Appendix: National Public Health Domains
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For current text, always refer to the Public Health Accreditation Board Standards and Measures online.
At the time of publication, PHAB was in the process of reviewing a new set of standards and measures.
Conduct and disseminate assessments focused on population health status and public issues facing the community.
Domain 1 focuses on the assessment of the health of the population in the jurisdiction served by the health department. The domain includes: systematic monitoring of health status; collection, analysis, and dissemination of data; use of data to inform public health policies, processes, and interventions; and participation in a process for the development of a shared, comprehensive health assessment of the community.
Investigate health problems and environmental public health hazards to protect the community.
Domain 2 focuses on the investigation of suspected or identified health problems or environmental public health hazards. Included are epidemiologic identification of emerging health problems, monitoring of disease, availability of public health laboratories, containment and mitigation of outbreaks, coordinated response to emergency situations, and communication.
Inform and educate about public health issues and functions.
Domain 3 focuses on educating the public. This domain assesses the health department's processes for continuing communication as standard operating procedures.
The population that a health department serves should have accurate and reliable information about how to protect and promote individual and family health. They should have information about healthy behaviors, such as good nutrition, hand washing, and seat belt use. The population should have access to accurate and timely information in the case of particular health risks like H1N1, a food borne disease outbreak, or an anthrax attack. Such information should be communicated in a language and format that people can understand. Public health departments also have a responsibility to educate the public about the value, roles, and responsibilities of the health department and the meaning and importance of public health.
These educational responsibilities require a continuing flow of information. To be effective, delivery of information shouldn't be a one-way street. For the health department to communicate with the public accurately, reliably, and in a timely manner, it must gather and use information that it receives from federal, Tribal, state and other local health departments. It also needs input from community partners and the population and sub-groups of the population that it serves. Communication requires dialogue with the target population to assure that the message is relevant, culturally sensitive, and linguistically appropriate.
Engage with the community to identify and address health problems.
Domain 4 focuses on community engagement. Community members are important partners in identifying and defining public health issues, developing solutions or improvements, developing policies, communicating important information, and implementing public health initiatives. Members of the community offer a unique perspective on how issues are manifested in the community, what community assets can be mobilized, and what interventions will be effective. Public health can broaden its leverage and impact by doing things with the community rather than doing things to the community. This domain addresses health departments' establishment and maintenance of community relationships that will facilitate public health goals being accomplished.
Develop public health plans and policies.
Domain 5 focuses on the development of public health policies and plans. Written policies and plans serve as tools to guide the health department's work and bring structure and organization to the department. Written policies and plans provide a resource to health department staff as well as the public. Policies and plans help to orient and train staff, inform the public and partners, and serve as a key component of developing consistency in operations and noting areas for improvement. Policies and plans can be a vehicle for community engagement and shared responsibility for addressing population health improvement.
Policies that are not public health specific may also impact the public's health. Policy makers should be informed of the potential public health impact of policies that they are considering or that are already in place. Policy makers and the public should have sound, science-based, current public health information when policies are being considered or adopted.
Enforce public health laws.
Domain 6 focuses on the role of public health departments in the enforcement of public health related regulations, executive orders, statutes, and other types of public health laws. Public health laws are key tools for health departments as they work to promote and protect the health of the population. Health department responsibilities related to public health laws do not start or stop with enforcement. Health departments also have a role in promoting new laws or revising existing laws. Public health related laws should be science-based and protect the rights of the individual, as they also protect and promote the health of the population. Health departments have a role in educating regulated entities about the meaning, purpose, compliance requirements, and benefit of public health laws. Health departments also have a role in educating the public about laws and the importance of complying with them.
The term "laws" as used in these standards and measures refers to ALL types of statutes, regulations, rules, executive orders, ordinances, case law, and codes that are applicable to the jurisdiction of the health department. For state health departments, not all ordinances are applicable, and therefore ordinances may not need to be addressed by state health departments. Similarly, some statutes are not applicable to local health departments, and therefore some statutes may not need to be addressed by local health departments. For Tribal health departments, applicable "laws" will depend on several factors, including governance framework and interaction with external governmental entities (federal, state, and local).
Public health laws include such areas as environmental public health (food sanitation, lead inspection, drinking water treatment, clean air, waste-water disposal, and animal and vector control), communicable disease (outbreak investigation, required newborn screenings, immunizations, communicable disease reporting requirements, quarantine, tuberculosis enforcement, and STD contact tracing), chronic disease (sales of tobacco products to youth, smoke-free ordinances, and adoption of bike lanes), and injury prevention (seat belt laws, helmet laws, and speeding limits). Clearly, health departments are not responsible for the enforcement of many or most of these laws. The adoption and implementation of such laws, however, have enormous public health implications. It is important for the health department to be involved in their adoption, monitoring their enforcement, providing follow-up services and/or education, and educating the policy makers and the public about their importance and impact.
Promote strategies to improve access to health care services.
Domain 7 focuses on the link between public health activities and health care services. The health care sector provides many preventive services, such as immunizations, cholesterol screening, screening for breast cancer, high blood pressure management, and prenatal care. Patient counseling on health promotion, disease prevention, and chronic disease management is an important link between health care and public health. Linkages between health care and public health ensure continuity of care and management for the population.
An important role of public health is the assessment of (1) the capacity of the health care system to meet the health care needs of the population, and (2) community members' access to health care services. Public health also works to increase access to needed health care services.
Maintain a competent public health workforce.
Domain 8 focuses on the need for health departments to maintain a trained and competent workforce to perform public health duties. Effective public health practice requires a well prepared workforce. A multi-disciplinary workforce that is matched to the specific community being served facilitates the interdisciplinary approaches required to address the population's public health issues. The manner in which services are provided to the public determines the effectiveness of those services and influences the population's understanding of, and appreciation for, public health. Continuous training and development of health department staff is required to ensure continued competence in a field that is making constant advances in collective knowledge and improved practices.
Evaluate and continuously improve health department processes, programs, and interventions.
Domain 9 focuses on using and integrating performance management quality improvement practices and processes to continuously improve the public health department's practice, programs, and interventions.
Contribute to and apply the evidence base of public health.
Domain 10 focuses on the role that health departments play in building and advancing the science of public health. Public health is strengthened when its practitioners continually add to the body of evidence for promising practices -- those practices that have the potential to become evidence-based over time. Health departments should employ evidence-based practices for increased effectiveness and credibility. Health departments also have important roles in developing new evidence. Health departments should apply innovation and creativity in providing public health services appropriate for the populations they serve.
Maintain administrative and management capacity.
Domain 11 focuses on health department management and administration capacity. Health department leaders and staff must be knowledgeable about the structure, organization, and financing of their public health department and other agencies and organizations that provide public health services. Health departments must have a well managed human resources system, be competent in general financial management, and knowledgeable about public health authorities and mandates.
Maintain capacity to engage the public health governing entity.
Domain 12 focuses on the health department's capacity to support and engage its governing entity in maintaining the governmental public health infrastructure for the jurisdiction served. Governing entities play an important role in the function of many public health departments. Governing entities both directly and indirectly influence the direction of a health department and should play a key role in accreditation efforts. However, much variation exists regarding the structure, definition, roles, and responsibilities of governing entities.
A governing entity, as it relates to the accreditation process, should meet the following criteria:
- It is an official part of Tribal, state, regional, or local government.
- It has primary responsibility for policy-making and/or governing a Tribal, state, or local, health department.
- It advises, advocates, or consults with the health department on matters related to resources, policy making, legal authority, collaboration, and/or improvement activities.
- It is the point of accountability for the health department.
- In the case of shared governance (more than one entity provides governance functions to the health department), the governing entity, for accreditation purposes, is the Tribal, state, regional, or local entity that, in the judgment of the health department being accredited or PHAB site visitors, has the primary responsibility for supporting the applicant health department in achieving accreditation.