The Foundational Public Health Services (FPHS) Framework includes a set of Foundational Capabilities and Foundational Areas that are specific to governmental public health. These Capabilities and Areas serve as a “minimum package” of public health services that should be provided by all governmental public health departments in all communities. The framework also acknowledges Community-specific Services, which are local programs and services that are unique to a specific community and vary by jurisdiction. This blog explores the distinction between what is foundational and what is a community-specific service and provides helpful guidance and resources to health departments and health department systems who are defining this work within their jurisdictions.
Foundational Capabilities are cross-cutting skills and capacities needed to support basic public health services. These are often referred to as foundational infrastructure. Foundational Areas are population-based health programs and services provided by governmental health departments in all communities. This may also include programs or services that are not population health focused but are required by federal or state law (i.e., tuberculosis treatment). Community-specific Services are not provided uniformly by all governmental health departments in all communities and may be (although are not exclusively) programs or services that are clinical, social, or behavioral health-related and based on specific needs of the community. It is important to note that Community-specific Services are not more or less important than Foundational Capabilities or Foundational Areas, they are just not considered to be part of the “minimum package.”
It is sometimes challenging to distinguish between Foundational Capabilities, Foundational Areas, and Community-specific Services. It is helpful for health departments and health department systems to engage in conversation around the distinction. These conversations bring shared awareness, clarity, agreement, and consistency in interpretation across a department or system. The distinction is especially important when a health department or health department system is completing the FPHS Capacity and Cost Assessment Tool to ensure the most accurate calculation of current and estimated future resources needed to deliver foundational activities.
To add to the complexity, some programs that typically would be considered a Community-specific Service may have components or elements that are Foundational. Here are some examples:
- Immunization Program
- Surveillance of vaccine preventable diseases: Foundational Area – Communicable Disease Control
- Vaccine administration: Community-specific Service
- Car Seat Program
- Analysis and reporting of child passenger related injury data: Foundational Area – Chronic Disease and Injury Prevention
- Car seat distribution and car seat safety checks: Community-specific Service
- Lead Prevention Program
- Convening cross-system partners to establish a plan for eradicating lead in old homes: Foundational Area – Environmental Health
- Lead abatement in homes and blood lead screenings/testing – Community-specific Service
PHAB has several resources that may be helpful to health departments and/or health department systems as they navigate the FPHS framework, including:
- FPHS Operational Definitions
- Foundational Capability Fact Sheets:
- Foundational Area Fact Sheets:
- Communicable Disease Control
- Chronic Disease and Injury Prevention
- Environmental Health
- Maternal, Child, and Family Health
- Access to and Linkage with Clinical Care
- Foundational vs Community-specific Services Crosswalk and Guide
If you have questions or would like to talk to a PHAB staff member about your specific FPHS related needs— including available technical assistance and consultation services, email phabta@phaboard.org.
About the Author
- Melissa Sever is Senior Advisor at PHAB Public Health Systems and Services.
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