PHE 500 Module 2 Essential Services Short Paper Example

Ten Services, One Virus: Mapping a County Rabies Program to the Essential Public Health Services

[Student Name]

Southern New Hampshire University

PHE 500: Principles of Public Health

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Ten Services, One Virus: Mapping a County Rabies Program to the Essential Public Health Services

Frameworks are easy to memorize and hard to use. Here both frameworks, the core functions and the ten essential services, are put to work on a single program: rabies prevention in a composite county of about 90,000 people in central Pennsylvania. Last year the county sent 412 animals to the state laboratory, 31 tested positive and 214 residents started post-exposure prophylaxis, nearly twice the usual number. Following that work through the frameworks shows both what they describe well and where the county falls short.

The Core Functions

Public health agencies have three core functions (Institute of Medicine, 1988). Assessment means systematically collecting and analyzing information on the community's health. Policy development turns what assessment finds into rules, plans and priorities. Under assurance, the agency guarantees that needed services reach people, whether it delivers them itself, pays others or requires them by rule. In rabies prevention, assessment is the testing of animals and the investigation of bites, policy development includes the county's vaccination and animal control rules, and assurance means that every exposed person can actually get vaccine in time.

The Ten Essential Services

The ten essential public health services break the core functions into specific activities. A 2020 revision updated the language and made equity the hub of the framework, meaning every service is judged by whether it reaches everyone. The updated list, Castrucci (2021) wrote, offers practitioners shared language for describing their work to outsiders, which matters because public health's successes, such as a rabies death that never happens, are usually invisible. Table 1 maps the services to the county's rabies work.

Table 1. The ten services in the county's rabies program

Note. Gaps come from the department's own after-action review.

One Exposure Through the Services

Following a single case shows how the services connect. When a farmer in the northern township was bitten by a raccoon in his barn last August, the bite report from an urgent care clinic reached the department a day late, a gap in service 1. A nurse called him within an hour of receiving it and arranged for animal control to collect the raccoon, which the state laboratory confirmed as rabid, services 2 and 4. The nurse explained the vaccine schedule in plain language, service 3, and the county's quarantine order covered the farmer's unvaccinated barn cats, service 6. The farmer had no health insurance, and the hospital bill for immune globulin and the first dose reached several thousand dollars before a charity program covered part of it, a gap in service 7. Nobody later checked whether he completed all four vaccine doses on schedule, a gap in service 9.

The case went well in the end. But two of its weak points, the late report and the bill, would have been decisive for a resident less determined to follow through.

Where the County Is Strong

The county does well on the services closest to the event. Animal testing, bite investigation and the on-call phone are mature, and the spring partner meeting means camps, veterinarians and animal control already know one another before summer. These strengths explain why last year's sharp rise in exposures was managed without a single delay in starting vaccine.

That habit of meeting before the season is the program's quiet advantage.

Where the Gaps Matter Most

Three gaps stand out because they undermine equity, which the revised framework places at its center. First, access to care. Pieracci et al. (2019) estimated that a full course of post-exposure prophylaxis costs several thousand dollars, which falls hardest on uninsured residents and may lead some to skip treatment after a real exposure. Second, communication. Outreach reaches English-speaking families through the news and camps, but not Spanish-speaking farm workers or Amish families, who are often near barns and livestock. Third, evaluation. The department counts exposures but has never checked whether vaccine was given on the right schedule, which is the outcome that protects people.

Other gaps, such as the out-of-date response plan and the lack of backup nurses, matter for resilience. They would become serious in a larger outbreak or if one of the two nurses left.

What the Exercise Shows

Mapping the program onto the ten services did two things. It showed that the county's rabies work, which staff think of as a nursing task, actually draws on every service, from law to data systems. And it showed that the services furthest from the event, such as evaluation and infrastructure, are the weakest, a pattern that probably holds for many local programs. Those services rarely make news, but they decide whether the next summer goes as well as the last.

Conclusion

The core functions and the ten essential services are most useful as a working checklist. Applied to rabies prevention, they reveal a program strong at investigating each exposure and weaker at making sure every resident can be protected and that the program learns from its results. The next milestones will build on this map.

The next step is to ask which gaps the county can close first.

References

Castrucci, B. C. (2021). The "10 Essential Public Health Services" is the common framework needed to communicate about public health. American Journal of Public Health, 111(4), 598-599. https://doi.org/10.2105/AJPH.2021.306189

Institute of Medicine. (1988). The future of public health. National Academy Press. https://doi.org/10.17226/1091

Pieracci, E. G., Pearson, C. M., Wallace, R. M., Blanton, J. D., Whitehouse, E. R., Ma, X., Stauffer, K., Chipman, R. B., & Olson, V. (2019). Vital signs: Trends in human rabies deaths and exposures, United States, 1938-2018. MMWR Morbidity and Mortality Weekly Report, 68(23), 524-528. https://doi.org/10.15585/mmwr.mm6823e1