state department of public health would be led by an individual who has formal credentials in public health.

While local, state, and federal agencies all play a role in developing a competent workforce, there is a role that is primarily the responsibility of federal agencies, that of providing funding to support efforts throughout the system. As detailed in Chapter 2, public health teaching, research, and infrastructure support were well funded during the 1960s and 1970s. Major reductions in funding occurred during the 1980s, with little or no improvement during the 1990s. Meanwhile tuition and other costs increased substantially, with the result that a reduction occurred in the amount of public health professional education actually provided.

Renewed interest in public health and the promise of increased funding may mean that needed investments to strengthen the public health infrastructure and workforce will be forthcoming. However we must ensure that funds are used for more than crash courses in a particular topic area (e.g., the current response to the threat of bioterrorism). We must also build the framework that will allow us, over the longer term, to ensure that public health professionals are prepared with the skills and knowledge necessary to improve population-level health. This means that increased funding must not only be a short-term response to a specific need but, instead, must be sustained over the long term. Such funding is crucial to developing the educational and research infrastructure necessary.

The committee has carefully considered the rationale and feasibility of implementing recommendations to significantly enhance federal funding for both public health education and leadership development and for public health research overall, including research on population health, public health systems, and public health policy. Investment in public health education is inadequate. Federal support for non-physician graduate-level public health training is minimal, as described in Chapter 2. Funding for residencies in preventive medicine is less than 1 percent of the overall federal investment in health professions training (about $1 million of the $300 million) (Glass, 2000). The report Addressing the Nation’s Changing Needs for Biomedical and Behavioral Scientists (NRC, 2000) states that there is clear evidence of a decline in the number of M.D.s conducting research and concludes that enormous opportunities exist for more broadly trained investigators.

Therefore, the committee recommends that federal agencies provide increased funding to

  • develop competencies and curriculum in emerging areas of practice;

  • fund degree-oriented public health fellowship programs;

  • provide incentives for developing academic and practice partnerships;

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