Opportunities and Challenges

Currently many efforts are under way at the national, State, and local levels to address four public health infrastructure areas: education and training of public health professionals, development and coordination of data and information systems, strengthening of State and local public health organizations, and increase of prevention research. These efforts reflect the many opportunities and challenges associated with the public health infrastructure.

The education and training of the public health workforce is central to the Nation's health. Public health professionals need to be proficient in a variety of core skills and competencies such as analysis, assessment, policy development, and program planning.³ This need has been emphasized by the Institute of Medicine's (IOM's) report Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century.^{4, 5} The maintenance and expansion of an adequately trained public health workforce requires relevant education and training.^{1, 2, 3}

These competencies, which are necessary to build and maintain a strong public health system, provide the most explicit statements available to date about the skills, knowledge, and functions a public health professional needs to deliver high-quality public health services.^{1, 2, 3} The competencies, training, and access to continuing education for the public health workforce are viewed as essential because of the effects that each could have on the achievement of Healthy People 2010 goals and other objectives.^{1, 2, 3}

Several opportunities exist for building a strong public health workforce; for example, competencies can be required by job descriptions or built into performance appraisal systems, new graduates can be trained to enter the workforce with competencies in core areas, and agencies can build in ongoing training and allocate time and resources for competency-based continuing education for all employees.^{1, 2, 3} Current efforts to address the education and training of public health professionals include the following:

• National Laboratory Training Network (NLTN).
• Educational Incentive for Curriculum Development and Training Program.

Sponsored by the Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories, NLTN provides clinical, environmental, and public health laboratory training for laboratory professionals throughout the United States.⁶

The Educational Incentive for Curriculum Development and Training Program (Bioterrorism Training and Curriculum Development Program) is supported by the Health Resources and Services Administration (HRSA). The program's goal is to develop a health care workforce with the knowledge, skills, abilities, and core competencies to recognize indicators of a terrorist event; meet the acute care needs of patients, including pediatric and other vulnerable populations; participate in a coordinated, multidisciplinary response to terrorist events and other public health emergencies and include consideration of surge capacity issues; and effectively alert the public health system of such an event at the national, State, and community levels.⁷

HRSA also supports Public Health Training Centers that provide basic and advanced training for the public health workforce.⁸

The National Guideline Clearinghouse (NGC) is another example of a program geared toward the training of health care professionals. The HHS Agency for Healthcare Research and Quality maintains NGC, created in partnership with the American Medical Association and America's Health Insurance Plans (formerly American Association of Health Plans). NGC is a public resource for evidence-based clinical practice guidelines.⁹

Data and Information Systems

Information technology (IT) is a core component of the public health infrastructure. IT can play a major role in responding to public health emergencies. Current efforts to develop and coordinate public health data and information systems include the following:

• Office of the National Coordinator for Health Information Technology (ONC).
• Public Health Information Network (PHIN).
• National Environmental Public Health Tracking Network.

An effort to assist in the development of health IT systems, ONC coordinates the HHS health IT programs. ONC provides leadership for the development and nationwide implementation of an interoperable health IT infrastructure, including the seamless exchange of information between different operating systems. Such an infrastructure is designed to improve the quality and efficiency of health care and the ability of consumers to manage their care and safety.¹⁰

PHIN is a national initiative run by CDC to improve electronic communication within the public health community. It defines and documents the systems needed to support public health professionals, identifies industry standards needed to make those systems work together, and develops the specifications needed to make the standards do the work of public health. PHIN includes a portfolio of software and solutions to maintain interconnected systems throughout public health. Among the solutions are those supporting surveillance, outbreak management, laboratory response, emergency response, and administration.¹¹

The National Association of County and City Health Officials (NACCHO) and CDC collaborate on the National Environmental Public Health Tracking Network. The goal of the network is to collect, integrate, analyze, and interpret data or information from monitoring environmental hazards, human exposure to environmental hazards, and human health effects potentially related to exposure to environmental hazards to better protect communities from adverse health effects.¹²

Public Health Organizations

In its congressional report, Public Health's Infrastructure: A Status Report,¹³ IOM found that

• Only one-third of the U.S. population is effectively served by public health agencies.
• In a test of e-mail capacity, only 35 percent of messages to local health departments were delivered successfully.
• Only 45 percent of local health departments have broadcast fax capability.

State and local health agencies, which are first responders to community health threats, have been stretched in responding to fears about severe acute respiratory syndrome (SARS), avian influenza, natural disasters, bioterrorism, and many other potential threats to the public's health. The infrastructure of the Nation's public health system has been weakened over time because of emerging health threats as well as the responsibility to aid in disease prevention, response to disasters, protection against environmental hazards, and encouragement of healthy behaviors.

Some opportunities exist to aid in the strengthening of the Nation's public health system. NACCHO, in collaboration with CDC, has produced MAPP—Mobilizing for Action through Planning and Partnerships.¹⁴ MAPP is a communitywide strategic planning and implementation tool for improving community health.

CDC also maintains the National Public Health Performance Standards Program, which is a national, State, and local instrument for assessing the public health system capacity to perform essential services.¹⁵ State and local health departments can use tools from this site to determine their infrastructure needs and develop public health improvement plans.

An example of programs that provide assistance to States in strengthening public health infrastructure is the Title V Maternal and Child Block Grants managed by HRSA. Another example is Title V of the Social Security Act, one of the largest Federal block grant programs. It leads the Nation in ensuring the health of all mothers, infants, adolescents, and children, especially those with special health care needs. Infrastructure building services provided under the grant include, but are not limited to, needs assessments, evaluation, planning, policy development, standards development, and training.¹⁶

Project Public Health Ready, a collaboration between NACCHO and CDC, prepares local government public health agencies to respond to emergencies and to protect the public's health through a competency-based training and recognition program.¹⁷

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