Public health is more than treating illness in hospitals. It is the science and practice of preventing disease, prolonging life, and promoting health across entire populations. To organise this vast mission, the United States Centers for Disease Control and Prevention (CDC), along with a federal working group, introduced the 10 Essential Public Health Services (EPHS) framework in 1994. Three decades later, this framework remains the most widely recognised blueprint for what public health systems should do in every community, from a metropolitan city to a rural block. Let’s unpack what these services are, why they matter, and how they translate into action.
Table of Contents
- The origin and purpose of the framework
- The three core functions: assessment, policy development, and assurance
- Services under assessment: knowing the community
- 1. Monitor population health
- 2. Investigate and diagnose health problems
- Services under policy development: shaping the response
- 3. Communicate and educate the public
- 4. Mobilise communities and partnerships
- 5. Create and implement health policies
- Services under assurance: delivering and protecting
- 6. Enforce laws and regulations
- 7. Ensure equitable access to healthcare
- 8. Build a strong public health workforce
- Services under research and infrastructure
- 9. Improve and innovate through research
- 10. Build organisational infrastructure
- How the framework applies in the Indian context
- Why this framework still matters
The origin and purpose of the framework
The story begins in 1988, when the Institute of Medicine (now the National Academy of Medicine) published a landmark report titled The Future of Public Health. The report identified three core functions of public health, namely assessment, policy development, and assurance. These three functions were too broad to operationalise on their own, so in 1994 the Public Health Functions Steering Committee, which included representatives from major US Public Health Service agencies, distilled them into ten concrete activities every community should undertake.
The framework was revised on September 9, 2020 by the Public Health National Center for Innovations and the de Beaumont Foundation to reflect modern realities, including health equity, the social determinants of health, and the need for stronger organisational infrastructure. The updated version explicitly seeks to remove systemic barriers like poverty, gender discrimination, and other forms of oppression that produce health inequities.
The three core functions: assessment, policy development, and assurance
Before diving into the ten services, it helps to understand the three umbrellas they fall under. Assessment involves collecting and analysing information about a community’s health. Policy development uses that information to design plans, laws, and partnerships that protect health. Assurance ensures that the services and systems needed to keep people healthy are actually delivered, accessible, and well-staffed.
Each of the ten essential services maps onto one of these functions, creating a logical flow from data collection to action.
Services under assessment: knowing the community
1. Monitor population health
The first service is to assess and monitor population health status, factors that influence health, and community needs and assets. This means continuously collecting data on births, deaths, disease patterns, nutrition, and risk factors. In India, the Integrated Disease Surveillance Programme (IDSP) and the National Family Health Survey (NFHS) play this role, generating the evidence that drives every other public health decision.
2. Investigate and diagnose health problems
The second service moves from passive monitoring to active investigation. When a cluster of dengue cases appears in a district, or food poisoning erupts at a wedding, epidemiologists must investigate, diagnose, and address health problems and hazards affecting the population. Laboratory networks, contact tracing, and outbreak response teams fall under this function. The COVID-19 pandemic showcased both the strengths and the gaps in this capability worldwide.
Services under policy development: shaping the response
3. Communicate and educate the public
The third service is to communicate effectively to inform and educate people about health. Behaviour change rarely happens without clear, culturally sensitive messaging. Campaigns like Swachh Bharat Abhiyan, polio immunisation drives, and ORS promotion for diarrhoea management have shown how mass communication can shift behaviour at scale. Today, this also includes fighting health misinformation on social media.
4. Mobilise communities and partnerships
No health department can act alone. The fourth service emphasises strengthening and mobilising communities and partnerships to improve health. ASHA workers, Anganwadi centres, panchayats, NGOs, faith-based organisations, and private providers all need to be part of the response. The National Health Mission in India explicitly relies on this multi-stakeholder approach.
5. Create and implement health policies
The fifth service is to create, champion, and implement policies, plans, and laws that impact health. Examples include India’s National Health Policy 2017, the Cigarettes and Other Tobacco Products Act (COTPA), the Food Safety and Standards Act, and rules mandating helmet use. Public health professionals draft evidence, lobby legislators, and design implementation plans so that policies do not remain on paper.
Services under assurance: delivering and protecting
6. Enforce laws and regulations
Policy without enforcement is decoration. The sixth service involves utilising legal and regulatory actions designed to improve and protect the public’s health. Drug regulators inspect pharmacies, food safety officers test samples, pollution control boards monitor emissions, and licensing authorities ensure healthcare establishments meet basic norms. Without these enforcement mechanisms, even the strongest laws fail to protect citizens.
