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Health Affairs, 25, no. 4 (2006):
899
doi: 10.1377/hlthaff.25.4.899 © 2006 by Project HOPE |
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Infrastructure |
PROLOGUE
Public Health Infrastructure And Capacity
As noted by the Institute of Medicine (IOM) in 2002, "By every measure, we are healthier, live longer, and enjoy lives that are less likely to be marked by injuries, ill health, or premature death." The U.S. public health enterprise must be seen as one of the great unsung heroes of this story. For decades it has labored dutifully in relative obscurity to implement interventions that reduced rates of illness and death. That it has done so in an environment where as much as 95 percent of health care–related spending has been allocated to medical care and biomedical research, not to public health, is clear testament to the heroism involved.
Ironically, the public health system has fallen victim to its own success. Quiet efficiency in the fulfillment of its tasks gradually eroded public understanding of the usefulness of its functions. Not surprisingly, this diminished public awareness translated into diminished attention from lawmakers, culminating in the IOM’s landmark 1988 declaration that the U.S. public health system was in "disarray." In recent years, however, certain high-visibility events, including 9/11, anthrax, SARS, flu vaccine shortages, and fears of avian flu, conspired to vault public health to center stage. Health Affairs’ 2002 special issue on public health was published at this critical juncture, when immediate infusions of federal funding appropriated to improve infrastructure would represent either the opening salvo for sustained commitment to public health or a flash in the pan.
Subsequent years have revealed both progress and problems. Notable improvements have been achieved in infrastructure, while public health departments have complained that increased federal expectations ultimately amounted to little more than unfunded mandates. Part of this ongoing neglect is attributable to the tendency of the policy and public health communities to talk past each other regarding mutual expectations. The papers that follow seek to bridge this communication gap by reporting on improvements to public health infrastructure and capacity during the past four years, as well as ongoing problems and future challenges. First, Hugh Tilson and Bobbie Berkowitz identify the major policy challenges confronting the public health enterprise as it attempts to grapple with emerging threats to population health while continuing to fulfill its core missions. Next, Leslie Beitsch and colleagues report findings from two key national surveys illustrating the misalignment between assigned state and local public health department functions and the resources allocated to implement them. Finally, Kristine Gebbie and Bernard Turnock present encouraging evidence of a more robust public health workforce since 2001, while offering policy guidance for navigating emerging obstacles.
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