The public health system represents a wide variety of actors playing key roles in the ongoing script to improve the quality and quantity of life for the U.S. population. The specific parts that public health is being asked to play and the resources available to support its infrastructure for prevention and response to infectious diseases, chronic medical conditions, and disasters are discussed here in light of new national survey data from state and local jurisdictions. Although the public health system has both traditional and newly defined roles to play, resources, as measured by per capita spending and workforce availability, have not kept pace. [Health Affairs 25, no. 4 (2006): 911-922; 10.1377/hlthaff.25.4 .911]A s s h a k e s p e a r e s o fa m o us ly s tat e d, "All the world's a stage." Indeed, public health has long been accustomed to performing its essential functions before an audience. In a post-bioterrorism world, however, public health now finds itself at center stage, a position it has not occupied since the discovery of the polio vaccine. Ironically, even though recognition has been delayed, the twentieth century may justifiably be termed the "Golden Age of Public Health." This designation is largely based upon the gain of more than 60 percent in life expectancy during the past hundred years, mostly attributable to gains in public health knowledge and its successful application.1 Yet, remarkably, these lifeextending benefits have accrued to the American public despite the relatively limited funding for governmental public health and its oft-neglected infrastructure.
2In fact, financial support for public health stands in stark contrast to its more glamorous sibling, the private health care delivery system, which has contributed more modestly to overall life extension during this time frame. precisely how limited their resources are. 4 In this paper we present salient findings of two recent, unique surveys conducted by the Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO). We use this information to briefly describe the structures and functions of U.S. public health departments and to examine their financial support and infrastructure. Lastly, based on the data we provide and on our collective experiences, we make specific policy recommendations.
A recently released report of the Exploring Accreditation Project affirmatively answered the questions regarding the desirability and feasibility of establishing a national voluntary public health accreditation program. The report's recommendations were made after 10 months of inquiry from public health experts, elected officials, the general public health workforce, academicians, and other interested parties, more than 650 public health professionals in all. Recommendations regarding how such a program might be implemented insofar as its governance, principles for standards development, financing and incentives, and evaluation were included. The report provides a blueprint for establishing a national voluntary public health accreditation program. This article describes key aspects of the Steering Committee recommendations, with limited linkage to implementation strategies where relevant, in the four areas in which the project was designed. Details are provided in the final reports of the Steering Committee (www.exploringaccreditation.org) and in other articles in this issue.
Information is the fourth core element of public health legal preparedness and of legal preparedness for public health emergencies specifically. Clearly, the creation, transmittal, and application of information are vital to all public health endeavors. The critical significance of information grows exponentially as the complexity and scale of public threats increase.Only a small body of organized information on public health law existed before the 21st century: a series of landmark books published beginning in 1926 by Tobey, Grad (1965), and Wing (1974); model public health laws published as early as 1907; systematic reviews of original research studies published in the 1990s; and a small but growing number of articles published in public health journals and law reviews.With the new century came new public health law programs and activities at the Centers for Disease Control and Prevention (CDC), in public health professional associations, and in numerous non-profit and academic organizations.
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