What are the “Foundational Capabilities” of a Functioning Public Health System?

Feb 3, 2015

What are the “foundational capabilities” of a functioning public health system and how are they defined? Do variations exist in these definitions among public health practitioners? The de Beaumont Foundation and RESOLVE recently teamed up to conduct research and publish two articles further examining how practitioners in governmental public health are conceptualizing, defining, and funding foundational capabilities and foundational areas (From Patchwork to Package: Implementing Foundational Capabilities for State and Local Health Departments and Practitioner Perspectives on Foundational Capabilities).

The findings in these reports build on a recommendation issued by the Institute of Medicine (IOM) in an April 2012 report calling for the description of, cost estimation for, and the sustained funding of a foundational set of public health services:

“The committee believes that it is a critical step to develop a detailed description of a basic set of public health services that must be made available in all jurisdictions. The basic set must be specifically defined in a manner that allows cost estimation to be used as a basis for an accounting and management framework and compared among revenues, activities, and outcomes. The committee developed the concept of a minimum package of public health services, which includes the foundational capabilities and an array of basic programs no health department can be without.”

In short, we need to have a clear understanding of what public health departments must do and provide everywhere for the health system to work anywhere. Many health departments at the state and local levels, including in Ohio, Colorado, Texas, and Washington have been working to do that.

In partnership with the de Beaumont Foundation, RESOLVE sought to further understand whether and how practitioners were thinking of this issue. The project team conducted 50 interviews with leaders representing state and local health departments in order to better understand their knowledge and beliefs about the foundational capabilities of governmental health departments. The team sought to gather perspectives from a diverse range of health departments across the country, conducting interviews with health department representatives based on geography and jurisdictional characteristics, including population size, governance structure (i.e., centralized or de-centralized), and level of poverty.

Researchers asked specifically about familiarity with the term “foundational capabilities,” and included discussion of public health’s role in communicable disease prevention and health promotion, policy development and support, workforce development, environmental health, assessment and surveillance, among other topics.

While only half of the interviewees had heard of the term “foundational capabilities,” most were familiar with, and affirmed the concept, citing examples in their particular context. When interviewees did relate to these concepts, they used different phrases to describe them, such as “cross-cutting capacities,” “core competencies,” “basic support services” and others. This data reveals that while the term “foundational capabilities” may not exist in the everyday language of a practitioner, the notion of a need to define and acknowledge a “foundation” for governmental public health clearly resonated with many interviewees.

Questions probed on (1) the extent to which their health departments possessed foundational capabilities, (2) how (if at all) these activities were funded, and (3) how they went about prioritizing these activities within their health department. Most respondents interviewed indicated their respective department currently possessed these capabilities, though to what degree was not investigated. Notably, many current public health department leaders said that while they were funding some amount of foundational capabilities with existing funds, they were doing so by piecing together a patchwork of support from state, local, and/or federal funds.

Health departments play a critical role in protecting and improving health in all communities across the country, and yet the funding and infrastructure is fragmented – hampering efforts to maximize public health’s role in providing all people the robust health system everyone should have regardless of their zip code. This study is the first of its kind to assess practitioner perspectives on foundational capabilities of public health and highlight the importance of being able to define, first, what public health is doing, and second, use those definitions to seek funding to support public health’s foundation.

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