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Public Health Infrastructure

Last updated March 16, 2020

Approved by: Lester Fahrner, MD

The Health Challenge:

Public Health Infrastructure

The Health Challenge:

The public health infrastructure is responsible for protecting people's health and safety, providing credible information for better health decisions, and promoting good health through a network of partnerships. It is made up of the work force, information and data systems, and the state and local public health organizations across the country.

In the last 100 years, public health as increased life expectancy by 30 years through vaccinations, control of infectious disease, fluoridated drinking water and many other activities. Today, this infrastructure lacks the capacity to respond quickly to public health threats. Whether it is the spread of the West Nile virus into new areas of the United States, an outbreak of E.coli 0157:H7, or a bioterrorism attack involving anthrax at an airport, the public health system has struggled to keep pace with increasing demands. At the same time, budget cuts, lack of training and outmoded information systems and laboratories have created greater challenges in protecting the public's health against threats and emergencies.

Recent Findings:

In March 2001, the Centers for Disease Control and Prevention delivered to the Senate Public Health’s Infrastructure: A Status Report, which included the following findings:

Only one-third of the U.S. population is effectively served by public health agencies.

Approximately 78 percent of people directing public health agencies do not have graduate training.

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.

At least one local health department admitted that it did not comply with reportable disease notification because it required a long distance phone call.

In a study of the nation's largest public health departments, the average score in performing 20 of the most basic public health functions was only 64 percent.

Pilot studies conducted in 2000 by the National Public Health Performance Standards Programs resulted in no scores higher than 62 percent (at either state or local health departments).

CDC Response:

The Public Health Threats and Emergencies Act of 2000, passed by Congress in November 2000, authorizes CDC and its national partners to design performance standards for state and local health departments, identify gaps in actual performance and provide federal assistance to help build core capacity. Under a new grant program, CDC will provide grants to states to develop their own assessment plan and public health infrastructure.

CDC and its national partners are focusing on three major areas of activity:

Work force capacity and competency - Each community will be served by a fully trained, culturally competent public health team, representing the optimal mix of professional disciplines.

Information and data systems - Each health department will be able to electronically access and distribute up-to-date public health information and emergency health alerts, monitor the health of communities and assist in the detection of emerging public health problems.

Broad-based organizational capacity - Each health department and laboratory will meet basic performance and accountability standards regarding their population base, census, geography and risk factors, with specific needs identified through state public health improvement plans.


The public health infrastructure sections of the Public Health Threats and Emergencies Act authorize $99 million for development of capacities, assessment, planning and core-capacity grants. The President's budget for fiscal year 2002 includes $1 million to begin implementation of these sections. Public health organizations, such as the National Association of County and City Health Officials, are advocating for $100 million for public health infrastructure in CDC's Public Health Improvement budget line. CDC is meeting with partners and state and local public health officials to determine what would be the best use of appropriated funds.

Specific Initiatives:

Work force Capacity

The Public Health Training Network is a distance-based learning approach that regularly provides training to nearly one million frontline public health workers each year in the United States and around the world. The network gives these workers continuing education and training in core skills such as principles of public health, public health surveillance, informatics, management, immunization, public health in the political arena, tobacco cessation, HIV/AIDS and environmental health. The Network has classes scheduled through December 2002.

CDC is committed to providing formal training to all public health workers who oversee public health agencies. CDC also is ensuring that all public health practitioners are culturally competent and know the language of those whom they serve. One step is the launch of a Spanish-language version of CDC's website.

Information and Data Systems

The Health Alert Network is a nationwide information and communication system that serves as a platform for the distribution of health alerts and prevention guidelines, distance learning, national disease surveillance and electronic laboratory reporting, and other initiatives to strengthen state and local preparedness.

CDC has provided $19 million in grant funds to state and local health departments. By the end of 2001, every state will be funded on the Health Alert Network. CDC has helped enhance state and local health agencies in detecting, reporting and responding to infectious disease outbreaks across the country.

CDC is committed to developing a local response system for early warnings in case of a public health emergency that will:

give local public health officials specialized training in crisis preparedness and methods for controlling information and misinformation amid public concern and possible panic, and

establish a well-identified, on-call, single point of contact at the local levels, and the capability to inform all doctors in the affected area within one hour, using blast fax technology or other means of effective


Organizational Capacity

The National Public Health Performance Standards Program has field-tested and revised its national, state and local instruments for assessing the public health system capacity to perform essential services. CDC plans to build on the work of the Performance Standards Program in developing the capacities called for under the Public Health Threats and Emergencies Act. From these capacities, state and local health departments will be able to determine their infrastructure needs and develop public health improvement plans.

Looking Forward:

The Public Health Threats and Emergencies Act of 2000 is a major step toward strengthening the public health infrastructure. CDC is playing a leadership role in implementing the Act and to ensure that every health department is prepared to address current and evolving threats to the health of the citizens it serves.

CDC Web Sites:

CDC Public Health Practice Program Office


CDC Status Report on Public Health Infrastructure, March 2001


CDC Public Health Training Network


CDC Public Health Alert Network


Other Web Resources:

National Association of County and City Health (NACCHO)


Association of State and Territorial Health Officials (ASTHO)


For more information, contact:

Office of Communication

Centers for Disease Control and Prevention

1600 Clifton Road, N.E.

Atlanta, Georgia 30333

Tel: 404-639-3286

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CDC protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

References and Information Sources used for the Article:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: March 16, 2020
Last updated: March 16, 2020