The 10 Essential Public Health Services: A Framework for a Healthy Nation

The 10 Essential Public Health Services: A Framework for a Healthy Nation

Public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing, and responding to infectious diseases. For decades, the operational backbone for this mission has been the 10 Essential Public Health Services (EPHS). First established in 1994, this framework was significantly updated in 2020 to meet modern challenges by explicitly placing equity at its core. [1][2] This pivotal shift reframed the goal: it is not enough to improve population health; public health must actively dismantle systemic barriers like poverty, racism, and discrimination that create health inequities. [3][4] The EPHS framework organizes the complex work of public health into three core functions—Assessment, Policy Development, and Assurance—providing a comprehensive roadmap for creating communities where every individual has a fair and just opportunity to achieve their highest level of health. [3][5]

The Core Function of Assessment: The Diagnostic Engine of Public Health

The Assessment function is the diagnostic engine of public health, comprising the first two essential services: monitoring health status and investigating health problems. [5] This goes far beyond simply counting disease cases. It involves a deep, analytical approach to understanding a community’s complete health picture. Essential Service 1: Assess and monitor population health status, factors that influence health, and community needs and assets, requires the systematic collection and analysis of data on everything from chronic disease prevalence to social determinants of health like housing quality, food access, and education levels. [6] A prime example is the Community Health Assessment (CHA), a process regularly undertaken by public health departments to identify local health needs and resources, which then informs strategic planning. [7] Essential Service 2: Investigate, diagnose, and address health problems and hazards affecting the population, is the epidemiological “disease detective” work. [8] This was famously demonstrated during the Flint, Michigan water crisis, where public health officials investigated elevated lead levels in children, tracing the source to contaminated drinking water and identifying the root cause in policy and infrastructure failures. [9][10] The 2020 update to the EPHS framework insists that this data be disaggregated by race, income, and other demographics, a practice that was critical during the COVID-19 pandemic to reveal and address the disproportionate impact on marginalized communities. [6]

The Core Function of Policy Development: Translating Knowledge into Action

Once a community’s health status is understood, the Policy Development function provides the blueprint for action. This function translates scientific knowledge into strategic plans and policies designed to improve health for all. It encompasses three essential services that focus on communication, partnership, and lawmaking. Essential Service 3: Communicate effectively to inform and educate people about health, is about more than just pamphlets; it involves creating culturally resonant, two-way communication to build trust and combat misinformation. [11] Successful anti-tobacco campaigns, for instance, have moved beyond simple warnings to create powerful narratives that have significantly reduced smoking rates. [12] Essential Service 4: Strengthen, support, and mobilize communities and partnerships to improve health, recognizes that public health agencies cannot succeed in isolation. [4] This is exemplified by programs like REACH (Racial and Ethnic Approaches to Community Health), a CDC-funded initiative that builds coalitions between local health departments, community groups, and faith-based organizations to eliminate health disparities. [12] Finally, Essential Service 5: Create, champion, and implement policies, plans, and laws that impact health, codifies these efforts into sustainable change. [4] The implementation of smoke-free air laws and mandatory seatbelt legislation are classic examples of policies that have fundamentally altered the environment to make healthy choices easier and safer, preventing countless deaths and illnesses. [13]

The Core Function of Assurance: Delivering on the Promise of Health

Assurance is the core function that ensures the strategies developed are actually delivered and that the entire system works for everyone. It is the promise of public health in action, guaranteeing that necessary services are in place and accessible. This function includes the final five essential services. Essential Service 6: Utilize legal and regulatory actions to protect the public’s health, involves the enforcement of standards that keep communities safe, such as restaurant health inspections to prevent foodborne illness or environmental regulations that limit air and water pollution. [8] Essential Service 7: Assure an effective system that enables equitable access to the individual services and care needed to be healthy, is a cornerstone of the equity-focused framework. [3] This means not only ensuring the existence of clinics but also addressing barriers to access. Federally Qualified Health Centers (FQHCs) embody this service by providing comprehensive primary care in underserved areas, regardless of a patient’s ability to pay. [14]

This function also requires a focus on the system itself. Essential Service 8: Build and support a diverse and skilled public health workforce, ensures that the people carrying out this work—from epidemiologists to community health workers—are well-trained and reflect the communities they serve, which is critical for building trust and effectiveness. [14] Essential Service 9: Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement, commits the field to being a learning system, using data to evaluate program effectiveness and pioneer new solutions. [3][15] Finally, all of this is supported by Essential Service 10: Build and maintain a strong organizational infrastructure for public health. [3] This foundational service—covering everything from funding and information systems to leadership—is the bedrock upon which all other public health activities depend. The COVID-19 pandemic starkly revealed that without a robust infrastructure, the capacity to perform every other essential service is critically compromised. [16] Together, these ten services form a dynamic and interdependent system, guiding public health in its unwavering mission to create a healthier and more equitable nation for all.