Well, good afternoon, everybody, and welcome to this webinar from Addressing the Ten Essential Public Health Services. Our presentation today will be by Dr. Boris Lushniak, moderated by Dr. Sam Shekhar. I'm Dr. Angela Michelide, the Vice President of Programs and Education at the American College of Preventive Medicine. The American College of Preventive Medicine is a professional medical society of more than 2,000 physicians dedicated to improving the health and quality of life of individuals, families, communities, and populations through disease prevention and health promotion. Our members are licensed medical doctors or doctors of osteopathy who possess expertise in a broad range of healthcare skills, including biostatistics, epidemiology, management of healthcare organizations, research, and the practice of prevention in clinical settings. They work in a variety of settings, including hospitals, government at the local, state, and federal levels, the military, laboratories, businesses, and academia. I have just a few housekeeping tips for us today. You've all been placed in listen-only mode. We will be posting a recording of this webinar on the ACPM.org website in a day or two, so please feel free to share it with your friends. We ask you that throughout the presentation that you type your questions and answers into the chat box. And, of course, we want to know what you thought about the webinar because we're always on the road to continuous improvement, so do fill out the survey. It gives me pleasure today to introduce our moderator, Dr. Sam Shaker. Dr. Shaker is a senior medical public health executive with an extensive leadership record over a 30-year career across the nation's health sector. He is a former chief medical officer with a Fortune 150 company where he provided strategic clinical leadership across its health portfolio, directed R&D initiatives and programs, and served as a key representative to the health sector. Dr. Shaker is currently a member of the American College of Preventive Medicine's Board of Regents, the National Academy of Medicine's Roundtable on Genomics and Precision Health, and the University of Michigan's School of Public Health's Dean's Advisory Board. And in that capacity, he co-chairs its research committee. Dr. Shaker is a retired Assistant Surgeon General Rear Admiral with the United States Public Health Service. He held executive medical policy decisions at HRSA, NIH, and CMS where he directed programs providing health care to millions of Americans, supported Medicare coverage and coding policy, and deployed and led public health service emergency response efforts. He completed a CDC preventive medicine residency and has an MD and an MPH from the University of Michigan. Dr. Shaker, I turn the virtual podium over to you. Thank you very much, Angela. Good afternoon to everyone. As we all know, the general field of public health and prevention spans many, many distinct areas of education, policy, research, and programmatic focus and interest for people in this nation and the world. The 10 essential public health services continue to provide an ever timely, comprehensive, and unifying framework for all the important and diverse public health and prevention values, goals, and efforts, a framework which is directly focused on reducing health inequities and helping advance the health of all people in all communities. To help us better understand the value and significance of the 10 essential public health services today, I'm very pleased to introduce my friend and colleague, a fellow regent of the college, Dr. Boris Lushchak. Boris leads the School of Public Health at the University of Maryland, the university's youngest and most racially, ethnically diverse academic college. As dean, he has developed several new programs to meet workforce needs, launched a global health initiative, and provided leadership during this coronavirus pandemic time. Dr. Lushchak was the United States Deputy Surgeon General from November of 2010 to September of 2015, and served as the U.S. Acting Surgeon General from July 2013 to December 2014. Among his wide range of successful efforts and initiatives in these positions, he oversaw the global operations of the United States Public Health Service Commission Corps, of which you're both members. He was responsible for the release of the 50th anniversary Surgeon General's Report on Smoking and Health, and the first ever Surgeon General's Call to Action to Prevent Skin Cancer. He began his USPH career in 1988 in the Epidemic Intelligence Service at CDC, and served both there and at the U.S. FDA in a number of agency assignments of increasing scope and responsibility over his career. He is an MD from Northwestern, an MPH from Harvard, and maintains certifications in dermatology and occupational medicine. As mentioned, he serves on the Board of Regents for the American College of Preventive Medicine, and is a key leader and spokesperson for the college. Dr. Lushchak. Thank you so much, Sam, and thank you for that kind introduction to you and Angela, and for inviting me here to be part of this discussion. We have a nice group of people out there. And this should be at the end of all this, a discussion, right? In this world of Zoom, which, by the way, we have to acknowledge, there's good parts to the world of Zoom, perhaps, you know, us gathering like this is made much more conveniently, efficiently. The negative is, I don't see you. And I tend to be a type of speaker, and Sam knows this well, that likes to walk the room, right? I like to stare into people's eyes. I like to get that whole sense of what's going on and what are the thoughts and to have conversations. So today, we're kind of going through some concepts, some ideas, there's some history thrown in, because we have to go back in time to see what's all been happening in terms of the 10 essential public health services. And specifically, it's bringing you up to date, right? The participants out there of what's been happening specifically in this last year, as we've been working and finally releasing the revision of the framework for the 21st century. Next slide, please. So, disclosure, no relevant relationships with industry, no relationship with commercial supporters, there won't be any off-label discussion of drugs or devices. Since 2017, I've been the Dean of the School of Public Health at the University of Maryland in College Park, fear the turtle, go Terps. Prior to that, much like Sam, spent a good chunk of my career in the whole world of the alphabet soups of U.S. government. So I spent 27 years in the U.S. government, 16 years at the CDC, 6 years at the FDA, 5 years at the Food and Drug Administration, and then a year as a Chair of Preventive Medicine and Biostatistics at the Uniformed Services University. If I have a bias, it's listed here, which is I'm pro-preventive medicine. And so my tact on all this, and I view myself as a public health practitioner, first and foremost. I am on the Board of Regents from the ACPM. And more specifically, the views expressed here are mine only and don't reflect policy or my position within the state of Maryland. Next slide. So, I'm going to start off with something that I love reminding people, right, and these are one of the things that I always have posted on every single office I've held since probably the turn of the century. And it's to remind me of the bold and noble mission all of us are on, right, which is if we're health people, and you can put in other adjectives into that whole thing, I'm a public health person, I'm a clinical, right, health care provider, I'm a health care researcher, but each of those components, no matter how you define yourself, has the word health. And the bold and noble calling is let's remind ourselves of what health really is. And I love this World Health Organization definition of health, because if we're going to be talking about essential services in public health, right, it has the word health in there. What we're trying to achieve here is, in fact, something that is, let's face it, maybe aspirational, but it's important to denote that it is so critical that we look at the definition of health from this aspirational component. First and foremost, it's a state of complete. Notice that adjective, complete. It's not partial. It's not I'm almost there. I'm looking for health to be a state of complete, and then what? It's the triplicate, complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. So realize that if we're taking on this mission of providing public health services, or we're in the health care arena, let's remind ourselves it's not just about the human body. It's not just about the body and the human mind. It's about society in general. Next slide. When we look at the definition of public health, I go back a century. I love the initial definition that was promulgated by C.E.A. Winslow, himself a microbiologist, a leader in public health, and he talks about the three P's, and I've modified them to some extent when I discussed this with my students, and the three P's are what? First of all, public health is about science and an art, and the three P's are what? It's about preventing disease and injury. It's about promoting health and well-being, with the ultimate goal of the third P being prolonging a high quality of life. So the first part of that sort of denotes some of the aspects of public health that are critical to our society. The second part of this definition is just as important, and this really ties into the essential public health services we'll be discussing shortly. Why? Because it takes a village to do public health right. It's not just in the realm of the feds, oh, I used to be a fed, I'm a public health leader, I'm in charge. No. Even 100 years ago, C.E.A. Winslow realized it's the organized efforts and informed choices of society, of organizations, both public and private, of communities, and ultimately it's a responsibility of the individual. So this is sort of the village, and we have a village gathered here today. The CBC Foundation sort of updated that to some extent, and it talks about what? The science of protecting the safety and improving the health of communities through various facets, right? And they include education, policymaking, and research for disease and injury prevention. Next slide. Now, back in 1988, right? Remember what it used to be like at the latter part of the 20th century? We were all anticipating that in a few short years, we're going to have the odometer switch, we're going to turn into the 21st century, the 2000s, but we had a problem back then that was looked at by the Institute of Medicine, right? Now always part of the National Academies of Sciences, but in that realm, they looked at the future of public health. And part of the problem that they discovered back in 1988, and to some extent it's arguable that we still have this problem, may be changed as a result of the pandemic and the very syndemics we've been seeing in the last year and a half. But back in 88, they said, you know, there's a lack of consensus on what the public could expect from public health. In other words, we in public health may not be defining ourselves well enough so that the public itself is confused as to what public health is. There was in fact significant disparities between the services that were offered from the public health world in different jurisdictions. Depending on where you live, public health did different things. And more to the core of the matter, there was a lack of agreed upon public health mission, right? Which agencies provided services? What's the organizational structure? Critical services that were not provided to the public, right? So even the mission was sort of questionable back in 88, and this came up as an evident problem. The role of politics in public health, right? Oftentimes at the local level, even the state and sometimes at the federal level, politics play the role in what services were being provided by public health. And the reality is also there's a public perception of public health doesn't really do anything until what? Until there's a crisis. We're now in the midst of that crisis, hopefully near the end of that crisis, but we know that in this last year and a half, public health has shined at times and has looked utterly incompetent at times. That's the honest truth, right? But at the same time, part of the issue is nobody knows public health until you really need it. And that was one of the issues sort of promulgated from the IOM report. It introduced the concept of a public health system, right? Sort of a systems based approach to public health. And it provided for a mission, which is fulfilling society's interest in assuring conditions in which people can be healthy. And once again, I'll denote the word healthy here really refers to the WHO definition, complete physical, mental and social well-being and not merely the absence of disease or infirmity. And the core functions that came from this IOM report really said it's about these three major buckets. It's about assessment. It's about policy development. And it's about assurance. Next slide. Now, as I talked about these core public health functions that came from this 1988 report, let's delve in a little bit further. And again, this is history, but these are the building blocks for the brand new essential services and public health. First of all, assessment and monitoring of the health of communities and populations at risk. In epidemiology, we use the term epidemiological surveillance. You identify health problems and the priority. So you're out there measuring, you're counting, you're surveying, you're making sure that you have your fingers on the pulse of the health of the population and of the community. But that's not enough, right? Counting and determining what are the problems really doesn't solve those problems. And ultimately leads to the second core component, which is the formulation of public policies. You do something about those problems. You solve those identified local and national health problems and priorities. And then ultimately what? It's about assurance to that population, making sure. And yes, this deals with the other A, which is access to appropriate cost effective care. That's part of the role of public health. And this includes health promotion and disease prevention services. Go American College of Preventive Medicine. Go prevention as a key component of the health paradigm. And ultimately, part of that assurance is making sure that we're constantly evaluating the effectiveness of that care. A key component, oftentimes neglected, is not just doing but evaluating and changing and improving those core public health functions where necessary. Next slide. Now, 1988 came and passed, 1994 comes up. And at that point, it really sort of delved into this idea of let's take the IOM report and let's work with it further. Under the leadership of CDC and federal public health, a federal working group was established. This includes multiple partners throughout the whole public health community. And an essential public health framework was established in 1994. Its purpose was to translate the Institute of Medicine's 88 assessment of the U.S. public health system. That is the document I mentioned already, the future of public health and the three core functions, assessment, policy development and assurance. It led to the concept of description of activities that public health systems should undertake in all communities. So it set that bar of here's the expectation. Here's what the public should expect. The voter should expect. The political should expect that public health should provide for that communities. Health departments were there encouraged, along with the community partners, to organize their work around these essential services. Public health schools, public health programs taught these services. This informed descriptions and definitions of the practice of public health. And ultimately, it led to the next stage of kind of having these performance standards, right? Building accreditation systems for public health and to also build global capacity. That is, if we're going to establish a global health paradigm and teach about public health to the world, how do we get our own house in order so that we understand and share with the world? Here's what we think public health should be doing and became a roadmap of goals for carrying out the mission of public health. Next slide. Now, in figure form, you'll notice there's going to be some similarities in terms of colors and graphics, but notice assessment, policy development, assurance on the outer wheel and then inside. We'll go briefly into each of these aspects. But under assessment, for example, is monitoring health, diagnosing, investigating policy development is informed, educate, empower, mobilize the community partnerships, develop the policies. And then their assurance includes the enforcing of laws, linking to and providing care, assuring a competent workforce and public health and the key component of evaluation. Most critical is the inner circle, because all this back in 1994, the decision back then, not an incorrect one, but one that you'll see is modified by the recent essential public health services. It was based on the concept of research and system management. That's what was the core of the wheel that all this was. We need to find out more. And that's what's going to get us to advance into the 21st century. Next slide. No longer in graphics. And I'm going to just buzz through these slides. The slides will be available to you. There's a lot of information on some of these slides. I really want to get to a conversation stage, so I'm not necessarily going to dig deeply into some of these slides, but they will be available for you just so you have the information in front of you. But once again, under assessment, you can see that the bullets there that I mentioned earlier, policy development assurance. So this is, in essence, the same graphic gets into more of the wording of things. But at the end, it really dealt with this idea that research was a key component for us to develop new insights and innovative solutions to health problems. Next slide. So this all has been going on. We all kind of accepted the 10 essential public health services. It led to a recognition of what health departments should be striving for. It was used for everything from trying to influence decision makers for further support of public health. It was there for the community to remind them of where public health fit in. But at some point, and this came sort of at the 25-year mark of the 1994 report, there was a realization that perhaps we should look at a revision of this, right? Since we're still dealing with words from the 20th century, we should take a 21st century viewpoint. And the world has changed a whole lot in those 25 years, right? The public health landscape has indeed shifted dramatically since 1994. And let's just bring up some of the shifts that we're all very much aware of, right? The issue of chronic diseases and spread globally, the globalization of the world in general and the spread of diseases globally, emerging diseases, right? The idea of infectious diseases, the fact that we have experienced in this century alone brand new coronaviruses, right? It's not just COVID-19, right? It's the idea that SARS came in the 21st century, MERS came in the 21st century. We had a pandemic of influenza just a decade ago, a little longer than a decade ago. The idea that vaccines have been further developed. We certainly had the issue of AIDS, which had existed, HIV-AIDS had existed when 1988 and 1994 reports came out, but at the same time, there's been a shift in terms of how we look at HIV and AIDS. The issue of terrorism, let's remember both the 9-11 components of our lives in this century and the anthrax attacks shortly thereafter. Natural disasters, all I have to do is say one word, Katrina, and in essence, how that natural disaster changed our public health approaches. Tobacco. Sam mentioned the fact that I was acting Surgeon General when we released the 25th anniversary, or the 50th anniversary report on smoking and health. Well, tobacco hasn't gone to the wayside. Yes, we've gone from 42% of our population, adult population, being smokers in 1964, when the first report was released, to roughly 16% of adult smokers now, so yay us, but I've got to remind you, 460,000 people still die every year from smoking-related diseases. We've not zeroed out this issue. Gun violence. What more can I say about that, right? We talk about all these incidents taking place and gun violence being a public health issue, and yet we're still in this quagmire of solutions for that. Gender identity, right? The movements in the LGBTQ world, the issue of equity and equality and recognition. Marijuana. I mean, think about it, right? Since 1994, the legalization or decriminalization of marijuana in our society, being sold in various states as an alternative. Opioids and the terrible addictions released with the opioid substance abuse issue nationwide, and certainly changes in technology, right? The idea that we're now wearing things on our wrists that really didn't exist, or maybe prototypes existed 25 years ago, but gives me health information, right? Who doesn't do the step counting, right? As part of perhaps their routine. Not 100% do it, but the information is there. You know, this watch tells me to breathe occasionally, right? The mental health aspects of this, the relaxation components, right? We have technologies that we now need to take advantage of. And also at the same time, the issues of health equity, which has come to a paramount in the midst of the COVID-19 pandemic. The issue of preparedness, management and government, informatics. The importance of us still having a component of assurance, right? That was a major breakdown in the midst of COVID-19. And certainly research and evaluation has continued to expand. So the idea here was what? We need to make some changes. We need to better reflect the current and future practice of public health. So, you know, the band came back together. It might've been different names, but in essence, the band came together in order to look at the recommendations for public health services from 25 years ago and to say, okay, we're going to look at the current world and how do we look at changes of this? Next slide. So this all started in the spring of 2019. The Beaumont Foundation and the Public Health National Center for Innovations, two great groups brought together a task force of public health experts and the plan to gather input from the field. This went on for 18 months. The task force met in person and virtually to begin working on this revision. And in the midst of all this, of course, what happened, right? We're going through a pandemic as part of this. This started in the spring of 2019. By January of 2020, we were in the midst of a changed world. The task force at that time decided it was still important and perhaps more important than ever to continue the revision process. We adjusted the timeline accordingly to allow for additional input from the field. And ultimately the aim was at bringing the 10 essential public health services national framework in line with current and future public health practice. So the idea was engage the public health community to assess the current state of use of the framework and update and refresh the national framework. Next slide. So how was this done, right? So this is all methods and procedures. An environmental scan occurred led by the Beaumont and PHNCI. And if you had a chance, and again, these slides will be available, this report that was issued in July of 2019, which was defining public health practice, 25 years of the 10 essential public health services was a great report looking at the environment at that time. They didn't include this idea of the revisions as yet, but it was an environmental scan. A task force of experts was put together. Data collection took place in two phases. Phase one was an initial feedback from the community of public health, from that component of the CEA Winslow definition, the village was asked, what do you think? And then a phase two of data collection, which was vetting of the draft revisions. Data analysis occurred for both phases. There were iterations of the revised framework, communication support and input, and then alignment of several documents that I'll talk about shortly. Next slide. And here is, you know, just sort of the litany. And it's not so important to look at the individual names. Yes, there's some big names out there in this group, but look at the organizations that they represent. And in essence is, I will submit to you, it's not 100% inclusive of all the village, but what you have there is you have private groups, you have well-known public health organizations, you have foundations, you have academic groups, you have US government, right? You have perhaps new partners, right? I'll guarantee you that 25 years ago, Google was not part of this group. And yet when we look at the importance of informatics and the bigger picture, it's critical. We have the ASTHO, the NACCHO groups, right? The whole idea of making sure we were representing both the state and territorial health officers, as well as the city and county individuals. We have people who work at all levels of public health, in the private sector, in the public sector. And so at the end of all this, if you looked at it, it was really a fascinating group. And one that I was honored and humbled to be part of, right, to be part of this group that began discussing how do we change things for the 21st century? Next slide. So once again, in this figurine, Futures Initiative timeline, it starts in spring of 2019. The data collection analysis lasts until December of 2020. We had draft revisions in the midst of the pandemic, January to February of 2020, the vetting that went on until May of 2020, data analysis until August of 2020 and further framework development. And then finally, this was launched officially on September 9th, 2020. On September 9th, 2020. Thank you. Next slide. So what were the guiding principles? Once again, a busy slide, I understand. I'm just gonna sort of emphasize the bolded text or the capitalized text here, right? So guiding principles for revision, equity-driven, right, was part of the guiding principles. That this was gonna be a transparent process. It was going to be an inclusive process, right? That comments, we wanted comments, we wanted people to put in their ideas and to be a part of this village that was looking at the essential public health services. Data-informed, evidence-driven as another guiding principle. Futuristic, which is not just a here and now, but the infamous, you're gonna go where the puck is going to be, not where it was. And then ultimately a guiding principle that it was going to be relevant, that this was going to drive public health practice regardless of organizational structure, of practice setting, or the geopolitical environment. So those were the ground rules, the guiding principles as this process unfolded. Next slide. So feedback, town halls, again, very difficult to undertake this well in the midst of a pandemic. But webinar town halls, there was a webinar town hall at CDC, an in-person town hall at APHA in 2019 before the pandemic hit. Online questionnaires, crowdsourcing events, meetings with professional organizations and thought leaders. And you can see, right? I mean, it's not the whole universe in terms of responses and was 1300 people ultimately commented on this, but also many of them represented organizational bodies. So that's probably perhaps even exponentially increased when you look at the representative groups that were out there. So feedback was in fact taking place and there was a mechanism for us on the task force to hear from the outside world. Next slide. So when we looked at sort of the phase one initial data collection, it was kind of interesting. And the question was really sort of simply put, if it were up to you to dictate the framework for the next 25 years, what would you do? And that was relative to the current framework from 1994. And what we saw was that the 1994 didn't need to be blown up and destroyed. You know, most people really advocated this idea is that, you know, the group in 1994 did a great job. And in spite of all the changes in the last 25 years, what we needed to do was minor tweaks to the current framework. That was sort of the general feel on things. Next slide. In phase two, when we looked at respondents by organizational type, again, I'm just giving you sort of the image, the picture of what was going on, is that, you know, we had local health departments as part of the respondents, academia, research, other groups, state health departments, nonprofit groups, students, CDC, national public health organizations, federal agencies, tribal health, as well as territorial health departments. And ultimately, when we looked at the assessment of framework as a whole on the right side of the slide, basically, this was already with the idea that we had that draft out there, and people strongly agreed or agreed that this helps them describe public health and provides a complete picture of what public health in the 21st century is all about. Next slide. Overall assessments, and I'll shortly go into this in terms of the 10 essential public health services, but this gives you a sense of at least of what we were hearing in terms of the statements and bullet points that came from this from the respondents. And in general, as you can see, we felt that at least we reflected that for each of the 10 components of the new public health services, they accurately captured the essential public health function and that the bullet points, which I'll provide to you, accurately captured the elements as well. So that was part of the feedback that we were getting in terms of this overall assessment. Next slide. Big sort of feature, and this was a major change that I'll get to shortly, is the idea of, remember when we talked about the 1994 essential public health services, the center, the core of all this was all about research. There was a marked decision, I think, that really does look at the world in light of what we were learning in the midst of COVID, but also understanding our societal issues in general in the 21st century, that we determined that it would be best to center the idea of the concept of equity as the core of many of the components of the essential public health services. And so when we went back to the groups of individuals that were opining on all this, there was strong agreement in general and agreement overall that the introductory statement on centering equity as a key component of this was an important and a timely fundamental concept. Next slide. So what is this all about now? How is this kind of unfolding in the midst of all this? So we look at these 10 essential public health services, once again, a framework to protect and promote the health of all people in all communities. It actively promotes policies, systems, and services that enable good health, and it seeks to remove obstacles and systemic and structural barriers, barriers such as poverty, racism, gender discrimination, ableism, other forms of oppression that have resulted in health equities, that that's a key component of now the essential public health services. Everyone should have a fair and just opportunity to achieve good health and wellbeing, right? So that's part of sort of the core of what we ended up with. Next slide. And notice it's a little bit modified in terms of the cartoon itself, and I'll go into some of the aspects of this. You don't have to look at the small print, but notice we kept up with the core services of assessment or the core functions of assessment, policy development, and insurance. In the midst of this, equity ends up being a key component, and I'll get into more of the details in the next few slides. Next slide. So 10 essential public health services for 2020. Again, modifications with expansions in many realm. Assess and monitor population health status, the factors that influence health and the community needs and assets. So it still is about assessment and monitoring with this whole idea of community needs and assets, not assessments, but assets, right? Looking at the factors that do influence health in that community. Second key, essential public health services. Essential public health function. Yes, we gotta be investigating things, right? We look at investigating, diagnosing, and addressing health problems and hazards that are affecting the population. Communication as a key component to this. And we saw this difficulty, right, in the midst of the COVID-19 pandemic of communication effectively. And the idea here was communicate effectively to inform and educate people about health, factors that influence it and how to improve it. Fourth component, strengthen, support, and mobilize communities and partnerships to improve health. I think there was more of an emphasis on the idea that it really does take a village, right? We go back to the CA Winslow of the former century and say, it is that village, and we need to be able to work with those communities and partnerships. Create, champion, and implement policies, plans, and laws that impact health. So we can't get away with this idea that we're just gonna do it without the idea that at times there is sort of the concept of policy development, and yes, at times regulatory public health that plays a key role. Utilizing legal and regulatory actions to improve and protect the public's health. Again, regulatory public health and the key component. Assuring an effective system that enables equitable access to the individual services and care needed to be healthy. The whole idea of access and assurance in the building. We can't neglect the public health workforce. So we, in essence, co-opted and expanded on that. Build and support a diverse and skilled public health workforce. Improvement is a key component to any good organizational structure. Evaluation and improvement. Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement. And then finally, building and maintaining a strong organizational infrastructure for public health. Next slide. And these, I'm just gonna sort of pick out some highlights. I'm gonna refer you to the handout that will be sent or available to you, right? So these are one by one with the sub-bullets, right? Assess and monitor population health. You gotta understand what's going on in the jurisdictions that are public health jurisdiction. Identify the threats, the emerging diseases. Again, with a particular emphasis on disproportionately affected populations. The idea of equity and the reality that we need to look at our populations and determining who is at higher risk and are we providing the services, right, for those individuals? Are we assessing and monitoring them as distinct groups? The other key component here is, again, engaging community members. You'll see multiple times this comes up. But again, I'm gonna buzz through these slides with the ideas that will be available for your carousal. Next slide, please. Under investigating, diagnosing, and addressing health problems and hazards, right? Monitoring real-time health status, identifying patterns more so than now. Surveillance systems use various methodologies. Long gone is the paper and pen approach or even the laptop approach, the Excel spreadsheet, the epi info approach, right? We're now getting real-time health status information. Information, the world of information, big data is out there. As I mentioned, the watches, right, provide information and the question is, how do we build up on these capabilities, right? Public health laboratory capabilities. We saw that as a major problem in the midst of COVID, which means we've let the lab kind of linger, right? It hasn't necessarily developed into the modern technologies. And we've seen that front and center as health departments. We're trying to get, for example, the diagnostic capabilities of the speed, even as CDC sort of fumbled through the initial diagnostic, right? That's a major problem. Next slide. Communicating again, effectively to inform and educate, right? And the key feature here, in my view, is looking at developing and deploying culturally and linguistically appropriate and relevant communications. The issue that it's not just about risk communication or health communication. A key word here is health literacy. At the end of the day is what am I doing about health literacy as a distinct aspect of public health, right? Does the public really understand, right? What I'm trying to say, how do I make sure that they understand and they are fully capable and they're smart enough to make the decisions, but they need the information to make those proper decisions. And the issue of health communication or health education in our society. Next slide. Strength and support and mobilize communities and partnerships to improve health. Once again, it's the idea of not only building brand new multi-sector partnerships and coalitions that influence health, right? Do we have the planning people on board, the transportation people, the housing people, the education people. This is part of the public health family. When we look at that village, we need to make sure that those partnerships exist and includes not only existing community partnerships, but the idea of learning from those existing partnerships, but expanding the community of public health. Next slide. Creating, championing, implementing policies, plans and laws that impact health. This really sort of brings up the idea of, are we developing the right policies? We examine and improve the existing policies to correct for the historical injustices. We look at fair and just opportunities for all to achieve public health. We provide input into policies, plans and laws to ensure that health impact is considered. I guess some states have developed and we have this, you know, as a key component in the state of Maryland is health and all policies approach. Are we looking at health as a key component as policies are being developed throughout the whole state? Next slide. Looking at legal and regulatory actions. Again, making sure we have the laws, making sure that we conduct enforcement activities. Yes, this includes the old fashioned sanitation, food and water, right? We've seen from, you know, the issues in Flint, Michigan of how the water issue, right? As the richest country on this planet, that still is a key component. We have to make sure we're taking care of people and those essentials. Reviewing drugs, biologics, the FDA approach, licensing and credentialing healthcare workers and healthcare consideration and laws from other sectors, for example, zoning laws. So we're looking at this legal and regulatory framework. Next slide. Assuring an effective system that enables equitable access, right? The whole idea is contributing to the development of a competent health workforce. That's key. Addressing and removing barriers to care is a key component and connecting the population to needed health and social services that support the whole person. And as preventive medicine docs, right? And people associated with preventive medicine, this includes the preventive services. It can't just be about sick care. It's gotta be about true health. Next slide. So building and supporting a diverse and skilled public health workforce. Part of this is leadership development. Part of this is providing education. As a dean, you know, my goal right now is to create the next generation of public health leaders, right? How do I incorporate public health principles in non-public health curriculum? We look at the expansion of the partnerships that exist out there. Next slide. Improving, innovating public health functions to evaluation research and continuous quality improvement. Again, evidence-based of effective public health practice. We look at the ideas. We need to gather the information. We need to have evaluations and research, but not just as an end all of having that data, but an end all of improving, right? Taking that next step. And then the final point, number 10, is building and maintaining a strong organizational infrastructure for public health. And if there's one lesson we've learned in the midst of COVID-19 that I hope we deal with is that the infrastructure really isn't that well supported. It isn't that well resourced. And not only in times of emergencies are we needed, we're gonna have to convince the world that we need that all the time. Next slide. As I complete this presentation, and we'll leave a few minutes for questions at the end, is how do you use these 10 public health services? And part of it is communication, right? It provides a common language so that we can share with others what public health work is. It also helps us internally to remind ourselves of what it's all about. It provides structure, right? A basis for organizing resources. It's preparing the workforce, informing and educating, right, our own workforce about what they need to consider as those essential services. A form of reporting. Many public health agencies are now using these essential public health services as their reporting scheme. This is what we're doing. This is where resources are going. This is how effective we are. And then strategic engagement. So, next slide. I'm gonna finish off with this idea of workforce issues, right? What we know is that from 2009 to 19, we've had incredible fiscal issues in public health. Public health spending fell from 3.2% of healthcare costs, right, of the $3.2 trillion or $3.4 trillion spent on healthcare. Most of it, in fact, goes to sick care. And money spent on prevention, on public health has fallen from 3.2% of that to 2.4%. This is half the spending of Canada or the United Kingdom. Our workforce has decreased since 2008, 23%, over 50,000 jobs. And in essence, in public health, we have an aging workforce. 55% of local public health workers are over the age of 45. 25% are retirement eligible. So now is the opportunity to take these essential public health services and look at what is going on in the midst of us replenishing the public health workforce. Next slide. The future, I'm talking here as a dean and as a person at a major academic institution, right? Growing student interest. At the University of Maryland, 440% increase in declared freshmen in public health. That's in the fall of 2020, right? This was already increasing just because. Now we're looking at fall 2021, early action applications are up 43 to 95% across my four majors. So already I'm getting a sense as today's high school student, right? Who's applying to determine what their path is, is not intrigued of and with public health. Growing fiscal support to fight COVID. We need to invest more for the future. There's needs and roles for a robust and effective workforce. And part of it is we as a group, everybody on this call now should be convinced of, we gotta be advocating for preventive medicine and we gotta be advocating for public support for public health. And part of it is the role of our own advocacy. Next slide. Other frameworks do exist out there. Foundational public health services, the core competencies, culture of health, public health 3.0 and national public health performance standards, as well as our ACPM power of prevention. And this really is not a substitute. The PHSs are not substitute, but an add on to these things. Next slide. And then finally, I'll mention our own ACPM power of prevention. Four distinct pillars, right? That must be prioritized in transforming our health system. Comprehensive, inclusive definition of health and the health system, health in all policies. Notice the crossover. Prevention is a priority. Sick care to true health, healthcare empowered patients, populations and providers and a well-resourced workforce and healthcare infrastructure. Again, great overlaps with the essential public health services. Next slide. So resources, again, great stuff that the CBC put out about the essential public health services, the Beaumont Foundation PHNCI. There's a free tool kit that's available on these resources. Many of the slides I took from that toolkit. Next slide. And again, these slides are gonna be available. And this is my concluding statement, right? In 1999, the CBC issues the great public health achievements for the former century, right? This is another thing that sits on my office wall. There's a great amount of progress we did in the 20th century. Next slide. But right now, you and me, right? And my students, other students out there, we're playing a role in the list that's gonna come out in 2099. I'm not gonna be around to see that list, but can we fantasize? Can we talk about things we'd like to see on there? Elimination of tobacco as a health hazard. Last list had recognition of tobacco as a health hazard. Elimination of vaccine-preventable infectious diseases. Possible, potentially, and yet that's part of our battle. Next slide. Thank you so much for your attention. There are surprises in the world. And on the right side, I happen to be a photographer and I've sort of become an amateur birder, is the painted bunting, a rare bird, never seen in Washington, DC. And this February and March, it made its appearance. Nobody knows where it came from. And yet in the midst of a dreary COVID winter, it was there. Then spring came around, right? The bluebirds came around. So let's have that optimism in public health. Next slide. Questions. Next slide. Thank you very much, Dr. Lushniak. Wonderful presentation on the essential public health services, the update, centering equity right in the middle of the wheel and focusing on where do we need to go forward? What do we need to think about as we prepare for this next century and practice it? So I recommend anybody and everybody who's on the call to please feel free to put questions in the chat box and ACPM staff will look at that and we'll pick them up and definitely ask them as well as we can and in the time we have available to try and get your questions with some outstanding answers from Dr. Lushniak. Boris, just maybe I'll kick it off with a quick one. We're talking about EPHS as a framework for how to categorize or look at public health. And as mentioned earlier, we have so many disparate elements of public health but they're all unified and this is a great way to kind of put them all together in one place, if you will. Are there, thinking about it from a practical perspective and applications perspective, are there some best practice examples at either the national state or local levels that show how EPHS is working and can work to help us in creating better public health and better health for all? Yeah, and as I think about this question, I think part of it is the practical aspects of this. And one example I briefly mentioned is the idea of how do we report our successes in public health, right? And oftentimes it's sort of disparate, it depends on kind of the jurisdictions, is there a reporting scheme? What we tend not to do well in public health is in essence, and that's because we're nice and humble people, is look at me, right? Look at public health and look at what we've achieved. I think one of the practical aspects of looking at the essential public health services is even from a reporting aspect, is looking through that list and in essence being bold enough to say, here's where we're flourishing, right? And look community or look political, you know, a political person, right? Look at what we've done, but also now here's the truth aspect, where have we failed, right? Something like this can be used both in terms of an advocacy aspect, which is, look, this is where we're shining because you, right, have restored us appropriately or we've been lucky, right? Other aspects can be used on a practical aspect, which is I'm reporting to you, right? Whether it's an official report, whether it's, you know, here's what I'm supposed to be doing and here's where I'm failing is just as important. So I think that's an example. Okay, very good. And I did some thinking about this and reflecting on this as well. And it seemed to me that there are a lot of things we do in public health that are in fact meeting those essential public health services, but we don't necessarily talk about it from that perspective. And I think if we did more of saying, oh, this belongs under EPHS eight or EPHS four or whatever it is, we'll find many examples where in fact we are living that essential public health services in our activities and initiatives. And I think that's part of it. You know, if you remember, Sam, when you and I were commissioned corps officers, we were sort of emboldened with this idea as we got to turn into emergency responders of what, of realizing the various facets of the FEMA approach to disasters and knowing that, you know, there were specific support functions that had a delineated pathway. You can point to say, who's taking care of water and sanitation in the midst of a crisis. What I think what we're doing with these essential public health services is saying, you know, not only in a crisis, but every single day, right? When people are dying from opioid, right? Overdoses or they're dying from diabetes, there's still deaths that are preventable. And so what are we doing? Where is this fit into my scheme? Exactly. And I, Angela or Stephanie, please let me know. And if there are questions in the chat that we need to discuss or access, happy to do that. And in the interim, I'll keep going with a couple of other questions. Yeah, I have a question here, Dr. Lushniak. From an academic perspective with the proliferation of schools and programs of public health at both the graduate and undergraduate levels, to what extent do you believe students are familiar with and applying these 10 essential public health services in their thinking and planning for their careers? Well, I know at least for the 1994 essential public health services, they were definitely being taught, right? The question, and I think, Angela, it's a great question because it's one thing, including them in the lecture and saying, oh, learn about these and maybe you'll get quizzed or tested on them. I think the approach we need to take, and I think where we failed was we're gonna teach them, but then you're gonna go and get your jobs, whether it's with the local health department, with the feds, with the foundation, et cetera, and you'll do whatever you want. I think this is now an opportunity to actually relook at the curriculum, both in schools and programs of public health, and to begin emphasizing, this is not only to be learned for a quiz, but this in essence is what you're gonna be doing for a living, so let's dig deeply, right? And maybe the health equity issue is a binding issue. That comes with a certain amount of emotion. When the binding issue was research, people were like, I don't know, but if it's about equity, right? The majority of our students want to be involved in bigger opportunities, and that in essence is a way to solidify this. Great, excellent. Boris, the task force was comprised of some of the greatest leaders in public health today. And me, somehow I got thrown in the group. So yeah, they were all great leaders and all that, and somehow I walked into the room one day. All right. And I was very humbled, right? You're absolutely right, incredible minds out there. Incredible minds out there from the public health community. And so this is leading to the question of how do we get beyond our borders? How do we include people in the healthcare system, in the educational system, in business and industry? How do we have the essential public health services be a guiding template that others and other industries and associations use? And can in fact prevention specialists be the leaders to help drive that change? I think it depends on us. To a large extent, it depends on the college, right? To be able to be the advocates out there. I'll provide two examples of this. Number one, my first medical meeting, I was discussing this with Sam before we went live today, was, you know, I'm a dermatologist by training. When I speak to the dermatology world, I don't speak about psoriasis. I talk about public health and dermatology, right? So I embed this idea that it's, and it goes beyond skin cancer prevention. It goes into other preventive aspects. In a profession that otherwise are a specialty area, you wouldn't think that would play a role. We got to convince people that they play a role. Second example is at College Park, right? Which is where the School of Public Health is located. The Medical School for University of Maryland is 30 miles away in Baltimore. And that to me is a good thing because that partnership has long been established, right? That goes into the last century. Medical schools and public health schools always get along. But my neighbors are now what? Urban planning people. They're engineers. They're government policy people. They're education people. And my goal now is to actually ride the wave of this syndemic, right? It's the pandemic of infectious disease. It's racism. It's gun violence. It's political upheaval. It's, you know, it's hatred, right? And right now convincing people, all these are public health issues. And you are, I am embracing you as a partner in this, in solving this issue. We haven't embraced people well enough. I think we've solidified our silos and said, hey, I'm a public health person. Don't forget the second part of Winslow's definition. It's the village. And we have to now recreate the village. Excellent. Excellent, very much. Thank you for your participation and your talk today. I see we're getting close to the end of the time and I will turn the session back over to Angela. Again, Dr. Lucinic, thank you very much for your participation and leadership. Great, thank you. Yes, indeed. Thank you so much for the excellent presentation and the expert facilitation today. ACPM invites you to two upcoming webinars, one on July the 8th, Good Business, a Fireside Chat with Bill Novelli and Dr. Barb Carr, one of our past presidents. On July 27th, you're invited to a writing for publication expert advice from Dr. Robert Wallace, who for many years has served the American Journal of Preventive Medicine and more to come. Stay tuned for the rest of 2021. We have an exciting set of webinars in the works. Please complete the event survey. And for more information about all of our educational offerings, please log on to acpm.org. Thank you.

Ten Essential Public Health Services

equity and social justice

health inequities

public health education

well-resourced workforce

organizational infrastructure

implementing essential services

preventive medicine

public support