CORE COMPETENCIESFOR PUBLIC HEALTHIN CANADARelease 1.0

To promote and protect the health of Canadians through leadership, partnership, innovationand action in public health.— Public Health Agency of Canada

© Her Majesty the Queen in Right of Canada, represented by the Minister of Health, 2008Cat.: HP5-51/2008ISBN: 978-0-662-05421-4

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1What are core competencies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Why do we need core competencies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1How were the current core competencies developed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Who are the core competencies for? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

CORE COMPETENCY STATEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Attitudes and values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Statements in seven categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

One... Public Health Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Two... Assessment and Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Three... Policy and Program Planning, Implementation and Evaluation . . . . . . . . . . . . . . . . . . 4Four... Partnerships, Collaboration and Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Five... Diversity and Inclusiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Six... Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Seven... Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Appendix A: A Glossary of Terms Relevant to the Core Competencies for Public Health . . . . . . 9Appendix B: Practice Examples of the Core Competencies for Public Health . . . . . . . . . . . . . . . 15

CONTENTS

ACKNOWLEDGEMENTS

The Public Health Agency of Canada would like to thank the many public health practitioners across Canada who con-tributed their time, expertise and experience to develop this set of competency statements.

Core Competencies for Public Health in Canada: Release 1.0 was developed by the Public Health Agency of Canada withleadership provided by the Workforce Development Division, Office of Public Health Practice.

Disponible en français sur le titre: Compétences essentielles en santé publiques au Canada : Version 1.0

Public Health Agency of Canada. Ottawa, September 2007.

Available online at:www.phac-aspc.gc.ca/core_competencieswww.aspc-phac.gc.ca/competences_essentielles

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WHAT ARECORE COMPETENCIES?Core competencies are the essential knowledge,skills and attitudes necessary for the practice ofpublic health. They transcend the boundariesof specific disciplines and are independent ofprogram and topic. They provide the buildingblocks for effective public health practice, andthe use of an overall public health approach.Generic core competencies provide a baselinefor what is required to fulfill public healthsystem core functions. These include populationhealth assessment, surveillance, disease andinjury prevention, health promotion andhealth protection.1

WHY DO WE NEEDCORE COMPETENCIES?Core competencies may improve the health ofthe public by:• contributing to a more effective workforce

• encouraging service delivery that is evidence-based, population-focused, ethical, equitable,standardized and client-centred

• helping to create a more unified workforceby providing a shared understanding of keyconcepts and practices

• helping to explain the nature of publichealth and public health goals.

Core competencies will benefit the people whowork in public health by:• providing guidelines for the basic knowledge,

skills and attitudes required by individualpractitioners in public health

• supporting the recruitment, developmentand retention of public health practitioners

• providing a rational basis for developingcurricula, training and professionaldevelopment tools

• improving consistency in job descriptionsand performance assessment

• supporting the development of discipline-and program-specific sets of competencies.

Core competencies can help public healthorganizations to:• identify the knowledge, skills and attitudes

required across an organization or programto fulfill public health functions

• help identify the appropriate numbers andmix of public health workers in a given setting

• identify staff development and training needs

• provide a rationale for securing funds tosupport workforce development

• develop job descriptions, interview questions,and frameworks for evaluation and qualityassurance

• facilitate collaboration, shared goals andinterdisciplinary work.

INTRODUCTION

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HOW WERE THE CURRENT CORECOMPETENCIES DEVELOPED?Recent public health events have emphasizedthe need to strengthen and develop the publichealth workforce. In their report –Building thePublic Health Workforce for the 21st Century –The Federal/Provincial/Territorial Joint TaskGroup on Public Health Human Resourcesproposed a pan-Canadian framework tostrengthen public health capacity.2 Identifyingcore competencies was one of the foundationalbuilding blocks in that framework.

In 2005, the Joint Task Group on Public HealthHuman Resources developed a draft set of corecompetencies.3 In its report, the Joint TaskGroup on Public Health Human Resourcesrecommended that the Public Health Agency ofCanada undertake a national process to reviewand modify or validate these draft core compe-tencies. Following preliminary consultation anddiscussion with public health stakeholders acrossthe country, a second draft of core competencieswas developed in 2006.4 This was enhanced by thedevelopment of a companion Glossary of TermsRelevant to the Core Competencies for PublicHealth.5 Appendix A is an edited version of thisglossary, which includes additions suggestedin the review process.

The second draft of the core competencies andthe glossary were shared and discussed with alarge number of public health practitioners andwith representatives of all levels of government.The extensive consultation process included:• regional meetings across Canada• a pan-Canadian survey

• implementation pilots

• work with specific disciplines andprofessional organizations.

The set of core competencies for public healthworkers in Canada in this document reflectsthe feedback and suggestions gained in theconsultation.

WHO ARE THE CORECOMPETENCIES FOR?Individuals with post-secondary training inpublic health are expected to possess all of thecore competencies at least at a basic level ofproficiency. Administrative staff and some otherpublic health workers (such as communityhealth representatives, out-reach workers andhome visitors) are not expected to have all ofthe core competencies listed in this document.They will have an appropriate sub-set of thecompetencies, depending on their role.

The core competencies primarily relate to thepractice of individuals, including front lineproviders, consultants/specialists and managers/supervisors (see Appendix B for a description ofthese roles). They can also serve as a tool forassessing and creating the best mix of compe-tencies for a public health team or organization.

