Developing a Financing System to Support Public Health Infrastructure.

All people in the United States deserve the same level of public health protection, making it crucial that every health department across the country has a core set of foundational capabilities. Current research indicates an annual cost of $32 per person to support the foundational public health capabilities needed to promote and protect health for everyone across the nation. Yet national investment in public health capabilities is currently about $19 per person, leaving a $13-per-person gap in annual spending.To "create the conditions in which people can be as healthy as possible" and to protect national security, this gap must be filled. The Public Health Leadership Forum convened national experts in the public health, public policy, and other partner sectors to develop options for long-term, sustainable financing. The group aligned around core principles and criteria necessary to establish a sustainable financing structure.Informed by the work of the expert panel, the authors recommend a Public Health Infrastructure Fund for state, territorial, local, and tribal governmental public health, that would provide $4.5 billion of new, permanent resources needed to fully support core public health foundational capabilities.

Practitioner perspectives on foundational capabilities.

CONTEXT: National efforts are underway to classify a minimum set of public health services that all jurisdictions throughout the United States should provide regardless of location. Such a set of basic programs would be supported by crosscutting services, known as the "foundational capabilities" (FCs). These FCs are assessment services, preparedness and disaster response, policy development, communications, community partnership, and organizational support activities. OBJECTIVE: To ascertain familiarity with the term and concept of FCs and gather related perspectives from state and local public health practitioners. DESIGN: In fall 2013, we interviewed 50 leaders from state and local health departments. We asked about familiarity with the term "foundational capabilities," as well as the broader concept of FCs. We attempted to triangulate the utility of the FC concept by asking respondents about priority programs and services, about perceived unique contributions made by public health, and about prevalence and funding for the FCs. SETTING: Telephone-based interviews. PARTICIPANTS: Fifty leaders of state and local health departments. MAIN OUTCOME MEASURES: Practitioner familiarity with and perspectives on the FCs, information about current funding streams for public health, and the likelihood of creating nationwide FCs that would be recognized and accepted by all jurisdictions. RESULTS: Slightly more than half of the leaders interviewed said that they were familiar with the concept of FCs. In most cases, health departments had all of the capabilities to some degree, although operationalization varied. Few indicated that current funding levels were sufficient to support implementing a minimum level of FCs nationally. CONCLUSIONS: Respondents were not able to articulate the current or optimal levels of services for the various capabilities, nor the costs associated with them. Further research is needed to understand the role of FCs as part of the foundational public health services.

From patchwork to package: implementing foundational capabilities for state and local health departments.

Daily public health responses are threatened by the inadequate capacity of public health agencies. A 2012 Institute of Medicine report defined a package of foundational capabilities that support all programs and services within a health department. Standardizing foundational capabilities may help address the increasing disparity in health department performance nationally. During the Fall of 2013, we collected information on how much state and local health departments knew about foundational capabilities. To our knowledge, this was the first study to assess current health department infrastructure as it relates to foundational capabilities.

Workgroup report: public health strategies for reducing aflatoxin exposure in developing countries.

Consecutive outbreaks of acute aflatoxicosis in Kenya in 2004 and 2005 caused > 150 deaths. In response, the Centers for Disease Control and Prevention and the World Health Organization convened a workgroup of international experts and health officials in Geneva, Switzerland, in July 2005. After discussions concerning what is known about aflatoxins, the workgroup identified gaps in current knowledge about acute and chronic human health effects of aflatoxins, surveillance and food monitoring, analytic methods, and the efficacy of intervention strategies. The workgroup also identified public health strategies that could be integrated with current agricultural approaches to resolve gaps in current knowledge and ultimately reduce morbidity and mortality associated with the consumption of aflatoxin-contaminated food in the developing world. Four issues that warrant immediate attention were identified: a) quantify the human health impacts and the burden of disease due to aflatoxin exposure; b) compile an inventory, evaluate the efficacy, and disseminate results of ongoing intervention strategies; c) develop and augment the disease surveillance, food monitoring, laboratory, and public health response capacity of affected regions; and d) develop a response protocol that can be used in the event of an outbreak of acute aflatoxicosis. This report expands on the workgroup's discussions concerning aflatoxin in developing countries and summarizes the findings.