The FY 1996 Data Investment includes funding for a strategy to obtain comprehensive baseline and trend data on the public health infrastructure at national, state, and local levels. The strategy will build, to the extent possible, on data created by public health agencies in the normal course of business. It will be developed and implemented through a Federal/State/local partnership to assure that periodic information can be obtained which is useful at all governmental levels and to the general public health community . A steering group, including representatives of federal, State, and local health agencies, community public health providers, and the research community will advise and guide the overall progress and direction of the study.
The term "public health infrastructure" is used here to mean the federal, State, and local government agencies responsible for the health of the population. These agencies share the vision, mission, and responsibility for providing the essential public health services. At a minimum, these agencies include the U.S. Public Health Service; State and local public health, mental health, and substance abuse agencies; and that portion of the U.S. Environmental Protection Agency and State environmental health agencies directly committed to the protection of public health.
Many agencies and organizations have or are collecting data on aspects of the U.S. public health infrastructure. Nonetheless, during the course of the recent policy debate over health reform, the inadequacy of these data became apparent. For example, with data currently available, policymakers at all levels are limited in their ability to assess the impact of proposed changes in the health care system on the capacity of communities, States, and the nation to carry out essential population-based public health functions or to provide safety-net services. Equally important, available data does not adequately support the evaluation and monitoring of our investment in public health or the relationship between the capacity and functioning of the public health system to health care costs and the health of the population.
A more comprehensive data collection strategy is needed, encompassing information from substance abuse, mental health, environmental and other health-related agencies, which can characterize at national, State, and local levels:
• the provision of "essential services" of public health
• the persons providing these services
• expenditures related to their provision
• revenue sources and uses
• the extent to which population-based public health services cross-subsidize personal health care services and vice versa.
These data need to be obtained periodically and be sufficiently resolved to support the analysis of trends in public health resources, staffing, capabilities, and performance. This requires linking of data across different jurisdictional boundaries (for example, between city, county, multicounty or district health departments and agencies providing mental health and substance abuse services). Linkage to other datasets is also necessary, to relate capacity in population-based public health to sociodemographic factors, risks to health, the utilization of medical care, and health outcomes.