7. Ensure equitable access to healthcare
The seventh service ensures an effective system that enables equitable access to the individual services and care needed to be healthy. In India, this principle drives flagship programmes like Ayushman Bharat, which combines Pradhan Mantri Jan Arogya Yojana (health insurance for the poor) with Ayushman Arogya Mandirs (formerly Health and Wellness Centres) for primary care. The Indian Public Health Standards, revised in 2022, set minimum benchmarks for facilities ranging from sub-centres to district hospitals, ensuring that quality services reach even remote populations.
8. Build a strong public health workforce
The eighth service calls for building and supporting a diverse and skilled public health workforce. This includes doctors, nurses, epidemiologists, sanitary inspectors, lab technicians, frontline community health workers, biostatisticians, and health economists. India’s expansion of community health workers like ASHAs and the strengthening of medical and public health education are direct responses to chronic workforce shortages identified in successive five-year plans.
Services under research and infrastructure
9. Improve and innovate through research
The ninth service is to improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement. Research is what separates evidence-based public health from guesswork. Institutions like the Indian Council of Medical Research (ICMR), the National Institute of Nutrition, and the National Centre for Disease Control generate the evidence that shapes vaccination schedules, dietary guidelines, and disease elimination programmes.
Innovation is equally important. The development of indigenous COVID-19 vaccines, the rollout of the eSanjeevani telemedicine platform, and digital health records under the Ayushman Bharat Digital Mission all represent how research and innovation translate into real-world impact. According to an analysis in Health Affairs, much of the economic and human cost of recent pandemics could have been reduced with sustained investment in research-driven public health systems.
10. Build organisational infrastructure
The tenth service, newly added in the 2020 revision, focuses on building and maintaining a strong organisational infrastructure for public health. This includes financing, data systems, governance, transparency, ethical leadership, and information technology. The authors of the revised framework note that the COVID-19 response exposed how fragile this infrastructure had become after years of underinvestment, making it impossible to assume robust systems exist by default.
How the framework applies in the Indian context
While the EPHS framework was developed by US agencies, its principles align closely with how Indian public health is organised. The three-tier system of sub-centres, primary health centres (PHCs), and community health centres (CHCs), leading up to sub-district and district hospitals, exists precisely to deliver these essential services at the population level. The Ministry of Health and Family Welfare uses the Indian Public Health Standards as benchmarks, and a web-based IPHS dashboard launched in 2024 allows real-time monitoring of facility performance.
Programmes like the National Health Mission, the Reproductive and Child Health Programme, the Revised National Tuberculosis Control Programme (now NTEP), and the National Vector Borne Disease Control Programme each operationalise multiple essential services simultaneously. For instance, the polio eradication effort combined surveillance (Service 1), outbreak investigation (Service 2), mass communication (Service 3), community mobilisation through ASHAs (Service 4), strict cold-chain regulation (Service 6), and ongoing research on vaccine efficacy (Service 9).
Why this framework still matters
The 10 Essential Public Health Services framework is not just an academic checklist. It serves several practical purposes. It guides public health department accreditation, shapes curricula in schools of public health, and informs how governments allocate budgets. Most importantly, it provides a common vocabulary for diverse actors, including government, civil society, academia, and the private sector, to coordinate their efforts.
The 2020 revision deliberately placed equity at the centre of the framework. This shift recognises a basic truth: health outcomes are unequally distributed along lines of caste, class, gender, geography, and ability. A public health system that ignores these disparities cannot claim to be serving all communities. For students of population and family health studies, this reframing is more than rhetoric. It is a call to design every intervention, from antenatal care to non-communicable disease screening, with equity as a non-negotiable starting point.
What do you think? Which of the ten essential services do you feel is most underdeveloped in your district or state, and what would it take to strengthen it? If you had to add an eleventh essential service to reflect the realities of the next decade, what would it be?
References
- https://www.cdc.gov/mmwr/preview/mmwrhtml/00023572.htm
- https://www.ama-assn.org/delivering-care/public-health/release-revised-essential-public-health-services-framework
- https://debeaumont.org/10-essential-services/
- https://www.cdc.gov/public-health-gateway/php/about/index.html
- https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=284&lid=154
- https://iphs.mohfw.gov.in/
- https://www.healthaffairs.org/do/10.1377/forefront.20210319.479091/
- https://www.mohfw.gov.in/?q=en/pressrelease-204
- https://phaboard.org/infrastructure/public-health-frameworks/the-10-essential-public-health-services/
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