Transforming Public Health through the FPHS

On Tuesday, January 31, 2023 we brought together a panel with representatives from 21st Century Learning Community states at different stages in their systems transformation journey. Watch the recording below or click here to learn why no matter where your state is in its transformation journey, your state does not need to do it alone; there are others to learn from, share resources with, and collaborate.

Revising the Foundational Public Health Services in 2022.

The Foundational Public Health Services (FPHS) were developed in 2013 to define a minimum package of public health capabilities and programs that no jurisdiction can be without. Almost 10 years and a global pandemic later, it was time to refresh the FPHS framework to assure it continues to reflect the evolving nature and modernization of governmental public health.

The FPHS framework outlines the unique responsibilities of governmental public health and can be used to explain the vital role of governmental public health in a thriving community; identify capacity and resource gaps; determine the cost for assuring foundational activities; and justify funding needs. However, to best serve their communities, health departments will provide additional services and may require additional capacity in different areas.

2022 FPHS

2022 revision highlights include:

    • Most notably, Equity was added as an eighth Foundational Capability, elevating its importance as a cross-cutting skill and capacity, and reinforcing its critical role in ensuring community health and well-being.
    • Definitions for Foundational Capabilities and Areas were refined for greater clarity where needed. Key topics important for today’s public health practice and modernization were emphasized in the definitions, such as equity and social determinants of health, data, technology, and the public health workforce.
    • The component titled “local protections and services unique to a community’s needs” was renamed “Community-specific Services”, and still acknowledges the flexibility needed to accommodate local additional services that are unique but critical to a given community.
    • The framework graphic was reorganized to better capture the connectivity among components. The framework now starts with the Capabilities as the base, recognizing the importance of building a strong infrastructure to support implementation of the FPHS. Foundational Areas and Community-specific Services are depicted as supported by the infrastructure, and equity now encircles all the Foundational Capabilities and Foundational Areas, emphasizing that equity is essential in all aspects of the framework.

An expanded factsheet contains detailed definitions of the public health infrastructure and programs required for health departments to provide basic protections to the communities they serve.

Understanding the history of the FPHS.

With the renewed momentum on improving public health systems and an increased focus on the FPHS, it is important to understand the framework and definitions, how it was developed and for what purpose, and its connection to public health department accreditation.

In November 2021, PHNCI at PHAB and the Funders Forum on Accountable Health released a Foundational Public Health Services and Public Health Modernization Background Report that reviews the original FPHS concept, summarizes how some states have already used the FPHS framework to spur local modernization efforts, describes the potential federal funding support for a nationally driven modernization effort, and suggests areas where the FPHS framework may need to be adapted in light of the lessons learned during the pandemic.

Journey to foundational public health services.

Beginning in spring 2013, the Public Health Leadership Forum, funded by the Robert Wood Johnson Foundation and facilitated by RESOLVE, convened to explore a recommendation from the Institute of Medicine report, For the Public’s Health: Investing in a Healthier Future, to create a “minimum package of services;” in other words, the suite of skills, programs, and activities that must be available in state and local health departments everywhere for the health system to work anywhere, and for which costs could be estimated. The result was a conceptual framework describing both the foundation and programs that no health department should be without. Based on several years of work by 21st century states and others in the field, PHNCI has updated materials that can be used to communicate the importance of building a strong public health infrastructure to support implementation of the FPHS.

Building a strong foundation of public health infrastructure.

Health departments provide public health protections in a number of areas, including: preventing the spread of communicable disease, ensuring food, air, and water quality are safe, supporting maternal and child health, improving access to clinical care services, and preventing chronic disease and injury. In addition, public health departments provide local protections and services unique to their community’s needs.

The infrastructure needed to provide these protections strives to provide fair opportunities for all to be healthy and includes eight capabilities: 1) Assessment & Surveillance, 2) Community Partnership Development, 3) Equity, 4) Organizational Competencies, 5) Policy Development & Support, 6) Accountability & Performance Management, 7) Emergency Preparedness & Response, and 8) Communications. Practically put, health departments have to be ready 24/7 to serve their communities. That requires access to a wide range of critical data sources, robust laboratory capacity, preparedness and policy planning capacity, and expert staff to leverage them in support of public health protections.

Download information sheets that can be used to communicate the importance of building a strong public health infrastructure to support implementation of the FPHS.

Connection to public health department accreditation.

While the FPHS was developed separately and for different reasons than the Public Health Accreditation Board (PHAB) Standards & Measures, there are areas of alignment. The FPHS was developed to represent a minimum package of public health services to make the case for sustainable funding and to set a foundation for what is needed everywhere for public health to function anywhere. The PHAB Standards & Measures were developed as a tool to improve the performance and quality of public health departments. Version 2022 of the PHAB Standards & Measures will designate which measures align with Foundational Capabilities.

Download a document that describes the alignment between the two efforts to support and improve governmental public health.

Additionally, PHAB has released a summary report that analyzes the performance of health departments on PHAB accreditation measures that are linked the foundational capabilities.