Ensuring that public health practitioners acquireand maintain competence and proficiency in allof the categories discussed in this document is ashared responsibility. Individuals must be sup-ported and assisted by employers, professionalorganizations, educational institutions, regulatorybodies, unions, and governments at the federal,provincial/territorial and local levels.

The core competency statements are notdesigned to stand alone, but rather to form aset of knowledge, skills and attitudes practicedwithin the larger context of the values ofpublic health.

ATTITUDES AND VALUESAll public health professionals share a core set ofattitudes and values. These attitudes and valueshave not been listed as specific core competenciesfor public health because they are difficult toteach and even harder to assess. However, theyform the context within which the competenciesare practiced. This makes them equally important.

Important values in public health include acommitment to equity, social justice andsustainable development, recognition of theimportance of the health of the community aswell as the individual, and respect for diversity,self-determination, empowerment and com-munity participation. These values are rootedin an understanding of the broad determinantsof health and the historical principles, valuesand strategies of public health and healthpromotion.6

If the core competencies are considered as thenotes to a musical score, the values and attitudesthat practitioners bring to their work provide thetempo and emotional component of the music.One may be a technically brilliant musician butwithout the correct tempo, rhythm and emotion,the music will not have the desired impact.

STATEMENTS IN SEVEN CATEGORIESThe 36 core competencies are organized underseven categories: public health sciences; assess-ment and analysis; policy and program planning;implementation and evaluation; partnerships,collaboration and advocacy; diversity and inclu-siveness; communication; leadership.

Please see Appendix B for practice examplesthat illustrate each of the core competencystatements.

ONE...PUBLIC HEALTHSCIENCES

This category includes key knowledge and criticalthinking skills related to the public health sciences:behavioural and social sciences, biostatistics,epidemiology, environmental public health,demography, workplace health, and the preven-tion of chronic diseases, infectious diseases,psychosocial problems and injuries. Competencyin this category requires the ability to applyknowledge in practice.

A public health practitioner is able to …1.1Demonstrate knowledge about the follow-

ing concepts: the health status of popula-tions, inequities in health, the determinantsof health and illness, strategies for healthpromotion, disease and injury preventionand health protection, as well as the factorsthat influence the delivery and use of healthservices.

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CORE COMPETENCY STATEMENTS

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1.2Demonstrate knowledge about the history,structure and interaction of public healthand health care services at local, provincial/territorial, national, and international levels.

1.3 Apply the public health sciences to practice.

1.4 Use evidence and research to inform healthpolicies and programs.

1.5Demonstrate the ability to pursue lifelonglearning opportunities in the field ofpublic health.

TWO...ASSESSMENTAND ANALYSIS

This category describes the core competenciesneeded to collect, assess, analyze and applyinformation (including data, facts, conceptsand theories). These competencies are requiredto make evidence-based decisions, preparebudgets and reports, conduct investigationsand make recommendations for policy andprogram development.

A public health practitioner is able to …2.1 Recognize that a health concern or issue exists.

2.2 Identify relevant and appropriate sources ofinformation, including community assetsand resources.

2.3 Collect, store, retrieve and use accurateand appropriate information on publichealth issues.

2.4 Analyze information to determine appropriateimplications, uses, gaps and limitations.

2.5Determine the meaning of information,considering the current ethical, political,scientific, socio-cultural and economiccontexts.

2.6 Recommend specific actions based on theanalysis of information.

THREE...POLICY ANDPROGRAM PLANNING,IMPLEMENTATION ANDEVALUATION

This category describes the core competenciesneeded to effectively choose options, and toplan, implement and evaluate policies and/orprograms in public health. This includes themanagement of incidents such as outbreaksand emergencies.

A public health practitioner is able to …3.1Describe selected policy and program

options to address a specific public healthissue.

3.2Describe the implications of each option,especially as they apply to the determinantsof health and recommend or decide on acourse of action.

3.3Develop a plan to implement a course ofaction taking into account relevant evidence,legislation, emergency planning procedures,regulations and policies.

3.4 Implement a policy or program and/or takeappropriate action to address a specific publichealth issue.

3.5Demonstrate the ability to implementeffective practice guidelines.

3.6 Evaluate an action, policy or program.

3.7Demonstrate an ability to set and followpriorities, and to maximize outcomes basedon available resources.

3.8Demonstrate the ability to fulfill functionalroles in response to a public health emergency.

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FOUR...PARTNERSHIPS,COLLABORATION ANDADVOCACY

This category captures the competencies requiredto influence and work with others to improvethe health and well-being of the public throughthe pursuit of a common goal. Partnership andcollaboration optimizes performance throughshared resources and responsibilities. Advocacy—speaking, writing or acting in favour of a particularcause, policy or group of people—often aims toreduce inequities in health status or access tohealth services.

A public health practitioner is able to …4.1 Identify and collaborate with partners in

addressing public health issues.

4.2 Use skills such as team building, negotiation,conflict management and group facilitationto build partnerships.

4.3Mediate between differing interests in thepursuit of health and well-being, and facilitatethe allocation of resources.

4.4 Advocate for healthy public policies andservices that promote and protect thehealth and well-being of individualsand communities.

FIVE...DIVERSITY ANDINCLUSIVENESS

This category identifies the socio-cultural com-petencies required to interact effectively withdiverse individuals, groups and communities.It is the embodiment of attitudes and practicesthat result in inclusive behaviours, practices,programs and policies.

