ESSENTIAL SERVICES OF ENVIRONMENTAL HEALTH A Training Module The of the Essential Services of Environmental Health Developed by Carl Osaki, MSPH, RS Department of Environmental and Occupational Health Sciences University of Washington Seattle, Washington July 2004 Developed for the Northwest Center for Public Health Practice, School of Public Health & Community Medicine, University of Washington and funded under a cooperative agreement from the Centers for Disease Control and Prevention through the Association of Schools of Public Health, grant number U36/CCU300430-22.
The of the Essential Services of Environmental Health Slide1 Introduction. Explain why this training is of importance to you personally. Explain the value to your department and what the benefit will be to the participants. Suggested language: Thank you for allowing me to share with you some important information about the practice of environmental health. The information you will be receiving today will help you understand the purpose of environmental health and will explain how to address many of the challenges and obstacles to our practice. It will demonstrate how to develop leadership in environmental health and help you think about new approaches to organize and deliver environmental health services. Slide 2 The Bottom Line. This slide depicts the components of an optimally functioning environmental health unit. This slide is put up front to sensitize participants about what will be coming later. The essential services are not mentioned. The bullet points appear one at a time and are briefly described. Suggested language: Many of you are curious about how your unit compares with other similar environmental health units around the country. The bottom line is that the components of an optimally functioning environmental health unit have already been defined. Let s quickly go over these steps. Think about the unit to which you most closely relate. This can be a program, district, section, or even an entire division or department. Then consider whether your unit systematically does the following: Does it proactively identify the presence or absence of environmental health threats or problems in the community? If problems or threats are present, does your unit determine the significance of those problems, by examining the risks and the affected population groups? Does the unit have the ability to communicate these risks to all people in a clear and complete manner? Can people act on that message? Northwest Center for Public Health Practice 2
Does it have formal or informal relationships with community and governmental groups or agencies so that collaborative efforts can be established or developed? Are there additional community or agency partners that can be mobilized to help? Does the unit, in conjunction with others, develop realistic and acceptable plans or policies that reflect community values and priorities which can be forwarded to decision makers for action? Does the unit ensure that the policies and plans are effectively carried out? Does the unit understand how to refer or connect people for needed help or assistance? Especially to those agencies that have been identified as our partners? Does the unit have people who have the knowledge, skills, and abilities to effectively carry out the plans? Does the unit evaluate its activities to determine whether they are making a difference? Is there some formal evaluation of the activities? Does the unit look for new and different ways of performing all of the above activities? Slide 3 Training Objectives. State the objectives of the training. Indicate that this is a starting point and not an end in itself. The training establishes a context for putting into practice the philosophy and concepts surrounding the latest thinking around building effective and optimal public health systems. Suggested language: The objectives of today s training will be to learn about 1. The history and philosophy of the Essential Services of Environmental Health; 2. The value of the Essential Services to you and to your organization; 3. How to write performance indicators; 4. How to assess your organization s readiness to integrate the Essential Services. You will do this by discussing the challenges and opportunities within your organization. Slide 4 Workforce Questionnaire This slide introduces an optional exercise. Some units may have already distributed this questionnaire prior to the training. The resource section of this trainer s manual has instructions on how to conduct this exercise and a copy of the questionnaire. The questionnaire is used to illustrate examples of Essential Services and also allows participants to assess the extent to which their unit currently performs each of the 10 Essential Services. Participants are also exposed to familiar activities Northwest Center for Public Health Practice 3
that will help in understanding the following slides in the presentation. This activity should take about 15 minutes to complete. The trainer can collect the questionnaires for further analysis or have the participants keep them for reference in other parts of the exercise. Some trainers may elect to discuss the results of the questionnaire before moving on further with the presentation. Suggested language: To illustrate examples of these activities, which are termed the Essential Services, we will take a few moments to complete a questionnaire. The purpose of this questionnaire is to determine your current knowledge and practice of the Essential Services. Slide 5 Why the Essential Services? This slide illustrates the value and benefits of the essential services to the individual. The benefits to the organization may be more obvious, but participants will want to know the value to them and to their job. This slide aims to solicit interest, commitment, and support as early as possible into the presentation. (If you are using the PowerPoint version with audio, the audio comments stress each of these points.) Suggested language: This slide explains some of the reasons why learning about and practicing the essential services should be important to you personally. These reasons may actually be different from what your organization may desire from the essentials. But they may help you to understand how your personal needs connect with your organization s efforts for overall systems improvement. Slide 6 NCEH Goals. This slide ties the last bullet of the previous slide to the national goals of the National Center for Environmental Health, CDC. It reaffirms the necessity to look at a long-term strategy to address some of the problems that will be identified in later slides. The aim is to link the listener to a bigger picture. (Note: The strategy is available from CDC as both a written document, A National Strategy to Revitalize Environmental Public Health Services, and as a video of a satellite broadcast that was broadcasted in May, 2002. Departments may find value in showing one or both to their staff prior to the training. (If you are using the PowerPoint version with audio, the audio comments stress each of these goals.) Northwest Center for Public Health Practice 4
