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Public health infrastructure provides communities, states, and the Nation the capacity to prevent disease, promote health, and prepare for and respond to both acute (emergency) threats and chronic (ongoing) challenges to health. Infrastructure is the foundation for planning, delivering, evaluating, and improving public health. Why Is Public Health Infrastructure Important?

All public health services depend on the presence of basic infrastructure. Every public health program—such as immunizations, infectious disease monitoring, cancer and asthma prevention, drinking water quality, injury prevention—requires health professionals who are competent in cross-cutting and technical skills, up-to-date information systems, and public health organizations with the capacity to assess and respond to community health needs. Public health infrastructure has been referred to as “the nerve center of the public health system." 1

While a strong infrastructure depends on many organizations, public health agencies (health departments) are considered primary players. Federal agencies rely on the presence of solid public health infrastructure at all levels 2 to support the implementation of public health programs and policies and to respond to health threats, including those from other countries.

In 2011, a voluntary national program for accreditation of public health departments was launched. 4 The program provides standards for the Nation’s health departments and increases accountability and visibility around the role of public health. Accreditation is also stimulating new attention to workforce development, the use of quality improvement, community health assessment and health improvement planning, health equity, surveillance, informatics, data-driven decision-making, and other topics represented through the national standards. Tribal Public Health Infrastructure

Challenges persist in describing and supporting Tribal public health infrastructure, which can vary considerably by Tribe and by region. This is further complicated by the complex nature of public health and health care services in tribal and urban settings, where, as sovereign nations, Tribes are responsible for the overall health and well-being of their members. New strategies and opportunities are being explored and require ongoing attention and support. Innovations in the Delivery of Public Health Services

Changes in the health system and other factors are prompting new roles for public health agencies, a growing focus on the integration of public health and primary care, a deeper examination of financing options for foundational or core services, and new strategies to deliver services more efficiently and effectively. One such example is cross-jurisdictional sharing, 5 which can range from supporting informal collaborations to sharing defined services such as laboratory testing, 6to more formal changes in structure, such as consolidating public health agencies.

Public health data must be accurate, relevant, and timely to inform public health action. National surveys, such as those sent to epidemiologists, laboratories, and health departments, play an important role in understanding the public health infrastructure. National surveillance and reporting systems also play a vital role. Efforts are underway to improve the content of surveys, data collection for major population groups, and timely access to data through public reports and data files. These national surveys and monitoring systems should be sustained, strengthened, and harmonized.

Continuing to strengthen the evidence base for effective community interventions and for the effective organization, administration, and financing of public health services is critical to the future development of public health infrastructure. Public health services and systems research plays an important role in the development of this evidence base; support should be expanded over the decade, with a strong focus on translating research into practice. References

6Ridderhof JC, Moulton AD, Ned RM, et al. The Laboratory Efficiencies Initiative: Partnership for Building a Sustainable National Public Health Laboratory System. Public Health Reports. 2013;128(Suppl 2):20-33. Available from: