The Three Core Functions of Public Health: The Job of the Local Board of Health

In 1988, the Institute of Medicine issued The Future of Public Health report which stated that America’s public health system was in disarray. The Institute’s panel recommended new governmental functions at federal, state and local levels to strengthen our nation’s public health system. Localities, they said, should reestablish boards of health or “public health councils” to assess public health needs, develop public health policy, and assure that public health services are available. It is these three core functions –

assess, address, and assure – that constitute the job of the local board of health.

 

Assess:
To scan, weigh and balance community needs, resources, statistics and politics.

 

Address:
To determine a course of action; to set targets, to allocate resources, to make policy and assign responsibility.

 

Assure:
To make certain that progress is made

Adapted from Assess, Address, Assure: Manual for North Carolina’s Local Health Boards. Copyright 1993 – Association of North Carolina Boards of Health.

 

The Ten Essential Public Health Services  <Revised 2020>

The 10 Essential Public Health Services provide a framework for public health to protect and promote the health of all people in all communities. To achieve equity, the Essential Public Health Services actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. Such barriers include poverty, racism, gender discrimination, ableism, and other forms of oppression. Everyone should have a fair and just opportunity to achieve optimal health and well-being.

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1. Assess and monitor population health status, factors that influence health, and community needs and assets

2. Investigate, diagnose, and address health problems and hazards affecting the population

3. Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it

4. Strengthen, support, and mobilize communities and partnerships to improve health

5. Create, champion, and implement policies, plans, and laws that impact health

6. Utilize legal and regulatory actions designed to improve and protect the public’s health

7. Assure an effective system that enables equitable access to the individual services and care needed to be healthy

8. Build and support a diverse and skilled public health workforce

9. Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement

10. Build and maintain a strong organizational infrastructure for public health

 

References:
1. Website of Department of Health and Human Services – Centers for Disease Control and Prevention - https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html
2. National Association of Local Boards of Health: Being an Effective Local Board of Health Member

 

Ten Essential Public Health Services and How They Can Include Addressing Social Determinants of Health Inequities
Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. These social determinants of health and actions to address the resulting health inequities can be incorporated throughout all aspects of public health work. Learn more.

 

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History of Public Health in North Carolina

The State Archives of North Carolina preserves and provides public access to historically significant archival materials related to North Carolina.  Archived files trace the history of the Department of Health and Human Services beginning with a reference to “an act of the 1755 Assembly ordering quarantine on vessels" and concluding with the 1990s.  As referenced in the The Eighteenth Biennial Report of the North Carolina State Board of Health:  "In the seventies Dr. Thomas Fanning Wood of Wilmington, caught the vision of the possibilities of public health work to North Carolina. How fully he grasped the far-reaching consequences of his idea, how clearly he saw the ever-growing hosts of lives saved as a result of his vision and inspiration, we shall never know. We do know that the vision never left him, and that under its sway he worked, through the Medical Journal which he edited and through the North Carolina State Medical Society, until his influence reached the people of the State in their General Assembly of 1877, with the effect that on February 12, 1877, the North Carolina State Board of Health was born. Ours was the twelfth State board of health to be established". The county boards of health were composed of the affiliated county medical societies and were under the direction of the State Board of Health. The intent was to create a uniform system of health and sanitation throughout the state. But “the General Assembly appropriated only one hundred dollars to establish this health system; and the existence of the State Board of Health was nominal.”

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Additional excerpts from this history:

 

• “In 1899 the General Assembly passed additional legislation to protect public water supplies from contamination, and the State Board of Health was charged with instructing local health boards and water company inspectors on the procedures for sampling and inspection.”

• “… in 1911 the General Assembly recognized the State Board of Health as the state's medical adviser …. The state board was also required to issue bulletins statewide in the event of a dangerous outbreak of disease.”

• “In 1917 the General Assembly also charged the state board with responsibility for the sanitary conditions and the hygienic care of prisoners in state prisons, local jails, county prison camps, and all other places of confinement…. .”

• “In 1931 the dental care program was established as a separate Division of Oral Hygiene and expanded its efforts to educate the public preventive dental care. In the early 1930s the Division of Preventive Medicine took responsibility for school health services, health education and information, and maternal and child health services. Later in the decade, they initiated a nutrition program offering consultation services to local health departments, schools, and other institutions requesting services.”

• “… in 1945, the General Assembly instructed the state board to initiate a program related to the prevention and cure of cancer, with emphasis on the early detection and treatment of cancers. Under terms of the law, the board was to provide a system of financial aid for low-income cancer patients; establish minimum standards for cancer clinics or departments in general hospitals; collect information on cancer and sponsor an educational program for citizens; and compile and preserve statistical, clinical, and other records relating to cancer prevention and cure. …

• “In 1949 the last remaining county established a full-time health department."

• “In 1963 the General Assembly created a new Department of Mental Health, transferring to that department the services previously performed by the Division of Local Health and its Mental Health Section. Other laws during the same period significantly increased the state board's responsibilities. In 1961 the legislature provided for the licensing of nursing homes by the State Board of Health rather than by the Medical Care Commission and the State Board of Public Welfare. The 1963 General Assembly gave the state board responsibility for a program of air pollution control, although they failed to fund it. In 1965 Governor Dan K. Moore designated the State Board of Health as the official state agency to administer Title XVIII of U.S. Public Law 89-97, commonly referred to as Medicare. The Office of Chief Medical Examiner and a Division of Medical Examiner were created in 1967 …."

• “Under the 1973 act, the Commission for Health Services was granted the power and duty to adopt rules and regulations for the conduct of the state's public health programs, to protect and promote public health, and to control diseases and other health impairments. … Furthermore, the law stipulated that local health departments, when directed by the DHR, would enforce rules established by the Commission for Health Services and that DHR would supervise the local health departments."

• “New programs in place by the early 1990s included the Office of Chief Nurse, charged with coordinating public health nursing services with local health departments and statewide programs; the Office of Health Education, charged with providing various services and developing teaching strategies for environmental, community, and personal health programs; and the Office of Legislative Affairs to represent the department in the General Assembly and to monitor proposed legislation and the work of the legislative study and research committees."

 

As it relates to Public Health, the State Archives collection includes links to 117 digitized original documents, dated 1879 – 1973, including the Bulletin of the North Carolina Board of Health and Biennial Reports of the North Carolina State Board of Health.

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View the First Bulletin of the North Carolina Board of Health [1886-1887 : v.1, 1-12 plus Supplements]

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View the First Biennial Report of the North Carolina Board of Health [1879-1880]