Suggested language: The previous slide mentions a connection of the essential services to national strategies and priorities. In May, 2002 the National Center for Environmental Health, CDC, shared six goals for enhancing the practice of environmental health in the 21st Century. These goals were broadcasted nationally on May 9, 2002, and are based on the 10 essential public health services. They include: 1. Building the capacity of our workforce to achieve the essential services. 2. Promoting research in Environmental Health for new insights and innovations for Environmental Health practice. The relationship between environmental factors and disease outcomes is a part of this goal. 3. Fostering leadership, particularly by demonstrating those departments that have successfully integrated the Essential Services into their practice. 4. Communicating and marketing Environmental Health in a way that people can understand and value. 5. Developing a competent Environmental Health workforce. 6. Creating strategic partnerships between public, private, and community organizations and academia. Slide 7 Background. The purpose of this slide is to describe the history of the essential services. Suggested language: Now I would like to turn to the history and background of the essential services. This background will provide some historical context for you. Let me begin by telling you about the Institute of Medicine s Report: The Future of Public Health, which was published in 1988. This well-respected national document served as a wake up call for public health agencies at all levels across America. A follow-up report, The Future of the Public s Health in the 21st Century, was published in 2003, and many of the findings and recommendations about environmental health are similar to the 1988 report. Slide 8 IOM report finding This slide depicts the findings of the 1988 IOM report. Suggested language: The 1988 IOM report found that the public health system across America was in disarray and that public health was characterized by: chronic under funding; fragmented efforts; lack of trained resources; outdated technology; and confusing legal authority. It s interesting to note that many departments continue to have these problems. Northwest Center for Public Health Practice 5
Slide 9 IOM report finding regarding Environmental Health. This slide describes the IOM findings about Environmental Health. You may want to use this slide to discuss your current and past status as compared to these findings. Suggested language. The IOM report also had some findings regarding Environmental Health. The report recognized that many Environmental Health activities were placed organizationally outside of traditional local or state public health agencies. Thus, Environmental Health was found to be characterized by: Disjointed policy development (that it was difficult to identify where and how policy was being made on environmental health issues). Fragmented services delivery (that you could have a passing parade of various agencies responding to a common issue water, food, indoor air, and so on; or in some cases, there would be a gap or lack of response for others). The lack of accountability (it was very difficult to document the results of our actions whether we were making a difference because of the lack of data). In sum, the IOM report suggested that there was a weakened public health effort when it came to identifying and managing environmental factors affecting people s health. Slide 10 The core functions. This slide explains the recommendation of the IOM report on how public health organizations should be organized to address the findings. Suggested language: The IOM report also contained recommendations on how public health agencies should be organized to address the findings contained in the report. These recommendations were defined as the three core functions of public health. They include: Assessment (identifying problems and threats in the community) Policy development (stating what will be done to address those threats based on community values, priorities, and resources) Assurance (seeing that the policies get carried out and then evaluating those activities to see whether or not they make a difference) Northwest Center for Public Health Practice 6
Slide 11 Responding to the IOM report. This slide describes some of the problems that resulted from attempting to implement the core functions into departments. Suggested language: Many local and state health departments were effective in implementing the core functions. Examples include statewide efforts in developing public health improvement plans; local health departments using the Assessment Protocol for Excellence in Public Health (APEXPH) to perform community assessments; and participating in Turning Point efforts in 41 communities and 14 states throughout the nation. Yet, despite these efforts, there still appeared to be a problem of communicating the core functions philosophy to people outside of public health, particularly to the community or to the policy makers responsible for supporting and funding public health efforts. The result was the lack of agreement or consensus on the purpose and practice of public health. Slide 12 Background. The purpose of this slide is to explain the reason why the essential services were created and the role of the Public Health Functions Steering Committee. Suggested language: As a result of this confusion about the purpose and practice of public health, a group of national, local, and state representatives with an interest in addressing this issue was convened in 1994 as the Public Health Functions Steering Committee. The group s goals were to clarify: The vision The purpose The activities or functions needed to effectively practice public health. These activities were termed the Essential Services of Public Health. Northwest Center for Public Health Practice 7
Slide 13 The VISION of Public Health. This slide describes the vision that was defined by the Steering Committee. Suggested language: The PH Functions Steering Committee defined this vision: Healthy People in Healthy Communities. Even today you may find this vision stated in mission or vision statements in local or state health departments across America. Slide 14 Purpose of Public Health. This slide is important since it aims to illustrate the purpose of public health and that, regardless of a person s experience or education in public health, all have responsibilities for achieving this purpose. Emphasize to learners that this is the big prize of public health. This slide may help learners understand more fully and clearly their reason for getting into public health and how their job helps to achieve the vision of public health. This may even be an aha moment for some. Take your time with this slide to emphasize its importance and try to illustrate examples of programs, activities, or services from your own department if possible. Suggested language: This slide describes the fundamental obligations of agencies responsible for public health. The purpose was written to communicate with all audiences both within and outside of public health. It provides a template for the organization and delivery of public health services. This purpose of public health was described as: Preventing epidemics and the spread of disease Protecting against EH hazards Preventing injuries Promoting and encouraging health behaviors and mental health Responding to disasters and assisting communities in recovery Assuring the quality and accessibility of health services So, if the description of the purpose tells us the ENDS of public health, it seems appropriate, even necessary, to describe the MEANS to achieve those ends. This then gave rise to the Essential Services of public health Northwest Center for Public Health Practice 8
Slides 15, 16, 17 The Essential Services of Environmental Health. These three slides depict the essential services of environmental health. Emphasize that they are exactly the same as the essential services of public health, but have been slightly altered to emphasize environmental health. The reason for this is to illustrate that the essential services can be used for environmental health activities regardless of where environmental health is organizationally placed (for example, environmental quality, agriculture, etc.). Suggested language: The essential services are not meant to stand alone as isolated activities to achieve the purpose of public health. Rather they are aligned in a cycle of public health effort. They are also clearly derived from the core functions of public health. The essential services you see on these three slides have been altered somewhat to illustrate that the essential services work no matter where they are placed. The bottom line is they must be managed at the system level and supported by sound science and good research in order to be effective. Many health departments say they currently practice all of these services. Some, on the other hand, may provide only a few. Regardless, what is often lacking is a way of measuring or evaluating whether the essentials are being practiced in a manner that makes a difference in improving the overall system. Northwest Center for Public Health Practice 9
Slide 18 The linkage of Essential Services to Core Functions. The purpose of this slide is to illustrate that the core functions and the essential services are the same. Suggested language: This slide illustrates the relationship of the core functions to the essential services. You can see that the essential services and the core functions are the same. For example observe the relationship of the assessment core function with the two first essential services: monitoring health status and diagnosing and investigating health problems. You can also see by this diagram that the core functions and essential services are managed systematically as a cycle of public health effort and that the Research essential service occurs throughout the entire process. Slides 19, 20, 21, 22 Words of Wisdom from the Field These slides contain audio quotes from practitioners from the environmental health practice arena or from academia. The quotes are used to illustrate important points from the presentation and to show real life examples of how others have used the Essentials. The slides cover how the Essential Services are used to: Evaluate existing programs Gregg Grunenfelder, Art Starry Plan for the future Art Starry, Dale Stephanson Work with staff Susan Brueggeman, Tom Turco Communicate environmental health Bud Nicola, Marianne Seifert Northwest Center for Public Health Practice 10
Slide 23 Making a difference. This slide provides a short summary of outcomes derived from successfully integrating the Essential Services. The purpose of this slide is to provide enthusiasm, motivation, and interest in the remaining parts of the training module. Suggested language. How can we determine whether the time and effort required to integrate the Essential Services will provide us with the desired benefits and outcomes and actually make a difference? The answer to that question, of course, is up to you. But to begin thinking about this question, here are some comments by others who have started the process of integrating the Essential Services into their work: Your services are appropriate and relevant because you have proactively begun to assess the new and emerging environmental health threats in your community. And you have developed polices and plans to address them People understand what you do because you can explain the purpose of public health and describe a process to achieve that purpose. This is in contrast to simply describing programs. You can demonstrate leadership by showing how the Essential Services are applied as a system of continuous improvement. Northwest Center for Public Health Practice 11
Your services and activities are organized around a philosophy that includes all public health disciplines and fields. Everyone is collectively striving for the same ultimate goal and vision. You understand your organization s capacity gaps and have a strategy on how to address those gaps. Slide 24 Next Steps Slide 25 Questions and Discussion. The purpose of this slide is to solicit or answer questions about the background and genesis of the essential services. By this stage, people should have some basic understanding about the reasons for the essential services and have some beginning thoughts about how they might or might not apply to their organization. Use this time for discussion. Northwest Center for Public Health Practice 12