions designed to improve and protect the public's health This service includes: Ensuring that applicable laws are equitably applied to protect the public's health Conducting enforcement activities that may include, but are not limited to sanitary codes, especially in the food industry; full protection of drinking water supplies; and timely follow-up on hazards, preventable injuries, and exposure-related diseases identified in occupational and community settings Licensing and monitoring the quality of healthcare services (e.g., laboratory, nursing homes, and home healthcare) Reviewing new drug, biologic, and medical device applications Licensing and credentialing the healthcare workforce Including health considerations in laws from other sectors (e.g., zoning)
EPHS #7: Assure an effective system that enables equitable access to the individual services and care needed to be healthy This service includes: Connecting the population to needed health and social services that support the whole person, including preventive services Ensuring access to high-quality and cost-effective healthcare and social services, including behavioral and mental health services, that are culturally and linguistically appropriate Engaging health delivery systems to assess and address gaps and barriers in accessing needed health services, including behavioral and mental health Addressing and removing barriers to care Building relationships with payers and healthcare providers, including the sharing of data across partners to foster health and well-being Contributing to the development of a competent healthcare workforce
EPHS #8: Build and support a diverse and skilled public health workforce This service includes: Providing education and training that encompasses a spectrum of public health competencies, including technical, strategic, and leadership skills Ensuring that the public health workforce is the appropriate size to meet the public's needs Building a culturally competent public health workforce and leadership that reflects the community and practices cultural humility Incorporating public health principles in non-public health curricula Cultivating and building active partnerships with academia and other professional training programs and schools to assure community-relevant learning experiences for all learners Promoting a culture of lifelong learning in public health Building a pipeline of future public health practitioners Fostering leadership skills at all levels
EPHS #9: Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement This service includes: Building and fostering a culture of quality in public health organizations and activities Linking public health research with public health practice Using research, evidence, practice based insights, and other forms of information to inform decision-making Contributing to the evidence base of effective public health practice Evaluating services, policies, plans, and laws continuously to ensure they are contributing to health and not creating undue harm Establishing and using engagement and decision-making structures to work with the community in all stages of research Valuing and using qualitative, quantitative, and lived experience as data and information to inform decision-making
EPHS #10: Build and maintain a strong organizational infrastructure for public health This service includes: