The Foundational Public Health Services (FPHS) define a minimum package of public health capabilities and programs that no jurisdiction can be without. The FPHS framework was updated in 2022 to assure it reflects the evolving nature and modernization of governmental public health.

The FPHS framework outlines the unique responsibilities of governmental public health and can be used to explain the vital role of governmental public health in a thriving community; identify capacity and resource gaps; determine the cost for assuring foundational activities; and justify funding needs. However, to best serve their communities, health departments will provide additional services and may require additional capacity in different areas.

foundational public health services

2022 revision highlights include:

  • Equity was added as an eighth Foundational Capability, elevating its importance as a cross-cutting skill and capacity, and reinforcing its critical role in ensuring community health and well-being.
  • Definitions for Foundational Capabilities and Foundational Areas were refined for greater clarity where needed. Key topics important for today’s public health practice and modernization were emphasized in the definitions, such as equity, social determinants of health, data, technology, and the public health workforce.
  • The component titled “local protections and services unique to a community’s needs” was renamed “Community-specific Services”, and still acknowledges the flexibility needed to accommodate local additional services that are unique but critical to a given community.
  • The framework now starts with the Foundational Capabilities as the base, recognizing the importance of building a strong infrastructure to support implementation of the FPHS. Foundational Areas and Community-specific Services are depicted as supported by the infrastructure, and equity now encircles all the Foundational Capabilities, Foundational Areas, and Community-specific Services, emphasizing that equity is essential in all aspects of the framework.

The FPHS factsheet contains high level definitions of the public health infrastructure and programs required for health departments to provide basic protections to the communities they serve. The operational definitions provided detailed definitions that can be used to assess capacity and cost towards the FCs and FAs.


Building a Strong Foundation of Public Health Infrastructure

Health departments provide public health protections in several areas, including preventing the spread of communicable disease, ensuring food, air, and water quality are safe, supporting maternal and child health, improving access to clinical care services, and preventing chronic disease and injury – these are also known as the Foundational Areas. Additionally, public health departments provide local protections and services unique to their community’s needs – these are known as Community-specific Services.

The infrastructure needed to provide these protections strives to provide fair opportunities for all to be healthy and includes eight capabilities – known as the Foundational Capabilities – include:

  • Assessment & Surveillance,

  • Community Partnership Development,

  • Equity,

  • Organizational Competencies,

  • Policy Development & Support,

  • Accountability & Performance Management,

  • Emergency Preparedness & Response, and

  • Communications.

Practically put, health departments must always be ready to serve their communities. This requires access to a wide range of critical data sources, robust laboratory capacity, preparedness and policy planning capacity, and expert staff to leverage them in support of public health protections.

While the FPHS was developed separately and for different reasons than the PHAB Standards & Measures, there are areas of alignment. The FPHS was developed to represent a minimum package of public health services to set a foundation for what is needed everywhere for public health to function anywhere. The FPHS may be used to make the case for sustainable funding and to advocate for increased support. The PHAB Standards & Measures were developed as a tool to improve the performance and quality of public health departments. This crosswalk describes alignment between the Foundational Capabilities and  Version 2022 of the PHAB Standards & Measures.

Additionally, PHAB has released a summary report that analyzes the performance of health departments on PHAB accreditation measures that are linked to the Foundational Capabilities.

Health Department Performance on Foundational Capability Measures

Beginning in Spring 2013, the Public Health Leadership Forum, funded by the Robert Wood Johnson Foundation and facilitated by RESOLVE, convened to explore a recommendation from the Institute of Medicine report, For the Public’s Health: Investing in a Healthier Future, to create a “minimum package of services;” in other words, the suite of skills, programs, and activities that must be available in state and local health departments everywhere for the health system to work anywhere, and for which costs could be estimated. The result was a conceptual framework describing both the foundation and programs that no health department should be without.

In November 2021, The PHAB Center of Innovation and the Funders Forum on Accountable Health released a Foundational Public Health Services and Public Health Modernization Background Report that reviews the original FPHS concept, summarizes how some states have already used the FPHS framework to spur local modernization efforts, describes the potential federal funding support for a nationally driven modernization effort, and suggests areas where the FPHS framework may need to be adapted in light of the lessons learned during the pandemic.


Based on several years of work by 21C states and others in the field, the Center for Innovation has updated the framework and developed materials that can be used to communicate the importance of building a strong public health infrastructure to support implementation of the FPHS.

The FPHS Planning Guide: Using Foundational Public Health Services to Transform Public Health is an implementation guide that can be used to support the processes needed to build a strong public health infrastructure through FPHS implementation. DOWNLOAD GUIDE