Public health systems are vital and unique entities within health systems (1). They are in all the levels of governmental and non-governmental entities responsible for ensuring and providing healthy social and physical environments (1,2). A clear or consistent definition of public health systems does not exist yet; in contrast, multiple health systems frameworks identify the components, functions, and healthcare systems' goals (1).
Although
in literature there is a significant emphasis on defining the essential roles
and functions of public health, there is a lack of clarity on public health
systems' definition, which could be due to: [1] public health systems have been
conceptualised in many ways, [2] there is terminology overlap with publicly
funded healthcare systems, and [3] funder and publications preferences (1,3). Inconsistent terminologies were used to describe the functions
and services of public health in different jurisdictions. For instance, the
responsibility of testing and monitoring the quality of air, food and water
were referred to as either "health protection" or "environmental
health" in different jurisdictions. Similarly, "population health
assessment" was used interchangeably with monitoring, surveillance or
epidemiological activities (1).
Defining public health systems can help decide how to best design systems and deliver programmes and services to support public health within the large health system (1). The governance, delivery, and financial arrangements of traditional healthcare systems align well with many public health systems components; nevertheless, there are distinct differences, especially in relation to partnerships and communications within public health (1,3).
Public health systems consist of various organisations that contribute to public health's core functions to protect and promote health within the community (1,2). A key element of public health systems is the capacity to perform core public health functions. The Institute of Medicine (IOM) provided the most frequently used public health framework (1). It assigns the function of public health into three core functions: [1] assessment, [2] policy development and [3] assurance, along with ten essential public health services that enhance the specific sets of functions and services (Table 1) (1,2,4). Core public health functions include workforce development, surveillance, laboratory capacity, emergency preparedness, and response activities (2,5).
To strengthen the public health workforce, it is recommended to improve training and developmental opportunities, create career paths for trained public health workforce with all government levels, plan for future workforce need, and ensure sufficient staffing (2,3,5). Sometimes, governments may grant the public health system legal authority through creating, passing, amending, and enforcing policies and legislations that strengthen the public health system (3,5).
It is necessary to formulate, promote, and enforce sound health policies to ensure the health of the populations, prevent and control disease, and reduce the prevalence of actors impairing the community's health (2,3). It is an essential function of public health to influence politics and policies at the local, national and global levels (2).
Public health often takes up services that are
not provided by healthcare systems, which overstretches public health budgets (1). Moreover, due to its capacity and expertise to
organise and respond to large-scale events or health threats, response to
health emergencies seems to have been adopted by public health systems (1,2).
Further research is required
in public health systems and services to determine how effective public health
governing entities are on the outcomes of the strategies delivered at local
states levels (4).
|
10
Essential Public Health Services |
IOM Three Core Functions of Public Health |
|
|
1 |
Health
Assessment and Monitoring |
|
|
2 |
Investigation/Surveillance |
|
|
3 |
Inform/educate/Health Promotion |
|
|
4 |
Partner
Engagement & Advocacy |
|
|
5 |
Policy Development & Planning |
|
|
6 |
Regulation/
Enforcement |
|
|
7 |
Link & provide health services |
|
|
8 |
Workforce
strengthening |
|
|
9 |
Evaluation of health services |
|
|
10 |
Research |
|
Table 1: Three core functions of Public Health
and the ten essential services. Adapted from: Jarvis, T(1). Key:
IOM = Institute of medicine.
References
(1) Jarvis T, Scott F, El-Jardali
F, Alvarez E. Defining and classifying public health systems: a critical
interpretive synthesis. Health research policy and systems. 2020; 18
(1): 1-68. Available from: doi: 10.1186/s12961-020-00583-z Available from: https://search.proquest.com/docview/2414908574 .
(2) Detels R, Chuan Tan C. The
scope and concerns of public health. In: Detels, R., Gulliford, M., Abdool
Karim, Q. and Chuan Tan, C. (ed.) Oxford Textbook of Global Public Health. Oxford
University Press; 2015.
(3) Bascolo E, Houghton N, del
Riego A, Fitzgerald J. A renewed framework for the essential public health
functions in the Americas. Revista panamericana de salud pública. 2020;
44 (119): e119. Available from: doi: 10.26633/RPSP.2020.119 Available from: https://search.proquest.com/docview/2454102761 .
(4) Carlson V, Chilton MJ,
Corso LC, Beitsch LM. Defining the functions of public health governance. American
journal of public health (1971). 2015; 105 Suppl 2 (S2): S159-S166.
Available from: doi: 10.2105/AJPH.2014.302198 Available from: https://www.ncbi.nlm.nih.gov/pubmed/25689187 .
(5) Clemente J, Rhee S, Miller
B, Bronner E, Whitney E, Bratton S, et al. Reading between the lines: A
qualitative case study of national public health institute functions and
attributes in the Joint External Evaluation. Journal of public health in
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