A Public Health Action Plan to Prevent Heart Disease and Stroke

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Section 2. A Comprehensive Public Health Strategy and the Five Essential Components of the Plan: A Platform for Action

The Three Core Functions of Public Health

FFor many people, addressing the meaning of "public health" and clarifying its essential role in protecting society from such chronic diseases as heart disease and stroke may be helpful. The 1988 IOM report, The Future of Public Health, was a critical assessment of the nation's public health system by the Committee for the Study of the Future of Public Health.⁵ The findings of that report provide an important perspective on what will be needed for a successful public health strategy to prevent heart disease and stroke. The following excerpts illustrate this point. 

• A definition of public health: Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy. 

• A key barrier to public health action: Health officials have difficulty communicating a sense of urgency about the need to maintain current preventive efforts and to sustain the capability to meet future threats to the public's health.

• The report's overall appraisal: ...this nation has lost sight of its public health goals and has allowed the system of public health activities to fall into disarray. 

• The needed response: This report conveys an urgent message to the American people. Public health is a vital function that is in trouble. Immediate public concern and support are called for in order to fulfill society's interest in assuring the conditions in which people can be healthy. 

Especially relevant to the development of the Action Plan is the IOM report's formulation of the three core functions of public health: "...the core functions of public health agencies at all levels of government are assessment, policy development, and assurance." Assessment refers to the obligation of every public health agency to monitor the health status and needs of its community regularly and systematically. Policy development refers to the responsibility of every public health agency to develop comprehensive policies that are based on available knowledge and responsive to communities' health needs. Assurance is the guarantee of governments that agreed–upon, high–priority personal and community health services will be provided to every member of the community by qualified organizations. 

Each of the recommendations in this plan is readily identifiable with one of these three core functions or addresses requirements for public health agencies to fulfill them. The recommendations also reflect many of the perceptions about the roles and relationships of public health agencies and other entities in the IOM report. Two points are especially relevant. First is the scope of participation needed to achieve public health goals. Private and voluntary organizations and individuals must join with government entities in actively contributing to the functions of public health. Second, state public health agencies have primary constitutional responsibility for public health functions. This premise is reflected in this plan's development and the expectation that these agencies must have a central role in implementing its recommendations. 

In this respect, as in many others, the views of the five Expert Panels that helped develop the Action Plan closely matched those expressed in the 1988 report. They also reflected agreement with the conceptual framework described here. Subsequent to the work of the Expert Panels, two new IOM reports on the present and future of public health in the United States have been released, and both of them strongly reinforce the recommendations presented here.^6,7 The first, Who Will Keep the Public Healthy?, focuses on new requirements for educating health professionals for the 21st century. It presents an ecological model (i.e., "a model of health that emphasizes the linkages and relationships among multiple determinants affecting health") as the essential backdrop, both in concept and in practice, for addressing future health challenges. The framework guiding development of the Action Plan is such a model. Further, the newly formulated goals and objectives for educating health professionals closely mirror the recommendations for strengthening capacity of the public health workforce. 

The second report, The Future of the Public's Health in the 21st Century, builds on the 1988 report. It emphasizes a broad view of the "public health system" that encompasses the governmental public health infrastructure as well as other potential partners, specifically the community, health care delivery system, employers and businesses, media, and academia. This report also explicitly embraces the vision of the nation's health expressed by Healthy People 2010: "healthy people in healthy communities." Topics addressed in the report include "adopting a focus on population health that includes multiple determinants of health; strengthening the public health infrastructure; building partnerships; developing systems of accountability; emphasizing evidence; and improving communication." The congruence between recommendations of the Action Plan and the IOM's recent reassessment of what is needed to strengthen the nation's public health system is striking.

 
Potential Roles of Partners 

The Action Plan recognizes the necessary scope of participation in public health activities expressed in the 1988 IOM report and highlights the need for partnership, collaboration, and shared responsibility. Although state health agencies are primarily responsible for fulfilling the core functions of public health, the potential roles of private and voluntary organizations and individuals in public health activities are also important.⁵ In anticipation of the involvement of various types of organizations and agencies, general descriptions of these roles are as follows: 

• Public health agencies are responsible for leadership in convening all participating organizations and agencies to define and delineate tasks and to support the long–term implementation of this plan at national, state, and local levels. Agencies will participate in accordance with their particular missions, interests, and resources. Some are already involved through the Healthy People 2010 Heart and Stroke Partnership. State and local (i.e., county/city) health agencies and tribal organizations will help guide national implementation and take direct responsibility for action at their own levels. 

• Health care providers are central to the provision of preventive services throughout the clinical phases of CVD. Addressing goals 2–4 of the Healthy People 2010 Heart and Stroke Partnership requires active collaboration with providers, third–party payers, and other relevant partners to assure access to and appropriate use of quality health services by those who need them. 

• Other health–sector partners will help implement the plan at national, state, or local levels, as appropriate. Their roles include contributing to detailed implementation plans, raising public awareness, and supporting legislative and regulatory action to fulfill the plan's policy goals. 

• Non–health sector partners represent such areas as education, agriculture and food production, community development and planning, parks and recreation, transportation, and the media. These partners can contribute different perspectives, as well as additional resources, to help implement the plan and are clearly essential for success. 

• The public at large and representatives of specific groups or settings are critical parties to public health action of any kind. Engaging these parties is also essential to the plan's implementation and success. 

• All interested parties and stakeholders should be included in implementation, and mechanisms for their involvement must be established and maintained.

Next Section: Five Essential Components of the Action Plan

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Date last reviewed: 05/12/2006
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion