Biology Reference
In-Depth Information
menace society. To successfully link the activities and outputs of detection
systems to effective responses, one must understand the origins and opera-
tions of the current public health system.
In the United States, legal responsibility for public health largely developed
as a local phenomenon, with temporary entities initially created to address
acute threats from epidemics of infectious diseases. In the 1850s, for exam-
ple, in New Orleans, officials appointed a Sanitary Commission to investi-
gate the yellow fever outbreak of 1853 in this thriving seaport enriched by
international commerce; the commission dissolved after the epidemic threat
had passed (Freedman 1951). Attempts to create a federal presence in public
health, the National Board of Health, were short-lived, lasting only 4 years,
after which Congress refused its reauthorization (Smillie 1943). In ensuing
decades, as additional local and state health departments became established
on a more permanent basis, the collection and reporting of information on
persons with infectious diseases became more standardized and systematic
(Koo and Wetterhall 1996). During the first half of the 20th century, the duties
of state and local health departments continued to grow, with outreach into
broader fields, such as those of maternal and child health and environmental
health (e.g., milk pasteurization) (Parran 1945). Concomitantly, the role of the
federal public health authorities continued to expand, both as a recipient of
surveillance information as well as through growth in other activities of the
Public Health Service, which provided consultative and technical assistance
to many state and local health authorities.
During the latter half of the 20th century, with the creation of the
Centers for Disease Control and Prevention (CDC), the federal role in pub-
lic health continued to grow, both in providing direct financial support
to state and local health departments, as well as in providing scientific
leadership in designing and implementing public health surveillance sys-
tems (Etheridge 1992). In the aftermath of the anthrax outbreak of 2001,
which some considered a period of infamy for medical and public health
response (Gersky 2003), there followed an unparalleled surge in resources
to bolster public health preparedness and response. With a flurry of activ-
ity, the federal government provided unprecedented amounts of money
($918 million and $125 million in fiscal year 2002 in cooperative agree-
ments with CDC and HRSA, respectively) to hire staff and create systems,
at all levels of public health—local, state, and federal—for early detection
and response to emerging health threats (U.S. Government Accountability
Office [GAO] 2004).
This flurry of new activity has been undertaken within a diverse public
health system, one whose complexity reflects its incremental development,
varied local origins, and differing legal authorities, sources of fiscal support,
and diverse stakeholders. Currently, there are approximately more than
2,500 local health departments in the United States. These vary consider-
ably by staffing and size. Some, such as those in large metropolitan areas
like New York City, boast large staffs of professionals, many of whom have
