Strengthening the public health system for a healthier future.

On November 6, 2002, Grantmakers In Health (GIH) convened a group of experts from the fields of philanthropy, research, government, and policy to examine the nation's public health infrastructure and explore opportunities for grantmakers to strengthen and sustain this fragile and troubled system. During the course of this meeting, representatives from the Institute of Medicine, which recently released a report on this topic, and the Centers for Disease Control and Prevention (CDC) discussed the role of the national public health system and reviewed weaknesses in its infrastructure. Elaborating on these points, local public health leaders offered an on-the-ground perspective of the challenges they face as they struggle to maintain and improve the health of the public at the same time as they prepare for the possibility of bioterrorism. Finally, several foundations with experience in this area shared their strategies for helping to buttress the infrastructure so vital to the health of the nation. This Issue Brief builds on a paper prepared in advance of the meeting by incorporating the highlights from presentations and discussions that took place at GIH's Issue Dialogue. It also incorporates comments and discussion from GIH's 2002 Fall Forum intensive breakout session Worst Case Public Health Scenario: Can Philanthropy Respond? Following a brief introduction to the public health system and its evolution over the past several decades, the Issue Brief discusses essential elements of the public health infrastructure, reviews the issues confronting each of these elements, and profiles various philanthropic initiatives aimed at repairing and improving the public health infrastructure. It concludes with an in-depth look at the infrastructure issues involved in emergency preparedness.