title: The public health infrastructure and our nation's health.
abstract: 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.
authors.affiliation: The North Carolina Institute for Public Health, Chapel Hill, 27599-8165, USA. elbaker@email.unc.edu
authors.forename: Edward L
authors.initials: EL
authors.lastname: Baker
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Potter
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Jones
authors.forename: Shawna L
authors.initials: SL
authors.lastname: Mercer
authors.forename: Joan P
authors.initials: JP
authors.lastname: Cioffi
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Green
authors.forename: Paul K
authors.initials: PK
authors.lastname: Halverson
authors.forename: Maureen Y
authors.initials: MY
authors.lastname: Lichtveld
authors.forename: David W
authors.initials: DW
authors.lastname: Fleming
mesh_terms: 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