Frequently Asked Questions
What is the origin of this Foundational Public Health Services work?
In April 2012, the Institute of Medicine (IOM) released For the Public’s Health: Investing in a Healthier Future. One of the report’s recommendations focused on a minimum package of 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… 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.” (Institute of Medicine, 2012)
Building from the IOM Report and at the encouragement of a number of public health leaders, the Public Health Leadership Forum, funded by The Robert Wood Johnson Foundation, was asked to organize, manage, and facilitate a group of stakeholders to further define and constitute what has evolved to be Foundational Public Health Services, comprised of Foundational Capabilities and Foundational Areas.
What is the Public Health Leadership Forum? How is it funded? Who manages it?
The Public Health Leadership Forum (PHLF) is an ongoing platform to engage a diverse set of leaders/stakeholders in dialogue around the current challenges and opportunities facing the public health community. The Forum identifies concrete actions through consensus-building processes to transform public health. Much of the current work of the Forum entails building the case for establishing and sustaining funding Foundational Public Health Services.
The PHLF is funded by The Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted solely to the public’s health, which works to improve the health and health care of all Americans.
RESOLVE is an independent, nonprofit organization that builds strong, enduring solutions to health, environmental, and social challenges through collaborative/consensus-building processes. RESOLVE’s health program includes work in the areas of community prevention, population health, food safety, and emergency preparedness, among other things.
In 2013, RESOLVE convened a small working group of national public health leaders, who have federal, state, and local level public health expertise. This working group’s task was to define and constitute Foundational Capabilities and Foundational Areas, building on the IOM recommendation, as well as work underway in various state and local health departments to define activities and develop cost estimations.
Over the past year, the Public Health Leadership Forum’s Definition and Constitution Working Group has developed an initial draft defining and constituting the Foundational Public Health Services. The Forum is now engaged in gathering feedback on that draft and will revise it based on input from the public health community, as well as integration of other components of a compelling case for Foundational Public Health Services.
How are key terms related to Foundational Public Health Services defined?
Foundational Capabilities are cross-cutting skills that need to be present in state and local health departments everywhere for the health system to work anywhere. They are the essential skills and capacities needed to support the Foundational Areas, and other programs and activities, key to protecting the community’s health and achieving equitable health outcomes. Examples of these skills include: organizational competencies such as leadership, governance, quality management, health equity and others (for a complete list, see pages 8-11 of the Defining and Constituting Foundational ‘Capabilities and Areas’ Version 1, V-1). The definitions outlined in this document are intended to be sufficiently focused and tangible so as to provide a basis for cost estimation.
Foundational Areas are substantive areas of expertise or program-specific activities in all state and local health departments essential to protect the community’s health. Examples of foundational areas include: communicable disease control, chronic disease and injury prevention, environmental health inspections and monitoring (for a complete list, see pages 11-13 of the Defining and Constituting Foundational ‘Capabilities and Areas’ Version 1, V-1). The definitions outlined in this document are intended to be sufficiently focused and tangible to provide a basis for cost estimation.
Programs and Activities Specific to a Health Department or a Community’s Needs are those determined to be of additional critical significance to a specific community’s health and are also supported by the Foundational Capabilities and Areas. Example: in some jurisdictions, a health department may provide testing/treatment for sexually transmitted disease and in other jurisdictions, this activity may not need to be provided by the health department.
Foundational Public Health Services are the array of skills, programs, and activities that must be available in state and local health departments system-wide, and includes the Foundational Capabilities and Areas as previously defined.
What is the purpose of this effort?
A variety of interested parties, from the Institute of Medicine to the states of Washington, Ohio, and others, have been working on Foundational Public Health Services frameworks in varying degrees for the last few years. The purpose of the Forum’s effort is to develop a clear and consistent conceptual framework that can be appropriately costed out so as to make a clear and compelling case for sustainable funding for Foundational Public Health Services.
A parallel effort involves the Cost Estimation Working Group, also funded by the Robert Wood Johnson Foundation, and managed by Dr. Glen Mays and his team at the University of Kentucky’s College of Public Health. This Working Group is developing costing models regarding the Foundational Public Health Services as defined by the Public Health Leadership Forum’s Definition and Constitution Working Group. Their work is in progress and materials are intended to be ready for dissemination towards the end of this calendar year.
What is the relationship between Foundational Public Health Services and the Ten Essential Services?
The Ten Essential Services serve as a framework for public health systems performance measures and are all encompassing, broad definitions that apply to everything a governmental health department might do, without regard for prioritization. Foundational Public Health Services stem from the IOM’s desire to develop a “minimum package” of public health services, including the foundational capabilities and an array of basic programs no health department can be without.
While the two frameworks have similarities, the context of their development and their purposes differ. Foundational Public Health Services were articulated and defined in such a way that allows them to be “costed out” and specifically relate to activities of local and state public health departments that are needed everywhere for the health system to work anywhere.
What is the relationship between Foundational Public Health Services and Accreditation?
In V-1, the working group preliminarily addressed the relationship with accreditation as follows:
The Accreditation process seeks to recognize that an accredited public health department has demonstrated conformity with evidence-based, nationally accepted organizational capacity standards and measures. Accreditation standards and measures also provide a level of detail and “stretch” opportunity for state and local health departments to use to measure and improve performance.
Accreditation focuses on performance and continued quality improvement, whereas Foundational Public Health Services may help prioritize spending of funds and are defined in such a way as to allow for them to be “costed out.” There are many areas where Foundational Public Health Services and accreditation standards and measures align. Efforts to make sure they continue to align, and positively reinforce one another, are ongoing, and additional clarification may be needed moving forward.
If a health department wants to develop Foundational Public Health Services, are there models available for references?
Were any potential capabilities or areas excluded because they would be too challenging to “cost out”?
The working group focused on those capabilities and areas that they felt were the most important to be present everywhere for the health system to work anywhere. Because this effort was partially a costing exercise, certain practices might only be mentioned in one place, while in reality, it may occur in many parts of a health department. In this sense, there were left out, but only so that they were not “double counted” in the costing exercise.
Are federal public health agencies engaged with this work?
Yes, representatives from the Centers for Disease Control and Prevention’s Office for State, Tribal, Local and Territorial Support have participated in these discussions, as have representatives of the State, Tribal, Local and Territorial Support Advisory Subcommittee, which also has been tracking the development of Foundational Public Health Services.
What are the immediate next steps for this project, and what are the available mechanisms for providing input and comment on the V-1 draft?
RESOLVE, on behalf of the Public Health Leadership Forum (PHLF) is currently gathering feedback from the public health community to further refine the V-1 draft. The mechanisms for conversing with the public health community include presentations at conferences, webinars, and submitting online comments. The Definition and Constitution Working Group will reconvene in the fall to discuss/review the feedback received on the V-1 document and prepare a next draft.