A public health practitioner is able to …5.1 Recognize how the determinants of health

(biological, social, cultural, economic andphysical) influence the health and well-beingof specific population groups.

5.2 Address population diversity when planning,implementing, adapting and evaluatingpublic health programs and policies.

5.3 Apply culturally-relevant and appropriateapproaches with people from diverse cultural,socioeconomic and educational backgrounds,and persons of all ages, genders, health status,sexual orientations and abilities.

SIX...COMMUNICATION

Communication involves an interchange ofideas, opinions and information. This categoryaddresses numerous dimensions of communica-tion including internal and external exchanges;written, verbal, non-verbal and listening skills;computer literacy; providing appropriate infor-mation to different audiences; working with themedia and social marketing techniques.

A public health practitioner is able to …6.1 Communicate effectively with individuals,

families, groups, communities and colleagues.

6.2 Interpret information for professional, non-professional and community audiences.

6.3Mobilize individuals and communities byusing appropriate media, communityresources and social marketing techniques.

6.4 Use current technology to communicateeffectively.

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SEVEN...LEADERSHIP

This category focuses on leadership competenciesthat build capacity, improve performance andenhance the quality of the working environment.They also enable organizations and communitiesto create, communicate and apply shared visions,missions and values.

A public health practitioner is able to …7.1Describe the mission and priorities of the

public health organization where one works,and apply them in practice.

7.2 Contribute to developing key values and ashared vision in planning and implementingpublic health programs and policies in thecommunity.

7.3 Utilize public health ethics to manage self,others, information and resources.

7.4 Contribute to team and organizationallearning in order to advance public healthgoals.

7.5 Contribute to maintaining organizationalperformance standards.

7.6Demonstrate an ability to build communitycapacity by sharing knowledge, tools,expertise and experience.

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Public health systems and services vary betweenand within provinces and territories acrossCanada. Thus, the use of the core competenciesfor public health may also vary according todifferent jurisdictional contexts.

The adoption of core competencies in publichealth requires acceptance and commitmentfrom a variety of groups including:• federal and provincial/territorial governments

• regional health authorities and local publichealth units

• employers and organizations

• human resource departments and managers

• unions

• public health associations(national and provincial/territorial)

• professional associations and disciplines

• regulatory bodies

• academic institutions

• individual public health practitioners.

As the dynamic practice of public health evolvesover time, so too must the core competencies,which describe the knowledge, skills and attitudesrequired for that practice. In collaboration with itspartners, the Public Health Agency of Canada iscommitted to ensuring that the core competenciesremain current and relevant. This plan willinclude monitoring the impact of adopting andapplying the core competencies on public healthpractice and on the broader public health system.

Work is underway to build on the core compe-tencies for public health by developing discipline-specific competencies in seven professions relatedto public health: public health epidemiologists,health promotion practitioners, environmentalpublic health professionals, nurses, physicians,dietitians and public health dental practitioners.Discipline-specific competencies include theindividual-based “breadth and depth of coreand technical competencies that are used todefine a particular discipline”.7

The practice of public health is both an art anda science. The common language and purposeof core competencies helps to define describeand standardize complex work in a complexenvironment.

At the same time, demographic changes, global-ization, new threats to health and security, andincreasing pressures on health services will con-tinue to intensify the need for a highly skilled anddiverse public health workforce. Public healthworkers in the 21st century will need to tap intotheir shared and unique knowledge, skills andattitudes to promote health and well-being inevery community across Canada.

CONCLUSION

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1. Advisory Committee on Population Health.Survey of Public Health Capacity in Canada.Highlights Report to the Federal, Provincial,Territorial Deputy Ministers of Health.Ottawa: Health Canada, 2001.

2. Federal/Provincial/Territorial Joint TaskGroup on Public Health Human Resources.Building the Public Health Workforcefor the 21st Century. Ottawa, 2005.

3. The Development of a Draft Set of PublicHealth Workforce Core Competencies.Summary Report. Federal/Provincial/Territorial Joint Task Group on PublicHealth Human Resources. AdvisoryCommittee on Health Delivery and HumanResources, Advisory Committee onPopulation Health and Health Security.January 2005.

4. Public Health Agency of Canada.Core Competencies for Public Health –Draft 2, October 2006.

5. Last J. Glossary of Terms Relevant to the CoreCompetencies for Public Health, 2006.

6. World Health Organization. Ottawa Charterfor Health Promotion, 1986.

7. The Development of a Draft Set of PublicHealth Workforce Core Competencies.Summary Report. Federal/Provincial/Territorial Joint Task Group on PublicHealth Human Resources. AdvisoryCommittee on Health Delivery and HumanResources, Advisory Committee onPopulation Health and Health Security.January 2005.

REFERENCES

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GLOSSARY OF TERMS RELEVANT TOTHE CORE COMPETENCIES FORPUBLIC HEALTH IN CANADA

Advocacy: Interventions such as speaking, writingor acting in favour of a particular issue or cause,policy or group of people. In the public healthfield, advocacy is assumed to be in the publicinterest, whereas lobbying by a special interestgroup may or may not be in the public interest.Advocacy often aims to enhance the health ofdisadvantaged groups such as First Nationscommunities, people living in poverty or personswith HIV/AIDS.

Analysis: The examination and evaluation ofrelevant information in order to select the bestcourse of action from among various alternatives.In public health, this requires the integration ofinformation from a variety of sources.

Assessment: A formal method of evaluating asystem or a process, often with both qualitativeand quantitative components.

