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Improving Health in the Community: A Role for Performance Monitoring
BOX 4-4CORE FUNCTIONS OF PUBLIC HEALTH
Assessment: Regular collection, analysis, interpretation, and communication of information about health conditions, risks, and assets in a community
Policy development: Development, implementation, and evaluation of plans and policies, for public health in general and priority health needs in particular, in a manner that incorporates scientific information and community values
Assurance: Ensuring—by encouragement, regulation, or direct action—that programs and interventions that maintain and improve health are carried out
SOURCE: IOM (1988); Washington State Department of Health (1994).
community empowerment. Adequate funding is also cited as an essential resource.
Other entities in a community also have specific functions that guide their participation in health improvement. These functions have been articulated in varying ways. For example, accreditation standards for hospitals and health plans point to clinical, organizational, and administrative functions that are deemed important (e.g., see JCAHO, 1996a; NCQA, 1996b). The NCQA (1996b) standards, for example, address quality improvement, physician credentials, member's rights and responsibilities, preventive health services, utilization management, and medical records.
Looking to the future, the Pew Health Professions Commission (1995) has proposed a set of "competencies" that the health professions should develop and enhance over the next decade (e.g., care for the community's health, clinical competence, prevention and health promotion, appropriate use of technology).
It is also possible to consider the capacities of a community as a whole—what the National Civic League (1993a) has called the civic infrastructure. The specific elements identified are citizen participation, community leadership, government performance, volunteerism and philanthropy, intergroup relations, civic education, community information sharing, capacity for cooperation and consensus building, community vision and pride, and inter-community cooperation. Various resources related to each of these areas have been identified (National Civic League, 1993a).