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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 |
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