The Public Health Infrastructure and Our Nation's Health

Abstract

public health preparedness ■ 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.

Evidence-Based Public Health: A Fundamental Concept for Public Health Practice

“…These concerns were noted two decades ago when the Institute of Medicine determined that decision making in public health is often driven by "crises, hot issues, and concerns of organized interest groups" (p. 4) (82). Barriers to implementing EBPH include the political environment and deficits in relevant and timely research, information systems, resources, leadership, and the required competencies (4,7,23,78).…”

Recent Advances in Public Health Systems Research in the United States

“…These governmental organizations form the backbone of the public health system and interact with a wide array of other community partners to ensure the public's health. To accomplish these tasks, the public health system and its infrastructure rely on having adequate resources such as a competent workforce, financing, data and technology, efficient organization and structure, and governance (standards, policy, and law), each of which are interdependent and interacting, encompassing all levels of government, as well as both the public and private sectors (10,11,31,83).…”

“…Improving performance and accountability for investments in state and local public health functional capacity, community health interventions, and health outcomes requires a unifying conceptual framework to facilitate accurate performance measurement (11,31). A recent article by Scutchfield et al (82) supports the logic that the public health system is the framework in which true accountability for funding and policy development in population health must be measured and demonstrated.…”

Economic stress and misaligned incentives in critical care medicine in the United States

“…Disease transmission to healthcare workers can further degrade surge capacity and add to cost. Increased spending on bioterrorism research and public health initiatives related to this threat has been hotly debated (53)(54)(55)(56)(57)(58). Critics of increased spending suggest that funding such research programs diverts funds from other needy programs and may actually increase the threat of a terrorist attack by increasing the number of experts in handling agents with potential to be weaponized and thus access to these materials (59,60).…”