The “10 Essential Public Health Services” Is the Common Framework Needed to Communicate About Public Health

Studies, polls, and focus groups conducted over decades repeatedly have found that leaders and professionals in other sectors, elected officials, and the public do not understand what is meant by the term “public health.”^1–3 When asked, many have a hard time responding at all.¹ Those who can offer up an attempted definition often confuse public health with health care, incorrectly equating public health practice with medical care for the poor or indigent or overemphasizing individual behavior rather than community-level change.¹

Our inability to communicate effectively about public health has consequences. Leaders working in education, health care, housing, and business are largely unclear about what public health professionals do and about their potential to add value to their work.¹ This has made it more difficult to form partnerships and secure necessary funding. If we are to successfully communicate about public health, we must establish a common understanding.⁴ That needs to start with a universal framework that is used consistently throughout the field to establish a common set of ideas before discussing more specific dimensions of public health practice. The “10 Essential Public Health Services” is that common framework.

For more than 25 years, the “10 Essential Public Health Services” (Essential Services) has provided a common set of ideas that everyone in the field can use, while simultaneously being responsive and flexible. Originally developed in 1994 by a federal working group, the Essential Services served as a description of the activities that public health systems should undertake in all communities. Organized around three core functions of public health—assessment, policy development, and assurance—the Essential Services provides a set of concepts that collectively define what public health does and how that work differs from other roles in the health field, specifically health care.

However, although they were innovative in 1994, the Essential Services grew increasingly out of touch with current public health practice. The original framework has persisted as part of nearly all public health curricula and as the basis of the Public Health Accreditation Board domains. Given its widespread acceptance, it was critical to reinvigorate the Essential Services framework to reflect new realities facing the field of public health.

In 2019, the de Beaumont Foundation and the Public Health National Center for Innovation partnered with many leading public health organizations to begin the long-overdue update. Through the revision process, we collected real-time feedback through polling at meetings and events, an online survey, and discussions with more than 1300 practitioners across all areas of public health and at all stages of their careers. This process allowed for more diverse participation than was possible when the framework was initially written and should serve as a template for developing future models and frameworks. This input was complemented by a task force that included experts from federal agencies, national public health organizations, state and local public health officials, tribal representatives, academics, and nonprofit groups.

Released in September 2020, the revised framework capitalizes on the strong Essential Services brand while ensuring that it is closely aligned with the current and future responsibilities and functions of public health.⁵ It has reinvigorated the framework as a tool to define and explain public health’s vital role in different contexts and with multiple audiences. With this update, the revised Essential Services can be the primary framework used to explain what a comprehensive public health system should deliver.

A significant part of the updated Essential Services is the explicit focus on equity. Health disparities have existed from long before we measured health outcomes.⁶ The injustice of slavery perpetuated by systemic policies that disproportionately affected people of color has had a direct and undeniable impact on health.⁷ Placing equity at the core of the framework is a powerful visual representation of public health’s obligation to help all people achieve good health and serves as a reminder of how public health must center on communities that have been historically marginalized in their work. The emphasis on equity also recognizes the emergence of social justice movements that are intertwined with public health values.

The new Essential Services framework also provides a universal lens through which we can assess public health system readiness and communicate public health funding needs. Many public health system challenges experienced during the COVID-19 pandemic—archaic data systems, neglected social policies exacerbating spread, needed partnerships, communications missteps, and a workforce starved for resources—can be tied to an inability to deliver on one or more of the Essential Services. Advocates for the resources necessary to rebuild the nation’s public health system can point to the Essential Services as a guide when developing new legislation to fund public health infrastructure.

For communicating about public health, the Essential Services framework remains one of the best tools available to practitioners, and 80% agree that the framework is useful for this purpose.⁵ Public health systems and specialized fields around the world use and tailor the framework for their own needs, but its themes are overarching. Having a common framework that prioritizes three themes (assessment, policy development, and assurance), defined by 10 widely accepted responsibilities, allows practitioners from all corners of the field to communicate the same core aspects of public health. Whether one is speaking with community members about local health promotion initiatives or advocating for investments in public health to policymakers, the Essential Services provides a consistent framework for messaging. The Essential Services has been thoughtfully crafted to be accessible to people from all backgrounds, in both language and design, which can help practitioners make connections across sectors.

At a time when public health is in crisis and the effects of decades of neglect are visible, it is necessary to breathe new life into the Essential Services. Now, more than ever, it is time for the field to embrace this new, refreshed framework and use it to ground and shape conversations about public health to garner sustained investments, partnerships, and appreciation. The 10 Essential Public Health Services framework will continue to evolve to meet the needs of public health. The more we use the Essential Services to talk about public health, the stronger and more influential our collective voice will be.