Attitude: A relatively stable belief or feelingabout a concept, person or object. Attitudescan often be inferred by observing behaviours.Related to definition of values.(See definition – Values.)

Collaboration: A recognized relationshipamong different sectors or groups, which havebeen formed to take action on an issue in away that is more effective or sustainable thanmight be achieved by the public health sectoracting alone.

Communication skills: These are the skillsrequired by public health professionals totransmit and receive ideas and information toand from involved individuals and groups.Communication skills include the ability tolisten, and to speak and write in plain language;i.e., verbal skills, often reinforced with visualimages.

Community participation: Procedures wherebymembers of a community participate directly indecision-making about developments that affectthe community. It covers a spectrum of activitiesranging from passive involvement in communitylife to intensive action-oriented participation incommunity development (including politicalinitiatives and strategies). The Ottawa Charterfor Health Promotion emphasizes the importanceof concrete and effective community action insetting priorities for health, making decisions,planning strategies and implementing them toachieve better health (www.phac-aspc.gc.ca/ph-sp/phdd/pdf/charter.pdf ).

Consultant/specialist: Consultants/specialistsare public health staff who are likely to haveadvanced preparation in a special content areaor a specific set of skills. They provide expertadvice and support to front line providers andmanagers although they may also work directlywith clients. Examples of consultants/specialistsinclude epidemiologists, community medicinespecialists, environmental health scientists,evaluators, nurse practitioners and advancedpractice nurses.

APPENDIX A

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Core competencies for public health:Core competencies are the essential knowledge,skills and attitudes necessary for the practiceof public health. They transcend the boundariesof specific disciplines and are independent ofprogram and topic. They provide the buildingblocks for effective public health practice, andthe use of an overall public health approach.

Culturally-relevant (and appropriate):Recognizing, understanding and applyingattitudes and practices that are sensitive to andappropriate for people with diverse culturalsocioeconomic and educational backgrounds,and persons of all ages, genders, health status,sexual orientations and abilities.

Data: A set of facts; one source of information.(See definition – Information)

Determinants of health: Definable entities thatcause, are associated with, or induce health out-comes. Public health is fundamentally concernedwith action and advocacy to address the full rangeof potentially modifiable determinants of health– not only those which are related to the actionsof individuals, such as health behaviours andlifestyles, but also factors such as income andsocial status, education, employment and workingconditions, access to appropriate health services,and the physical environment. These, in combina-tion, create different living conditions whichimpact on health. For more details, please visitwww.phac-aspc.gc.ca/ph-sp/phdd/determinants

Disease and injury prevention: Measures toprevent the occurrence of disease and injury,such as risk factor reduction, but also to arrestthe progress and reduce the consequences ofdisease or injury once established. Disease andinjury prevention is sometimes used as a com-plementary term alongside health promotion.(A public health system core function)

Diversity: The demographic characteristic ofpopulations attributable to perceptible ethnic,linguistic, cultural, visible or social variationamong groups of individuals in the generalpopulation.

Empowerment: A process through whichpeople gain greater control over decisions andactions affecting their health. Empowerment maybe a social, cultural, psychological or politicalprocess through which individuals and socialgroups are able to express their needs, presenttheir concerns, devise strategies for involvementin decision-making, and achieve political, socialand cultural action to meet those needs.(See definition – Health promotion)

Ethics: The branch of philosophy dealing withdistinctions between right and wrong, and withthe moral consequences of human actions. Muchof modern ethical thinking is based on the con-cepts of human rights, individual freedom andautonomy, and on doing good and not harming.The concept of equity, or equal considerationfor every individual, is paramount. In publichealth, the community need for protectionfrom risks to health may take precedence overindividual human rights, for instance whenpersons with a contagious disease are isolatedand their contacts may be subject to quarantine.Finding a balance between the public healthrequirement for access to information and theindividual’s right to privacy and to confidentialityof personal information may also be a sourceof tension.

Equity/equitable: Equity means fairness. Equityin health means that peoples’ needs guide thedistribution of opportunities for well-being.Equity in health is not the same as equality inhealth status. Inequalities in health status betweenindividuals and populations are inevitable con-sequences of genetic differences and various

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social and economic conditions, or a result ofpersonal lifestyle choices. Inequities occur as aconsequence of differences in opportunity, whichresult, for example in unequal access to healthservices, nutritious food or adequate housing.In such cases, inequalities in health status ariseas a consequence of inequities in opportunitiesin life.

Evaluation: Efforts aimed at determining assystematically and objectively as possible theeffectiveness and impact of health-related (andother) activities in relation to objectives, takinginto account the resources that have been used.

Evidence: Information such as analyzed data,published research findings, results of evaluations,prior experience, expert opinions, any or all ofwhich may be used to reach conclusions onwhich decisions are based.

Front line provider: Public health staff whohave post-secondary education and experiencein the field of public health. Front line providershave sufficient relevant experience to workindependently, with minimal supervision. Frontline providers carry out the bulk of day-to-daytasks in the public health sector. They workdirectly with clients, including individuals, fam-ilies, groups and communities. Responsibilitiesmay include information collection and analysis,fieldwork, program planning, outreach activities,program and service delivery, and other organi-zational tasks. Examples of front line providersare public health nurses, public health/environ-mental health inspectors, public health dietitians,dental hygienists and health promoters.

