Ten organizational practices of public health: a historical perspective

In 1988, the Institute of Medicine took a major step forward when it defined the functions of governmental public health agencies as assessment (monitoring the health of the American people), policy development (promoting the development of scientifically sound public health policy), and assurance (guaranteeing the benefits of public health for all citizens). The effort to further describe and measure the practice of public health began in January 1989 when the Centers for Disease Control and Prevention (CDC) convened a meeting of public health leaders including representatives of the Association of State and Territorial Health Officials, National Association of County Health Officials, United States Conference of Local Health Officers, Public Health Foundation, American Public Health Association, Association of Schools of Public Health, Health Resources and Services Administration, and CDC. Consensus was reached that these core functions provided an appropriate framework. A beginning effort was made to identify the specific practices or processes required to carry out the core functions. The result of this two-year effort was the delineation of 10 organizational practices that functionally define the practice of public health, provide a basis for measuring the three core functions of public health, and also describe a continuum of problem-solving activity from problem identification to evaluation in order to redirect resources and interventions. Although extensive external examination and validation of these 10 organizational practices is called for, early application and investigation of this framework seem promising.