Strengthening New York's Public Health System for the 21st Century



In accordance with New York State Public Health Law § 225, the Public Health Council shall consider any matter related to the preservation and improvement of public health. Further, the law provides that the Public Health Council may, from time to time, appoint advisory committees that are expert in the major areas of public health to make recommendations pertinent to the public health system.

Consistent with this role, the Public Health Council has had a long-standing interest in the effectiveness of the public health system. In 1996, the Council appointed a committee to identify public health priorities for New York State. Among other findings, the report issued by the committee, Communities Working Together for a Healthier New York (CWT), noted that a strong public health infrastructure is essential in helping New York achieve its public health objectives. In early 2001, the Public Health Council asked for an update on the CWT project to assess progress in achieving the 12 priorities that had been targeted. During this update, the Council learned that while many objectives had been achieved or surpassed since 1996 (see Appendix E), other challenges still remained. As a natural follow-up to the CWT findings, the Council also expressed an interest in a study of how the public health system infrastructure supports communities in their efforts to achieve these health priorities. In particular they directed that a review of the public health infrastructure in New York State be undertaken.

The events of September 11, 2001 followed by anthrax attacks and their subsequent investigations occurred after this New York State Public Health Council dialogue on infrastructure had begun. As a consequence, expectations for the public health system in general were raised to a compelling new level across the nation. While public health had always performed an important role in helping communities prepare for and respond to emergencies, public health was now being asked to assume an ever more critical role. Assuring the capacity of the public health system to carry out effective emergency preparedness and response became essential at all levels. These events underscored the Public Health Council's established commitment to assess New York State's public health infrastructure as a platform on which to deliver effective services and achieve a newly strengthened emergency readiness system.

Charge to the Workgroup

Accordingly, in late 2001 the New York State Public Health Council appointed a Public Health Infrastructure Work Group and charged it with the task of assessing the public health system infrastructure in New York State. The Council requested that this body provide the Council with recommendations on how to strengthen the system with particular focus on infrastructure. The members of this newly constituted Work Group included individuals in positions of public health leadership and expertise in academia, medicine, public policy, government, private foundations, the business community, and the voluntary sector.


The Work Group adopted a mission statement to guide its evaluation of the New York State public health infrastructure. The mission of the work group was:

  1. To understand the current organizations and systems that comprise New York State's public health infrastructure and evaluate its strengths and weaknesses;
  2. To identify strategies to strengthen the capabilities of the public health system; and
  3. To make appropriate recommendations for improvement to the Public Health Council.


The Work Group envisions a state and local public health system in New York State that focuses on the core public health functions of assessment, policy development and assurance, and on ensuring conditions under which all New Yorkers can lead healthy and productive lives. Public health agencies must deliver the essential public health services from an infrastructure platform comprised of three elements: public health workforce, public health organizational systems and relationships, and public health data and information systems. These infrastructure elements must have adequate resources and be competent to meet the demands and opportunities presented to public health in New York State today. Also, state and local public health agencies are the focus of the public health efforts at their respective levels, and should serve as the conveners, facilitators and coordinators of community wide public health efforts.

The public health system must strive for integration of these infrastructure elements within state and local government and through government's effective partnerships with private and voluntary health and human service providers, academia, community and business leaders, and citizens. Partners share a common purpose and stand to mutually benefit from coordinated joint efforts to promote health and prevent disease. The vision assumes an enterprise that is adequately funded to achieve its goals and mandates, informed by the best science and technology, efficiently and effectively coordinated and poised to meet society's needs into the 21st century.