(Health) planning: A set of practices and proce-dures that are intended to enhance the efficiencyand effectiveness of health services and to improvehealth outcomes. This important activity of allhealth departments commonly includes short-

term, medium-term, and long-range planning.Important considerations are resource allocation,priority setting, distribution of staff and physicalfacilities, planning for emergencies and ways tocope with extremes of demand and unforeseencontingencies, and preparation of budgets forfuture fiscal periods with a feasible time horizon,often 5 years ahead, sometimes as far ahead as10 or even 15 years.

Health policy: A course or principle of actionadopted or proposed by a government, politicalparty, organization, or individual; the written orunwritten aims, objectives, targets, strategy, tactics,and plans that guide the actions of a governmentor an organization. Policies have three intercon-nected and ideally continually evolving stages:development, implementation and evaluation.Policy development is the creative process ofidentifying and establishing a policy to meet aparticular need or situation. Policy implementa-tion consists of the actions taken to set up ormodify a policy, and evaluation is the assessmentof how, and how well, the policy works in prac-tice. Health policy is often enacted throughlegislation or other forms of rule-making, whichdefine regulations and incentives that enablethe provision of and access to health andsocial services.

Health program: A description or plan of actionfor an event or sequence of actions or eventsover a period that may be short or prolonged.More formally, an outline of the way a systemor service will function, with specifics such asroles and responsibilities, expected expenditures,outcomes, etc. A health program is generally longterm and often multifaceted, whereas a healthproject is a short-term and usually narrowlyfocused activity.

Health promotion: The process of enablingpeople to increase control over, and to improve

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their health. It not only embraces actions directedat strengthening the skills and capabilities ofindividuals, but also action directed towardschanging social, environmental, political andeconomic conditions so as to alleviate theirimpact on public and individual health. TheOttawa Charter for Health Promotion (1986)describes five key strategies for health promotion:build healthy public policy; create supportiveenvironments; strengthen community action;develop personal skills; and re-orient healthservices. (A public health system core function.)

Health protection: A term to describe importantactivities of public health, in food hygiene, waterpurification, environmental sanitation, drugsafety and other activities, that eliminate as faras possible the risk of adverse consequences tohealth attributable to environmental hazards.(A public health system core function.)

Investigation: A systematic, thorough and formalprocess of inquiry or examination used to gatherfacts and information in order to understand,define and resolve a public health issue.

Leadership: Leadership is described in manyways. In the field of public health it relates tothe ability of an individual to influence, motivate,and enable others to contribute toward theeffectiveness and success of their communityand/or the organization in which they work. Itinvolves inspiring people to craft and achieve avision and goals. Leaders provide mentoring,coaching and recognition. They encourageempowerment, allowing other leaders to emerge.

Lifelong learning: A broad concept where edu-cation that is flexible, diverse and available atdifferent times and places is pursued throughoutlife. It takes place at all levels—formal, non-formaland informal—utilizing various modalities suchas distance learning and conventional learning.

Information: Facts, ideas, concepts and data thathave been recorded, analyzed, and organized in away that facilitates interpretation and subsequentaction.

Manager/supervisor: Public health staff whoare responsible for major programs or functions.Typically, they have staff who report to them.Sometimes senior managers come from sectorsother than public health and therefore relyheavily on consultants/specialists and otherpublic health professionals for content expertiseand advice. In other situations, managers withpublic health experience and qualifications areexpected to bring more content knowledge.

Mediate: A process through which the differentinterests (personal, social, economic) of individualsand communities, and different sectors (publicand private) are reconciled in ways that promoteand protect health. Facilitating change in peoples’lifestyles and living conditions inevitably producesconflicts between the different sectors and interestsin a population. Reconciling such conflicts inways that promote health may require consid-erable input from public health practitioners,including the application of skills in advocacyfor health.

Mission: The purpose for which an organization,agency or service exists, often summarized in amission statement.

Partnerships: Collaboration between individuals,groups, organizations, governments or sectorsfor the purpose of joint action to achieve acommon goal. The concept of partnershipimplies that there is an informal understandingor a more formal agreement (possibly legallybinding) among the parties regarding roles andresponsibilities, as well as the nature of the goaland how it will be pursued.

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Performance standards: The criteria, often deter-mined in advance, e.g., by an expert committee,by which the activities of health professionals orthe organization in which they work, are assessed.

Population health assessment: Population healthassessment entails understanding the health ofpopulations and the factors that underlie healthand health risks. This is frequently manifestedthrough community health profiles and healthstatus reports that inform priority setting andprogram planning, delivery and evaluation.Assessment includes consideration of physical,biological, behavioural, social, cultural, economicand other factors that affect health. The healthof the population or a specified subset of thepopulation can be measured by health statusindicators such as life expectancy and hospitaladmission rates. (A public health system corefunction.)

Public health: An organized activity of society topromote, protect, improve, and when necessary,restore the health of individuals, specified groups,or the entire population. It is a combination ofsciences, skills, and values that function throughcollective societal activities and involve programs,services, and institutions aimed at protecting andimproving the health of all people. The term“public health” can describe a concept, a socialinstitution, a set of scientific and professionaldisciplines and technologies, and a form ofpractice. It is a way of thinking, a set of disci-plines, an institution of society, and a manner ofpractice. It has an increasing number and varietyof specialized domains and demands of its prac-titioners an increasing array of skills and expertise.

