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10 Essential Public Health Services

The 10 Essential Public Health Services (EPHS) describe the public health activities that all communities should undertake.  For the past 25 years, the EPHS have served as a well-recognized framework for carrying out the mission of public health.  The EPHS framework was originally released in and more recently updated in   The revised version is intended to bring the framework in line with current and future public health practice.

The revised EPHS framework was released on September 9, , as a result of a collaborative effort by the Public Health National Center for Innovationsexternal icon (PHNCI) and the de Beaumont Foundationexternal icon, who convened a task force of public health experts, leaders, and practitioners and engaged the public health community in activities to inform the changes. The task force also included experts from federal agencies, including CDC, which were instrumental in establishing and supporting the original EPHS framework.  Details about the process to update the EPHS can be found on the PHNCI websiteexternal icon, along with accompanying materials.

Essential Public Health Services (Revised, )

The 10 Essential Public Health Services provide a framework for public health to protect and promote the health of all people in all communities. To achieve equity, the Essential Public Health Services actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. Such barriers include poverty, racism, gender discrimination, ableism, and other forms of oppression. Everyone should have a fair and just opportunity to achieve optimal health and well-being.

  1. Assess and monitor population health status, factors that influence health, and community needs and assets
  2. Investigate, diagnose, and address health problems and hazards affecting the population
  3. Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it
  4. Strengthen, support, and mobilize communities and partnerships to improve health
  5. Create, champion, and implement policies, plans, and laws that impact health
  6. Utilize legal and regulatory actions designed to improve and protect the public’s health
  7. Assure an effective system that enables equitable access to the individual services and care needed to be healthy
  8. Build and support a diverse and skilled public health workforce
  9. Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement
  10. Build and maintain a strong organizational infrastructure for public health

EPHS Launch Event

On September 9, , the de Beaumont Foundation and Public Health National Center for Innovations hosted a virtual launch for the revised 10 Essential Public Health Services. View the complete launch event recording below. Listen to remarks from José T. Montero, MD, MHCDS, Director of CDC’s Center for State, Tribal, Local, and Territorial Support, at


Nutrition and COPD

Most people are surprised to learn that the food they eat may affect their breathing. Your body uses food as fuel for all of its activities. The right mix of nutrients in your diet can help you breathe easier. No single food will supply all the nutrients you need—a healthy diet has lots of variety. You and your healthcare team will work out a meal plan just for you. Meeting with a registered dietitian nutritionist (RDN) will help you get on track. Find an RDN who specializes in COPD by asking your doctor or visiting the Academy of Nutrition and Dietetics at

Be sure to mention:

  • What foods you like
  • What foods you don't like and won't eat
  • Your daily schedule, including your exercise
  • Other health problems or special dietary needs you have

How Does Food Relate to Breathing?

The process of changing food to fuel in the body is called metabolism. Oxygen and food are the raw materials of the process, and energy and carbon dioxide are the finished products. Carbon dioxide is a waste product that we exhale.

The right mix of nutrients in your diet can help you breathe easier.

Metabolism of carbohydrates produces the most carbon dioxide for the amount of oxygen used; metabolism of fat produces the least. For some people with COPD, eating a diet with fewer carbohydrates and more fat helps them breathe easier.

Nutritional Guidelines

Choose complex carbohydrates, such as whole-grain bread and pasta, fresh fruits and vegetables.

  • To lose weight: Opt for fresh fruits and veggies over bread and pasta for the majority of your complex carbohydrates.
  • To gain weight: Eat a variety of whole-grain carbohydrates and fresh fruits and vegetables.

Limit simple carbohydrates, including table sugar, candy, cake and regular soft drinks.

Eat 20 to 30 grams of fiber each day, from items such as bread, pasta, nuts, seeds, fruits and vegetables. Eat a good source of protein at least twice a day to help maintain strong respiratory muscles. Good choices include milk, eggs, cheese, meat, fish, poultry, nuts and dried beans or peas.

  • To lose weight: Choose low-fat sources of protein such as lean meats and low-fat dairy products.
  • To gain weight: Choose protein with a higher fat content, such as whole milk, whole milk cheese and yogurt.

Choose mono- and poly-unsaturated fats, which do not contain cholesterol. These are fats that are often liquid at room temperature and come from plant sources, such as canola, safflower and corn oils.

  • To lose weight: Limit your intake of these fats.
  • To gain weight: Add these types of fats to your meals.

Limit foods that contain trans fats and saturated fat. For example, butter, lard, fat and skin from meat, hydrogenated vegetable oils, shortening, fried foods, cookies, crackers and pastries.

Note: These are general nutritional guidelines for people living with COPD. Each person's needs are different, so talk to your doctor or RDN before you make changes to your diet.

