Strengthening the public health system
C. WILLIAM KECK AND MARGUERITE A. ERME
The mission of public health is assuring the conditions in which people can be healthy. Terrorism is anathema to public health. This chapter reviews the evolution of the public health system in the United States, describes the strengths and deficiencies in the system that were revealed by the terrorist attacks in 2001, and provides recommendations for strengthening the public health system so that it can be more effective—in responding not only to the health consequences of terrorism but also to other major challenges as well.
The public health “system” in the United States is intended to protect the country's population from disease and injury. By some measures, it has been remarkably successful in doing so. It has been estimated that approximately 25 years of the 30-year gain in life expectancy during the 20th century was due to public health interventions, compared to 3.7 years for medical treatment and 1.5 years for clinical preventive services.1Yet, at the end of the 20th century, many people doubted that the public health system had the resources to meet ongoing public health needs, let alone respond to purposeful acts intended to injure or to spread disease.