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General Resources
In order for public health agencies and workers to prevent and protect against the spread of disease, injuries, and disaster, and to carry out the 10 Essential Public Health Services, an infrastructure--or network of people, agencies, services, knowledge, regulations, and equipment--needs to be in place. An overview of each of the three main areas of public health infrastructure can be found in the PDF documents below:
To find the latest information, resources, data, and reports for each area, click on the selected category on the navigation bar above.
The following resources relate to public health infrastructure more broadly.
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Top Resources
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A Strong Public Health Infrastructure Can Help Save Lives - This fact sheet, produced by the Public Health Foundation, highlights the benefits of public health and the need for strengthening its infrastructure.
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CDC Fact Sheet on Public Health Infrastructure - This is a one-page overview of the current status of public health infrastructure, including facts and figures to help make the case in your jurisdiction for the need to strengthen the system. It provides links to further information.
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Promoting and Protecting Healthy Communities: A City Officials Guide to Public Health - The National League of Cities, in collaboration with the National Association of County and City Health Officials, has released this publication to engage the interest of local elected officials in public health. In layperson's terms, the publication explains what the public health system is and what it does; it also includes suggestions for how city officials can help support the local public health department that serves their jurisdiction.
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Public Health Infrastructure - This January 2000 presentation by William Beery, MPH from Group Health/Kaiser Permanente Community Foundation; Laura Landrum, MS, Illinois Department of Public Health; and Joe Kimbrell, MA, BCSW, Louisiana Department of Health & Hospitals Office of Public Health, was profiled at the Partnerships for Health In the New Millennium conference. It defines the role of public health and gives an overview of why public health infrastructure is needed.
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Public Health Systems Research (PHSR) - This field focuses on studying the organization, staffing, financing, and management of systems that are the backbone of public health efforts. PHSR can provide critical information to help public health agencies and organizations develop policy, spend infrastructure dollars wisely, and better protect the public's health. The Council on Linkages Between Academia and Public Health Practice has put together a number of resources about PHSR, including tips for seeking funding for PHSR, a summary of research needs, and several research agendas. The Robert Wood Johnson Foundation-funded project "Public Health Finance: Advancing a field of study through public health systems research" has also developed some useful tools in this area, including this webcast of a meeting that provides an overview of PHSR.
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Public Health’s Infrastructure: A Status Report - This March 2001 CDC report was prepared for the Appropriations Committee of the United States Senate. It provides recommendations to bolster public health’s foundation, anticipate threats to health, and avert both unnecessary costs and needless morbidity and mortality. The recommendations are built on an ethic of accountability and a commitment to measuring not only health outcomes but also the performance and contributions of public health’s infrastructure.
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Public Health—Costs of Complacency - This article from the February 2004 issue of Governing Magazine outlines several weaknesses in public health infrastructure, including: the steady decline in budget and qualified personnel and shortsighted funding processes (with recent emphasis on health emergencies, leaving long-term prevention programs vulnerable). The article makes detailed recommendations for the improvement of funding allocation, communication among agencies, workforce development, and increased use of technology. It stresses the importance of striking a balance between acute and chronic public health and the need for legislators to consider the broader public health picture.
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Research Brief: Changes in Occupations of Local Health Department (LHD) Staff - This report examines changes in employment of staff within selected occupations from 1989 to 2005, based on the results of NACCHO's 2005 National Profile of Local Health Departments study. Overall, the study shows that the percentage of LHDs that employ epidemiologists, health educators, and public information specialists increased substantially between 1989 and 2005, while the percentage of LHDs that employ physicians decreased significantly. There was little change in the percentage of LHDs employing nurses, environmental health specialists and scientists, and clerical staff.
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StatePublicHealth.org - StatePublicHealth.org, a product of the Association of State and Territorial Health Officials, was designed to provide basic state-based public health information. The site provides a directory of State Health Officials, State Health Agencies (SHAs), and public hotlines. Among other facts, users can find out which SHAs are part of larger umbrella agencies, which states are served by a Board of Health, and which states require State Health Officials to have an MD.
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Strengthening the Public Health System for a Healthier Future - This Februrary 2003 document from Grantmakers in Health is a synopsis of discussions that took place in November 2002. At that time, a group of experts from the fields of philanthropy, research, government, and policy convened to examine the nation's public health infrastructure and explore opportunities for grantmakers to strengthen and sustain the public health system.
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Ten Great Public Health Achievements in the 20th Century - In 1999 the CDC’s Morbidity and Mortality Weekly Report (MMWR) published an article highlighting the 10 greatest public health achievements over the last century. This link highlights those 10 achievements.
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The Future of the Public’s Health in the 21st Century - This November 2002 Institute of Medicine (IOM) report outlines progress made within the public health community since the IOM’s widely known 1988 report, The Future of Public Health, which painted an infamous picture of public health in “disarray.” The 2002 report notes the new challenges facing public health—the recent spread of West Nile virus and the anthrax scare of 2001—as well as existing challenges, such as the need to overhaul and expand funding, coordinating governmental public health infrastructure, and updating outdated policies and laws. The book highlights the following:
- The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement.
- The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system.
- The roles nongovernment actors, such as academia, business, local communities, and the media can play in creating a healthy nation.
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Essential Public Health Services: What They Are and What They Do - This 2001 PowerPoint presentation, given by Dr. Barney Turnock from the University of Illinois at Chicago School of Public Health, provides an overview of the 10 Essential Public Health Services. It includes background information on the role of governmental public health and its core functions, explores the importance of the Essential Services, and shows how they relate to public health practice.
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Healthy People 2010 Chapter 23: Public Health Infrastructure - This chapter from the Healthy People 2010 book provides national objectives, data, and descriptions of activities needed to strengthen public health infrastructure. It highlights the importance of data and information systems and the importance of being able to track Healthy People 2010 objectives. It also includes information on workforce development; competencies for public health workers; training in 10 Essential Public Health Services; continuing education and training by public health agencies; performance standards for Essential Public Health Services; access to public health laboratory services and epidemiology services; and model statutes related to Essential Public Health Services.
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Local Public Health Agency Infrastructure: A Chartbook - This October 2001 chartbook, from the National Association of County and City Health Officials (NACCHO) contains data and statistics that provide a “snapshot” of local public health agencies (LPHAs). It includes data that may be used by practitioners for benchmarking or comparing an agency’s capacities to LPHAs nationwide. The chartbook can also be used to identify areas for change or improvement in their jurisdictions and to set planning priorities.
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NIH Centers for Population Health and Health Disparities - The National Institutes of Health has established eight Centers for Population Health and Health Disparities to support innovative, interdisciplinary research designed to improve understanding of and reduce differences in access to care, quality of care, and health outcomes. This collaborative effort of the National Institute of Environmental Health Sciences, the National Cancer Institute, the National Institute on Aging, and the Office of Behavioral and Social Sciences Research will examine how biology, social and behavioral factors, and the physical environment interact in determining the health of populations.
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Rebuilding the Public Health Infrastructure: Final Report and Recommendations of the Governmental Public Health Implementation Team, CDC Futures Initiative - As part of the CDC Futures Initiative, the Governmental Public Health Implementation Team was formed in order to develop strategies to support the sustainability and effectiveness of public health agencies, with a focus on infrastructure issues related to preparedness, workforce development, and accreditation of health agencies. This October 2004 report summarizes the work of that Team. Among the suggestions for CDC’s role in these areas are: increasing the collection, assessment, and dissemination of "best practices" in preparedness; working with partners to develop standards and incentives for local public health agencies; and supporting leadership, competencies efforts, and other workforce-development activities.
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The Basics: The Public Health Service - This document, prepared by the National Health Policy Forum, provides a quick overview of the U.S. Public Health Service, which houses the Office of the Surgeon General and Commission Corps, as well as CDC, the Health Services and Resources Administration, the National Institute of Health, and five other agencies. This information about the budgets and purpose of those eight agencies provides useful background on federal health agencies.
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Turning Point Toolkit - The Turning Point Initiative was a collaborative effort between state and local public health agencies, national public health organizations, and The Robert Wood Johnson Foundation that sought to transform public health. Through this project, National Excellence Collaboratives were developed to create models and tools in five key areas. This website contains links to those resources. Individuals working on strengthening their organization's infrastructure might be particularly interested in the following areas: collaborative leadership, performance management, information technology, and statute modernization.
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General Resources
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Operational Definition Prototype Metrics - This site showcases the prototype metrics for the Operational Definition. These proposed metrics will be used to convert the Operational Definition standards into practical measures that can be used by local health departments (LHD) to measure themselves against the standards set forth in the Operational Definition.
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National Poll on Americans’ Attitudes Toward Public Health - This November 2004 presentation features the results of a public opinion survey conducted by Research!America and the American Public Health Association. 74% of individuals surveyed said that they and their community have benefited from public health services. The poll describes which services the highest percent of Americans consider top public health benefits, including childhood vaccination programs, restaurant sanitation, and drinking water inspection. The survey also asked questions about high priority public policy areas, factors people perceive contribute to high quality health care, and environmental health. Additional poll data to help make the case for investment in public health services and infrastructure is available at http://www.researchamerica.org/polldata/index.html.
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Operational Definition of a Local Health Department (LHD) - The National Association of County and City Health Officials has developed this definition in an effort to help convey "what people in any community, regardless of size, can expect from their LHD." Public health agencies can use the definition to foster greater accountability for themselves and to help others understand their role.
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Remarks to the American Public Health Association - These are the prepared remarks of Claude Earl Fox, M.D., MPH, former Administrator, Health Resources and Services Administration (HRSA) which were presented at the Annual Meeting of the American Public Health Association; Session on Public Health Infrastructure; Boston, Massachusetts, November 14, 2000. Dr. Fox outlines HRSA’s role in developing infrastructure, progress since the 1988 Institute of Medicine report, workforce goals for the future, and improving data collection efforts.
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Searchable Archive of Public Opinion Questions on Health - Kaiser Health Poll Search, a feature on kaisernetwork.org, is a Searchable archive of more than 60,000 public opinion questions on health issues, covering 29 topics and 300 subtopics. This free service, a partnership between the Kaiser Family Foundation and The Roper Center for Public Opinion Research at the University of Connecticut, provides easy access to the latest public opinion questions and answers from more than 40 national polling organizations.
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State Health Facts Online - State Health Facts Online is a resource provided by the Henry J. Kaiser Family Foundation that allows users to compare how their state ranks on various health, health care, and health policy measures. This data can be useful in setting performance measures or in making the case for greater investment in building public health infrastructure in areas of need.
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Using the Operational Definition as a Practical Tool - These examples pulled together by the National Association of County and City Health Officials (NACCHO) illustrates how several health departments have used the Operational Definition as a planning tool in their work.
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Other Resources
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Innovations in Public Health: Understanding State Public Health - This 2007 publication focuses on ASTHO's efforts to define state public health through the roles, responsibilities, and values common among all state health agencies.
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Local Board of Health Operating Procedures (North Carolina) - Template to assist Local Boards of Health in developing operating procedures.
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