Vitamins and minerals

Many people find taking a general-purpose multivitamin helpful. Often, people with COPD take steroids. Long-term use of steroids may increase your need for calcium. Consider taking calcium supplements. Look for one that includes vitamin D. Calcium carbonate or calcium citrate are good sources of calcium. Before adding any vitamins to your daily routine, be sure to discuss with your doctor.


Too much sodium may cause edema (swelling) that may increase blood pressure. If edema or high blood pressure are health problems for you, talk with your doctor about how much sodium you should be eating each day. Ask your RDN about the use of spices and herbs in seasoning your food and other ways you can decrease your sodium intake.


Drinking plenty of water is important not only to keep you hydrated, but also to help keep mucus thin for easier removal. Talk with your doctor about your water intake. A good goal for many people is 6 to 8 glasses (8 fluid ounces each) daily. Don't try to drink this much fluid at once; spread it out over the entire day. Some people find it helpful to fill a water pitcher every morning with all the water they are supposed to drink in one day. They then refill their glass from that pitcher and keep track of their progress during the course of the day. Remember, any healthy caffeine-free fluid counts toward your fluid goal, and most foods contribute a substantial amount of fluid, as well.

Using medical nutritional products

You may find it difficult to meet your nutritional needs with regular foods, especially if you need a lot of calories every day. Also, if your RDN has suggested that you get more of your calories from fat—the polyunsaturated, monounsaturated, and low-cholesterol variety—you may not be able to meet this goal easily with ordinary foods. Your RDN or doctor may suggest you drink a liquid called a medical nutritional product (supplement). Some of these products can be used as a complete diet by people who can't eat ordinary foods, or they can be added to regular meals by people who can't eat enough food.

Read more on our Each Breath Blog about COPD and Nutrition: Managing Difficulties with Weight Gain

Diet Hints

  • Rest just before eating.
  • Eat more food early in the morning if you're usually too tired to eat later in the day.
  • Avoid foods that cause gas or bloating. They tend to make breathing more difficult.
  • Eat 4 to 6 small meals a day. This enables your diaphragm to move freely and lets your lungs fill with air and empty out more easily
  • If drinking liquids with meals makes you feel too full to eat, limit liquids with meals; drink an hour after meals.
  • Consider adding a nutritional supplement at night time to avoid feeling full during the day

Reviewed and approved by the American Lung Association Scientific and Medical Editorial Review Panel.

Page last updated: June 10,

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Reportable diseases

Reportable diseases are diseases considered to be of great public health importance.  In the United States, local, state, and national agencies (for example, county and state health departments or the United States Centers for Disease Control and Prevention) require that these diseases be reported when they are diagnosed by doctors or laboratories.

Reporting allows for the collection of statistics that show how often the disease occurs. This helps researchers identify disease trends and track disease outbreaks. This information can help control future outbreaks.

All US states have a reportable diseases list. It is the responsibility of the health care provider, not the patient, to report cases of these diseases. Many diseases on the list must also be reported to the US Centers for Disease Control and Prevention (CDC).

Reportable diseases are divided into several groups:

  • Mandatory written reporting: A report of the disease must be made in writing. Examples are gonorrhea and salmonellosis.
  • Mandatory reporting by telephone: The provider must make a report by phone. Examples are rubeola (measles) and pertussis (whooping cough).
  • Report of total number of cases. Examples are chickenpox and influenza.
  • Cancer. Cancer cases are reported to the state Cancer Registry.

Diseases reportable to the CDC include:

  • Anthrax
  • Arboviral diseases (diseases caused by viruses spread by mosquitoes, sandflies, ticks, etc.) such as West Nile virus, eastern and western equine encephalitis
  • Babesiosis
  • Botulism
  • Brucellosis
  • Campylobacteriosis
  • Chancroid
  • Chickenpox
  • Chlamydia
  • Cholera
  • Coccidioidomycosis
  • Cryptosporidiosis
  • Cyclosporiasis
  • Dengue virus infections
  • Diphtheria
  • Ehrlichiosis
  • Foodborne disease outbreak
  • Giardiasis
  • Gonorrhea
  • Haemophilus influenza, invasive disease
  • Hantavirus pulmonary syndrome
  • Hemolytic uremic syndrome, post-diarrheal
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • HIV infection
  • Influenza-related infant deaths
  • Invasive pneumococcal disease
  • Lead, elevated blood level
  • Legionnaire disease (legionellosis)
  • Leprosy
  • Leptospirosis
  • Listeriosis
  • Lyme disease
  • Malaria
  • Measles
  • Meningitis (meningococcal disease)
  • Mumps
  • Novel influenza A virus infections
  • Pertussis
  • Pesticide-related illnesses and injuries
  • Plague
  • Poliomyelitis
  • Poliovirus infection, nonparalytic
  • Psittacosis
  • Q-fever
  • Rabies (human and animal cases)
  • Rubella (including congenital syndrome)
  • Salmonella paratyphi and typhi infections
  • Salmonellosis
  • Severe acute respiratory syndrome-associated coronavirus disease
  • Shiga toxin-producing Escherichia coli (STEC)
  • Shigellosis
  • Smallpox
  • Syphilis, including congenital syphilis
  • Tetanus
  • Toxic shock syndrome (other than streptococcal)
  • Trichinellosis
  • Tuberculosis
  • Tularemia
  • Typhoid fever
  • Vancomycin intermediate Staphylococcus aureus (VISA)
  • Vancomycin resistant Staphylococcus aureus (VRSA)
  • Vibriosis
  • Viral hemorrhagic fever (including Ebola virus, Lassa virus, among others)
  • Waterborne disease outbreak
  • Yellow fever
  • Zika virus disease and infection (including congenital)