Public Health Agency of Canada (PHAC):Established in 2004, PHAC aims to protect andpromote the health and safety of all Canadians.Its activities focus on preventing chronic diseases

and injuries, health promotion, and respondingto public health emergencies and infectiousdisease outbreaks. Details are available atwww.phac-aspc.gc.ca

Public health practitioner:Syn: public health professional, public healthworker. A generic term for any person who worksin a public health service or setting. They maybe classified according to profession (nurse,physician, dietitian, etc.); according to role andfunction (direct contact with members of thepublic or not); whether their role is hands-onactive interventions or administrative; or in variousother ways.

Public health sciences: A collective name forthe scholarly activities that form the scientificbase for public health practice, services, andsystems. Until the early 19th century, scholarlyactivities were limited to natural and biologicalsciences sometimes enlightened by empiricallogic. The scientific base has broadened to includevital statistics, epidemiology, environmentalsciences, biostatistics, microbiology, social andbehavioral sciences, demography, genetics,nutrition, molecular biology, and more.

Research: Activities designed to develop orcontribute to knowledge, e.g., theories, principles,relationships, or the information on whichthese are based. Research may be conductedsimply by observation and inference, or by theuse of experiment, in which the researcher altersor manipulates conditions in order to observeand study the consequences of doing so. Inpublic health, there is an ill-defined distinctionbetween research and routine surveillance, casefinding, etc. Qualitative research aims to doin-depth exploration of a group or issue, andthe methods used often include focus groups,interviews, life histories, etc.

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Social justice: Refers to the concept of a societythat gives individuals and groups fair treatmentand an equitable share of the benefits of society.In this context, social justice is based on theconcepts of human rights and equity. Undersocial justice, all groups and individuals areentitled equally to important rights such as healthprotection and minimal standards of income.The goal of public health—to minimize prevent-able death and disability for all—is integral tosocial justice.

Social marketing: The design and implementationof health communication strategies intended toinfluence behaviour or beliefs relating to theacceptability of an idea such as desired healthbehaviour, or a practice such as safe foodhygiene, by a target group in the population

Surveillance: Systematic, ongoing collection,collation, and analysis of health-related informa-tion that is communicated in a timely mannerto all who need to know which health problemsrequire action in their community. Surveillanceis a central feature of epidemiological practice,where it is used to control disease. Informationthat is used for surveillance comes from manysources, including reported cases of communicablediseases, hospital admissions, laboratory reports,cancer registries, population surveys, reports ofabsence from school or work, and reported causesof death. (A public health system core function.)

Sustainable development: The use of resources,investments, technology and institutionaldevelopment in ways that do not compromisethe health and well-being of future generations.There is no single best way of organizing thecomplex development-environment-healthrelationship that reveals all the importantinteractions and possible entry points for publichealth interventions.

Values: The beliefs, traditions and social customsheld dear and honoured by individuals and col-lective society. Moral values are deeply believed,change little over time and are often groundedin religious faith. They include beliefs about thesanctity of life, the role of families in society,and protection from harm of infants, childrenand other vulnerable people. Social values aremore flexible and may change as individualsundergo experience. These may include beliefsabout the status and roles of women in society,attitudes towards use of alcohol, tobacco andother substances. Values can affect behaviourand health either beneficially or harmfully.

Vision: If a strategic plan is the "blueprint"for an organization's work, then the vision isthe "artist's rendering" of the achievement ofthat plan. It is a description in words thatconjures up the ideal destination of the group'swork together.

Working environment: A setting in which peoplework. This comprises not merely the physicalenvironment and workplace hazards, but also thesocial, cultural and psychological setting thatmay help to induce harmony among workers,or the opposite – tension, friction, distrust andanimosity which can interfere with well-beingand aggravate risks of injury.

This glossary was compiled by Dr. John M. Last inOctober 2006 and revised and edited by PeggyEdwards in August 2007 in response to suggestionsfrom the consultation process and changes in the corecompetency statements. Primary sources includeA Dictionary of Public Health by John M. Last(2007) and the Health Promotion Glossary pub-lished by the World Health Organization (1998)(www.who.int/hpr/NPH/docs/hp_glossary_en.pdf )

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PRACTICE EXAMPLES OFTHE CORE COMPETENCIESFOR PUBLIC HEALTH

The following table provides some practicalexamples of each of the core competencystatements. It is based on a report prepared bythe Public Health Research, Education andDevelopment (PHRED) Program in 2006 forthe Public Health Agency of Canada.

Each statement is illustrated with one or twoexamples – for a front line provider, a consultant/specialist or a manager. The reader is encouragedto develop additional examples, based on yourown experience and understanding of thecompetency statements.

Front line providers are public health staff whohave post-secondary education and experiencein the field of public health. Front line providershave sufficient relevant experience to workindependently, with minimal supervision.Front line providers carry out the bulk ofday-to-day tasks in the public health sector.They work directly with clients, includingindividuals, families, groups and communities.Responsibilities may include informationcollection and analysis, fieldwork, programplanning, outreach activities, program andservice delivery, and other organizational tasks.Examples of front line providers are publichealth nurses, environmental public healthprofessionals, public health dietitians, dentalhygienists and health promoters.

Consultants/specialists are public health staffwho are likely to have advanced preparation ina special content area or a specific set of skills.They provide expert advice and support to frontline providers and managers although they mayalso work directly with clients. Examples ofconsultants/specialists include epidemiologists,community medicine specialists, environmentalhealth scientists, evaluators, nurse practitionersand advanced practice nurses.

