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In 1988, the Institute of Medicine (IOM) released The Future of Public Health,1 a seminal report that found the national public health infrastructure to be in disarray. The IOM committee defined the mission of public health as fulfilling society's interest in assuring conditions in which people can be healthy. It then developed clear statements about the role of government in three core public health functions: assessing health status, developing policy, and assuring that necessary services are provided. Finally, the committee made specific recommendations for responsibility and action at the national, state, and local levels to achieve the core functions.

The 1988 IOM publication was ultimately complemented by the 1994 report of the Department of Health and Human Services (DHHS) Public Health Functions Steering Committee, which described 10 essential public health services that corresponded to the IOM core functions (Table 57-12). The core functions and essential services focused on the roles and responsibilities of governmental public health organizations at the national, state, and local level and were important for refocusing public health organizations and for promoting organized approaches to public health.


With the publication in 2003 of The Future of the Public's Health in the 21st Century,3 the IOM expanded its definition of public health to include all of society's efforts to achieve improved health. Recommendations addressed health policy at every level of American society and expanded efforts to enlist all sectors in improving health outcomes. For example, in this later report, recommendations for responsibility and action in public health are made not only for governmental entities but also for community representatives and organizations (e.g., congregations, civic groups, and schools), ...

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