The county or state health department will try to find the source of many of these illnesses, such as food poisoning. In the case of sexually-transmitted diseases (STDs), the county or state will try to locate sexual contacts of infected people to make sure they are disease-free or are treated if they are already infected.

The information gained from reporting allows the county or state to make informed decisions and laws about activities and the environment, such as:

  • Animal control
  • Food handling
  • Immunization programs
  • Insect control
  • STD tracking
  • Water purification

The provider is required by law to report these diseases. By cooperating with state health workers, you can help them locate the source of an infection or prevent the spread of an epidemic.

Centers for Disease Control and Prevention website. National Notifiable Diseases Surveillance System (NNDSS). Updated March 13, Accessed May 23,

Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The U.S. Healthcare System: A Health Policy Primer for Medical School Applicants

What Are the Signs of Alzheimer&#;s Disease?

Scientists continue to unravel the complex brain changes involved in the onset and progression of Alzheimer’s disease. It seems likely that damage to the brain starts a decade or more before memory and other cognitive problems appear. During this preclinical stage of Alzheimer’s disease, people seem to be symptom-free, but toxic changes are taking place in the brain.Illustration of a woman having trouble finding words, remembering dates, losing keys

Damage occurring in the brain of someone with Alzheimer’s disease begins to show itself in very early clinical signs and symptoms. For most people with Alzheimer’s—those who have the late-onset variety—symptoms first appear in their mids. Signs of early-onset Alzheimer’s begin between a person’s 30s and mids.

The first symptoms of Alzheimer’s vary from person to person. Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer’s disease. Decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer’s disease. And some people may be diagnosed with mild cognitive impairment. As the disease progresses, people experience greater memory loss and other cognitive difficulties.

Alzheimer’s disease progresses in several stages: preclinical, mild (sometimes called early-stage), moderate, and severe (sometimes called late-stage).

Signs of Mild Alzheimer’s Disease

In mild Alzheimer’s disease, a person may seem to be healthy but has more and more trouble making sense of the world around him or her. The realization that something is wrong often comes gradually to the person and his or her family. Problems can include:

Alzheimer’s disease is often diagnosed at this stage.

Signs of Moderate Alzheimer’s Disease

Forgetfulness infographic icon

In this stage, more intensive supervision and care become necessary, which can be difficult for many spouses and families. Symptoms may include:

  • Increased memory loss and confusion
  • Inability to learn new things
  • Difficulty with language and problems with reading, writing, and working with numbers
  • Difficulty organizing thoughts and thinking logically
  • Shortened attention span
  • Problems coping with new situations
  • Difficulty carrying out multistep tasks, such as getting dressed
  • Problems recognizing family and friends
  • Hallucinations, delusions, and paranoia
  • Impulsive behavior such as undressing at inappropriate times or places or using vulgar language
  • Inappropriate outbursts of anger
  • Restlessness, agitation, anxiety, tearfulness, wandering—especially in the late afternoon or evening
  • Repetitive statements or movement, occasional muscle twitches

Signs of Severe Alzheimer’s Disease

People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care. Near the end, the person may be in bed most or all of the time as the body shuts down. Their symptoms often include:

  • Inability to communicate
  • Weight loss
  • Seizures
  • Skin infections
  • Difficulty swallowing
  • Groaning, moaning, or grunting
  • Increased sleeping
  • Loss of bowel and bladder control

A common cause of death for people with Alzheimer’s disease is aspiration pneumonia. This type of pneumonia develops when a person cannot swallow properly and takes food or liquids into the lungs instead of air.

There is currently no cure for Alzheimer’s, though there are medicines that can treat the symptoms of the disease.

Some people have a condition called mild cognitive impairment, or MCI. It can be an early sign of Alzheimer’s. But, not everyone with MCI will develop Alzheimer’s disease. People with MCI can still take care of themselves and do their normal activities. MCI memory problems may include:

  • Losing things often
  • Forgetting to go to events or appointments
  • Having more trouble coming up with words than other people the same age

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About the Signs of Alzheimer's Disease

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
[email protected]
The NIA ADEAR Center offers information and free print publications about Alzheimer’s and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.
Explore the portal for information and resources on Alzheimer’s and related dementias from across the federal government.

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed: May 16,


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