An Overview of the U.S. Public Health System in the Context of Emergency Preparedness

Publication Date: March 2005

Publisher: Library of Congress. Congressional Research Service

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Research Area: Health; Social conditions

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Abstract:

This report describes the U.S. public health infrastructure: the structure, organization, and legal basis of domestic public health activities. In contrast with healthcare, public health practice is aimed at decreasing the burden of illness and injury in populations, rather than individuals. Public health agencies use epidemiologic investigation, laboratory testing, information technology, public and provider education, and other tools to support their mission, activities that in turn rely on an adequate and well-trained public health workforce. Federal leadership for public health is based in the Department of Health and Human Services (HHS) and in particular at the Centers for Disease Control and Prevention (CDC). Most public health authority, such as mandatory disease reporting, licensing of healthcare providers and facilities, and quarantine authority, is actually based with states as an exercise of their police powers. Local and municipal health agencies vary in size, governance, and authority, but they are the front line in responding to public health threats.

In 2001, terrorist attacks on the nation brought the weaknesses of our public health system into sharp focus. Prior to the 2001 terrorist attacks, Congress passed the Public Health Threats and Emergencies Act (P.L. 106-505), to address the decaying public health infrastructure and to prepare for bioterrorism and other public health emergencies. After the 2001 attacks, Congress passed the Public Health Security and Bioterrorism Preparedness and Response Act (P.L. 107-188), expanding grants to state health departments and adding a new national hospital preparedness program, as well as adding new food safety and security authorities, protections for water infrastructure, and other provisions. Congress also passed the Homeland Security Act (P.L. 107-296), creating the new Department of Homeland Security (DHS) to serve as a coordination point for homeland security activities and to house certain public health preparedness programs.

This report describes the nation's public health infrastructure and authorities at the federal, state, and local levels. It provides a history of relevant legislation and appropriations, both prior to and after the 2001 terrorist attacks. In addition, it describes selected public health preparedness programs at HHS and DHS.

This report also discusses a number of issues in ensuring public health preparedness. Specific challenges include: ensuring the coordinated planning for and response to emergencies by a variety of public health and other governmental actors, given that public health authority rests principally with states rather than the federal government; setting goals and standards for preparedness at the federal, state, and local levels; ensuring programmatic and fiscal accountability, and steady progress toward goals; and training and sustaining a skilled workforce for public health at all levels of government. The overarching challenge for policymakers is in making sound trade-offs with finite resources; ensuring all-hazards preparedness for a variety of emergencies, while balancing resources appropriately between emergency preparedness and the prevention of injuries and chronic diseases that kill millions annually. This report will be updated periodically.