Managers/supervisors are public health staffwho are responsible for major programs orfunctions. Typically, they have staff who reportto them. Sometimes senior managers come fromsectors other than public health and thereforerely heavily on consultants/specialists and otherpublic health professionals for content expertiseand advice. In other situations, managers withpublic health experience and qualifications areexpected to bring more content knowledge.

In some organizations, practitioners may findthemselves in multiple roles. For example, anepidemiologist may act as a content consultant/specialist but also be responsible for managinga team.

APPENDIX B

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COMPETENCYSTATEMENTS

1.1Demonstrate knowledge about the followingconcepts: the health status of populations,inequities in health, the determinants ofhealth and illness, strategies for health promo-tion, disease and injury prevention and healthprotection, as well as the factors that influencethe delivery and use of health services.

1.2Demonstrate knowledge about the history,structure and interaction of public healthand health care services at local, provincial/territorial, national, and international levels.

1.3 Apply the public health sciences to practice.

1.4 Use evidence and research to inform healthpolicies and programs.

1.5Demonstrate the ability to pursue lifelonglearning opportunities in the field of publichealth.

PRACTICEEXAMPLES

Front line provider: Discuss the need for a pre-natal nutrition program in an Aboriginal com-munity as well as contributing factors such asincome, education, culture and traditional foods.

Front line provider: Recall public health eventssuch as the implementation of universal immu-nization programs in order to explain to parentsthe importance of this measure for maintainingpublic health.

Front line provider: Apply the epidemiologytriangle (host, environment and agent) to theissue of West Nile virus.

Consultant/Specialist: Integrate GeographicInformation System (GIS) software for mappingcases of West Nile Virus to account for seasonaltrends.

Front line provider: Discuss how evidence from arecent research study can be utilized in practice.

Consultant/Specialist: Summarize key findingsfrom a contact tracing report to support policychanges in communicable disease services.

Front line provider: Register for a Skills Onlinemodule with the Skills Enhancement for PublicHealth Program.

ONE...PUBLIC HEALTH SCIENCES

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COMPETENCYSTATEMENTS

2.1 Recognize that a health concern orissue exists.

2.2 Identify relevant and appropriate sourcesof information, including community assetsand resources.

2.3 Collect, store, retrieve and use accurateand appropriate information on publichealth issues.

2.4 Analyze information to determine appropriateimplications, uses, gaps and limitations.

2.5Determine the meaning of information,considering the current ethical, political,scientific, socio-cultural and economiccontexts.

2.6 Recommend specific actions based on theanalysis of information.

PRACTICEEXAMPLES

Front line provider: Describe a situation in aschool community recognizing that the lack ofhealthy food choices in the school cafeteria isan issue.

Front line provider: Identify key informantssuch as student leaders and service providers.

Front line provider: Use data collection tools(e.g., IPHIS) to document practice.

Consultant/Specialist: Design a data collectiontool on Fetal Alcohol Spectrum Disorder(FASD) and obtain relevant provincial/territori-al statistics on the prevalence of FASD.

Front line provider: Identify the limitations ofinformation resulting from a telephone surveyin a diverse community.

Front line provider: Identify how smoking affectsmen and women differently and how reasonsfor smoking differ between genders, and amongsocioeconomic groups and different cultures.

Consultant/Specialist: Make recommendations forhealth policies regulating artificial tanning salonsdue to the increasing incidence of skin cancers.

TWO...ASSESSMENT AND ANALYSIS

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COMPETENCYSTATEMENTS

3.1Describe selected policy and program optionsto address a specific public health issue.

3.2Describe the implications of each option,especially as they apply to the determinantsof health and recommend or decide on acourse of action.

3.3Develop a plan to implement a course ofaction taking into account relevant evidence,legislation, emergency planning procedures,regulations and policies.

3.4 Implement a policy or program and/or takeappropriate action to address a specific publichealth issue.

3.5Demonstrate the ability to implementeffective practice guidelines.

3.6 Evaluate an action, program or policy.

3.7Demonstrate an ability to set and followpriorities, and to maximize outcomes basedon available resources.

PRACTICEEXAMPLES

Front line provider: Identify potential schoolintervention programs and activities to addressincreasing rates of sexually transmitted infectionsamong youth.

Front line provider: Explore the social andeconomic implications of a folic acid educationprogram directed at adolescents and decidewhether or not to proceed.

Consultant/Specialist: Prioritize the componentsof a restaurant inspection logic model includingappropriate rationale and develop the implemen-tation plan for each component.

Consultant/Specialist: Act according to theorganization’s emergency response plan in theevent of an outbreak or emergency.

Front line provider: Use universal infectioncontrol measures appropriately.

Front line provider: Develop and implementan evaluation plan for a smoke-free workplaceprogram in collaboration with stakeholders.

Front line provider: Set priorities for actionon safer crack use in a local harm reductionprogram based on existing resources.

THREE... POLICY AND PROGRAM PLANNING,IMPLEMENTATION AND EVALUATION

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COMPETENCYSTATEMENTS

3.8 Demonstrate the ability to fulfill functionalroles in response to a public health emer-gency.

PRACTICEEXAMPLES

Front line provider: Be familiar with the organi-zation’s emergency management manual.

Manager/Supervisor: Arrange a debriefing ses-sion after a public health incident to identifylessons learned and assess the need for recoveryintervention for team members involved.

THREE... POLICY AND PROGRAM PLANNING,IMPLEMENTATION AND EVALUATION continued...

