"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.

Contents

• COMMITTEE FOR THE STUDY OF THE FUTURE OF PUBLIC HEALTH
• Preface
• [Dedication]
• Acknowledgements
• Summary and Recommendations
  • Why Study Public Health
  • The Approach
  • The State of U.S. Public Health
  • The Future of Public Health: Recommendations
  • The Public Health Mission, Governmental Role, and Levels of Responsibility
  • Fulfilling the Government Role: Implementing Recommendations
  • Concluding Remarks
• 1. The Disarray of Public Health: A Threat to the Health of the Public
  • Immediate Crises
  • Enduring Public Health Problems
  • Growing Challenges and Impending Crises
  • References
• 2. A Vision of Public Health in America: An Attainable Ideal
  • A Definition of Public Health
  • The Basic Services of Public Health
  • References
• 3. A History of the Public Health System
  • History
  • Conclusion
  • References
• 4. An Assessment of the Current Public Health System: A Shattered Vision
  • Viewing the System
  • The Public Health System
  • Conclusion
  • References
• 5. Public Health as a Problem-Solving Activity: Barriers to Effective Action
  • The Lack of Consensus on Mission and Content of Public Health
  • Impediments to the Essential Work of Public Health
  • Leadership for Public Health
  • Structure and Organization of Public Health
  • Deficits in the Capacity to Conduct Programs
  • How the Public Health System Works—Aids as an Example
  • The State of Public Health
  • References
• 6. Conclusions and Recommendations
  • The Public Health Mission, Governmental Role, and Levels of Responsibility
  • Fulfilling the Government Role: Recommendations
  • Concluding Remarks
  • References
• Supplementary Statements
  • Harvey I. Sloane
  • Robert J. Rubin
• Appendixes
  • Appendix A Summary of the Public Health System in the United States
  • Appendix B Biographies of Committee Members
  • Appendix C Model Standards
  • Appendix D Site Visits: Site Selection and Methodology

This project was supported by the W. K. Kellogg Foundation and two agencies of the U.S. Public Health Service (the Centers for Disease Control and the Health Resources and Services Administration, Contract No. U50/CCU 300989-01).

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.