Supporting the Public Health Infrastructure
When one talks about the infrastructure for public health, we need to think about three different issues that we face as an association and as a nation. As Dr. Keck mentioned, we talk about a public health system that is very diverse and includes 3,000 local health departments – some of which consist of one person, and others of which are large-scale, well-organized departments. We need to think about the nature of that system and the way it must be reorganized if it is do the kinds of tasks that the Association has set forth in the priorities of its strategic plan. I am convinced that we need larger bases for local public health departments to function, so that they can bring together the kinds of resources and personnel to deal with the kinds of health problems that we confront in our society today.
That poses a dilemma for us. At the same time, we need to create in those organizations a capacity to be more responsive to the pecularities and the particularities of the needs of their communities. With large-scale organizations, this is sometimes not as easy to do, but it is something that we have to do if we are going to achieve our purposes.
Finally, following up on what Dr. Terris said about APHA being proactive, if we are to really reconstruct and try to create a different and more responsive and more effective infrastructure for public health, we need to think about standards, and, specifically, to what kinds of performance standards we want those agencies and those parts of the public health system to adhere. This may raise questions about accreditation or certification for public health agencies, with which the American Public Health Association has been concerned in its past. Here public health, particularly APHA, might be able to take a leadership role in partnership with ASTHO, NACCHO, and many of the other organizations.