Equity at center of revised 10 Essential Public Health Services =============================================================== * Kim Krisberg ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/50/9/1.5/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/50/9/1.5/F1) Equity is now officially at the core of one of the most important and influential frameworks in public health. First created in 1994, the newly revised 10 Essential Public Health Services — released in September after months of input gathering from across the field — formally places “equity” at the center of the framework’s familiar multicolored wheel of activities that public health systems should carry out in all communities. While most of the 10 services remain fundamentally the same, the language has been updated to reflect 25 years of public health advances and recognition that equity is at the root of ensuring optimal health for all. “Now the challenge is for us all to make the revised framework ‘real’ — to use it to inform and guide our work,” said Paul Kuehnert, DNP, RN, president and CEO of the Public Health Accreditation Board, which helped lead the revision. “I urge everyone in the field to find their unique way to adopt and use the new framework so that we are all moving in the same direction and talking about the role and value of public health with clarity and consistency.” In 1994, the Centers for Disease Control and Prevention led a working group — spurred in part to clearly distinguish public health from health care during the health reform debates of the early 1990s — to develop a consensus on the field’s essential services. The resulting 10 Essential Public Health Services became the go-to framework for understanding the role of public health. It is used across the field, from health practice, education and accreditation to public health policy, research and funding. But after 25 years of advances and changes in public health — not to mention society at large — it made sense to revisit one of the field’s foundational frameworks, said APHA member Katie Sellers, DrPH, CPH, vice president for impact at the de Beaumont Foundation, which led the revision process in partnership with PHAB’s Public Health National Center for Innovations. From the outset of the revision process, Sellers said it was clear that equity — which had become a core public health value and objective — was missing. “That message came through loud and clear from the field, from just about everyone we interacted with,” Sellers told *The Nation’s Health.* “It made it easy to know what to do.” In many ways, Sellers said the newly revised framework is catching up to present-day public health, with language that more accurately reflects current practice and future needs. For example, the first service originally said that public health systems should “monitor health status to identify and solve community health problems.” The new language, revised explicitly with equity in mind, calls on public health systems to “assess and monitor population health status, factors that influence health, and community needs and assets.” The only service that changed substantially was service No. 10, which shifted from a focus on research to maintaining a strong public health infrastructure. In the center of the new essential services wheel, “equity” replaces “research.” The new framework also includes clear language that the Essential Public Health Services “actively promote policies, systems and services that enable good health and seek to remove obstacles and systemic and structural barriers, such as poverty, racism, gender discrimination and other forms of oppression.” APHA member Jessica Solomon Fisher, MCP, vice president for strategic initiatives at PHAB, said the equity-centered framework also recognizes the field’s shift from a focus on individual behaviors to a focus on the systems and environments that shape who has access to opportunities for health and longevity and who does not. “Our hope is that the revised framework sheds light on how to approach public health work through an equity lens, though we know a lot of this work is already well underway,” Fisher told *The Nation’s Health.* “Much of the revision is really about making sure we’re all working from the same page.” The PHAB innovations center and de Beaumont Foundation launched the revision process in summer 2019, using a crowd-sourced, field-driven process that included in-person and virtual town halls, public comment periods and guidance from a task force of public health leaders from across the discipline, including APHA Executive Director Georges Benjamin, MD. Thousands of comments from stakeholders working across the field — including public health workers, students, educators, researchers and advocates — were collected and considered. Because so many public health agencies, organizations and standards already center and include equity, the new essentials framework will not likely change day-to-day work right away. But it will change how the foundational framework is taught in the classroom. “Focusing on equity isn’t new for public health,” said APHA member Donna Petersen, ScD, MHS, CPH, dean of the University of South Florida College of Public Health and a member of the revision task force. “But placing it at the center underscores that equity isn’t only the goal, it’s also the means.” As a public health educator, Petersen said putting equity at the center of the 10 essential services is especially meaningful for her students, who often see racial equity in particular as a key lens for their future public health practice. “Centering equity reminds us that we can’t do this work alone,” she told *The Nation’s Health*. “It gives us a new tool to engage other partners in the work of public health — which at the end of the day, is the only way we’ve ever been and will be successful.” For more on the new 10 Essential Public Health Services, visit [http://ephs.phnci.org/toolkit](http://ephs.phnci.org/toolkit). ![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/50/9/1.5/F2.medium.gif) [Figure2](http://www.thenationshealth.org/content/50/9/1.5/F2) Images courtesy PHNCI * Copyright The Nation’s Health, American Public Health Association