What Is the Public Health System?

The public health system once was thought of as comprising only official government public health agencies, but now is understood to include both other public-sector agencies (such as schools, Medicaid and environmental protection agencies, and land-use agencies) and private-sector organizations whose actions have significant consequences for the health of the public¹. The public health system includes the following four main components:

• Mission – The mission of the public health system includes its goals at any point in time and how, at the conceptual level, these goals are operationalized. At the beginning of the 21st century, the mission of public health is to ensure conditions in which people can be healthy.²
• Structure – The structural capacity of the public health system is the cumulative resources and relationships necessary to carry out the important processes of public health. Structural capacity includes the following elements: information resources, organizational resources, physical resources, human resources, and fiscal resources. ²
• Process – The practice of public health can be thought of in terms of the key processes through which practitioners seek to identify, address, and prioritize community or population-wide health problems and resources and the outputs of these more fundamental processes, public health’s interventions, policies, regulations, programs, and services.The processes of public health are those that identify and address health problems as well as the programs and services consistent with mandates and community priorities. ²
• Outcome – The immediate and long-term changes experienced by individuals, families, communities, providers, and populations are the system’s outcomes, the cumulative result of the interaction of the public health system’s structural capacity and processes, given the macro context and the system’s mission and purpose. Outcomes can be used to provide information about the system’s overall performance, including its efficiency, effectiveness, and ability to achieve equity between populations. ²

Mapping Public Health Quality Concepts to Process and Outcomes

References

1. Moulton, A. D., Halverson, P. K., Honore, P. A., & Berkowitz, B. (2004). Public Health Finance: A Conceptual Framework. Journal of Public Health Management and Practice , 377-382.
2. Handler, A., Issel, M., & Turnock, B. (2001). A Conceptual Framework to Measure Performance. American Journal of Public Health , 1235-1239.
3. Bialek, R., Duffy, G. L., & Moran, J. W. (2009). The Public Health Quality Improvement Handbook . Milwaukee: American Society for Quality, Quality Press.

Additional Resources

• Public Health Systems and Services Research  Information on Public Health Systems and Services Research supported by the Robert Wood Johnson Foundation.
• Robert Wood Johnson Foundation The Robert Wood Johnson Foundation and its partners are building the field of Public Health Systems and Services Research  to answer some of the most important and challenging questions about how best to structure, fund and support our public health system so it can improve the lives of the people it serves.
• Trust for America’s Health Blueprint for a Healthier America Outlines steps for reorganizing the current federal system with a focus on prevention and preparedness.
• APHA Partnership for Public Health Quality APHA and ASH partner to promote a strategic framework for public health quality.