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COMPETENCYSTATEMENTS

4.1 Identify and collaborate with partners inaddressing public health issues.

4.2 Use skills such as team building, negotia-tion, conflict management and group facili-tation to build partnerships.

4.3Mediate between differing interests in thepursuit of health and well-being, and facili-tate the allocation of resources

4.4 Advocate for healthy public policies andservices that promote and protect the healthand well-being of individuals and commu-nities.

PRACTICEEXAMPLES

Front line provider: Explain the roles of theprovincial government, local recreation depart-ment, school boards, boards of health and theBoys and Girls Club in addressing childhoodobesity to a parent group.

Front line provider: Assist the school indeveloping a school health team.

Consultant/Specialist: Facilitate the developmentof the terms of reference for a partnershipbetween school boards and public health.

Front line provider: Interview key communitymembers to determine the range of opinions onthe implementation of a local tobacco by-law.

Consultant/Specialist: Synthesize input fromindividuals and organizations in order to preparea report on the readiness of a community tooffer a needle exchange clinic.

Consultant/Specialist: Using information fromthe Canadian Community Health Survey andfeedback from principals, make a presentation tothe Board of Health to advocate for a provincialschool nutrition policy.

FOUR...PARTNERSHIPS, COLLABORATION AND ADVOCACY

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COMPETENCYSTATEMENTS

5.1 Recognize how the determinants of health(biological, social, cultural, economic andphysical) influence the health and well-beingof specific population groups.

5.2 Address population diversity when planning,implementing, adapting and evaluatingpublic health programs and policies.

5.3 Apply culturally relevant and appropriateapproaches with people from diverse cultural,socioeconomic, and educational backgrounds,and persons of all ages, genders, health status,sexual orientations and abilities.

PRACTICEEXAMPLES

Consultant/Specialist: Develop a funding proposalin collaboration with key stakeholders for acommunity kitchen project in a disadvantagedarea with a culturally diverse population.

Front line provider: Provide access to vaccinesfor people of all cultural groups and populations(e.g., drive-through vaccine clinics for disabledpopulation groups)

Front line provider: Collaborate with membersof an Afghanistan community to develop atuberculosis screening program in their neigh-bourhood.

Manager/Supervisor: Negotiate with primarycare team to provide cancer screening clinicsstaffed with female practitioners for Muslimwomen.

FIVE...DIVERSITY AND INCLUSIVENESS

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COMPETENCYSTATEMENTS

6.1 Communicate effectively with individuals,families, groups, communities and colleagues.

6.2 Interpret information for professional, non-professional and community audiences.

6.3Mobilize individuals and communities byusing appropriate media, communityresources and social marketing techniques.

6.4 Use current technology to communicateeffectively.

PRACTICEEXAMPLES

Front line provider: Revise oral presentations tomeet the needs of various audiences.

Front line provider: Develop immunizationschedule fact sheets for people with lowliteracy levels.

Consultant/Specialist: Discuss populationhealth information about health status anddemographics with front line providers.

Front line provider: Use multiple strategies toeffectively communicate health messages appro-priate to audiences (e.g., community newspapers,local television, radio, billboards, face-to-faceevents).

Manager/Supervisor: Use community networksto receive and provide information about issuesaffecting the health of citizens.

Consultant/Specialist: Forward workplacehealth information from a health promotionlistserv to staff members on a workplace healthcommittee.

SIX...COMMUNICATION

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COMPETENCYSTATEMENTS

7.1 Describe the mission and priorities of thepublic health organization where one works,and apply them in practice.

7.2 Contribute to developing key values and ashared vision in planning and implementingpublic health programs and policies in thecommunity.

7.3 Utilize public health ethics to manage self,others, information and resources.

7.4 Contribute to team and organizationallearning in order to advance publichealth goals.

PRACTICEEXAMPLES

Front line provider: Illustrate how a program logicmodel incorporates the organization’s missioninto program specific goals and outcomes.

Manager/Supervisor: Apply the priorities ofthe organization to the work plan of an inter-disciplinary team.

Front line provider: Involve parents, teachers,and students in developing a vision and healthgoals for the school community.

Consultant/Specialist: Develop a research protocolthat protects the privacy of participants from alocal women’s shelter.

Manager/Supervisor: Facilitate a lunch andlearn session for the interdisciplinary team witha local ethicist to discuss vaccine security.

Front line provider: Participate on a staffcommittee whose purpose is to facilitate theincorporation of best practice guidelines intopolicies and practice.

Consultant/Specialist: Participate in a mentoringprogram with other employees.

SEVEN...LEADERSHIP

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COMPETENCYSTATEMENTS

7.5 Contribute to maintaining organizationalperformance standards.

7.6 Demonstrate an ability to build communitycapacity by sharing knowledge, tools,expertise and experience.

PRACTICEEXAMPLES

Front line provider: Assist in the collection ofdata for inclusion in the organization’s annualperformance report.

Manager/Supervisor: Develop a plan to form anaccreditation team to review and use the PublicHealth Standards of the Canadian Council onHealth Services Accreditation.

Front line provider: Facilitate discussion with acommunity group that is developing an activeliving program, to identify factors that couldimpact on program delivery such as resources,space and previous community experience.

Manager/Supervisor: Sponsor and participatein a continuing education session for an inter-disciplinary team on working effectively withcommunity groups to achieve public health goals.

SEVEN...LEADERSHIP continued...

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NOTE