The public health infrastructure and our nation's health.
Threats to Americans' health-including chronic disease, emerging infectious disease, and bioterrorism-are present and growing, and the public health system is responsible for addressing these challenges. Public health systems in the United States are built on an infrastructure of workforce, information systems, and organizational capacity; in each of these areas, however, serious deficits have been well documented. Here we draw on two 2003 Institute of Medicine reports and present evidence for current threats and the weakness of our public health infrastructure. We describe major initiatives to systematically assess, invest in, rebuild, and evaluate workforce competency, information systems, and organizational capacity through public policy making, practical initiatives, and practice-oriented research. These initiatives are based on applied science and a shared federal-state approach to public accountability. We conclude that a newly strengthened public health infrastructure must be sustained in the future through a balancing of the values inherent in the federal system.
Baker
Edward L
EL
The North Carolina Institute for Public Health, Chapel Hill, 27599-8165, USA. elbaker@email.unc.edu
Potter
Margaret A
MA
Jones
Deborah L
DL
Mercer
Shawna L
SL
Cioffi
Joan P
JP
Green
Lawrence W
LW
Halverson
Paul K
PK
Lichtveld
Maureen Y
MY
Fleming
David W
DW
D000068:Accreditation / Q000458:organization & administration; D002908:Chronic Disease / Q000453:epidemiology; D002983:Clinical Competence; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000453:epidemiology; D004189:Disaster Planning; D005380:Financing, Government / Q000458:organization & administration; D018166:Health Care Reform / Q000458:organization & administration; D006291:Health Policy; D006292:Health Priorities / Q000458:organization & administration; D006304:Health Status; D006801:Humans; D017146:Models, Organizational; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D020380:Needs Assessment / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011634:Public Health / Q000193:education / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D011635:Public Health Administration / Q000193:education / Q000379:methods / Q000592:standards; D040442:Public Health Informatics; D023481:Terrorism / Q000517:prevention & control / Q000706:statistics & numerical data; D017749:Total Quality Management / Q000458:organization & administration; D014481:United States / Q000453:epidemiology; D014492:United States Public Health Service / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control