Public health remains one of the best investments of the public dollar that the public can make to promote the general welfare-our constitutional obligation.1 Sadly, this claim is also one of the least well established and, therefore, least credible among the competing demands upon public and complementary private and voluntary expenditures. Exhorting a tax-weary and big-government-eschewing public to spend in a largely government system for a largely intangible and future-based benefit delivered by an often obscure or even intentionally opaque infrastructure by a humble and hard-working public workforce may be one of the most challenging tasks ever wished upon a public health professional. Add to the mix the confounding realities-our messages often are unwelcome: decrying the effects of self-indulgence in quest of behavior change; counseling caution in exploitation of our social and physical environments in the face of compelling commercial interests to the contrary; and espousing prevention for which mainly there is only long-term abstraction to show for our success when there are headline-grabbing immediate miracles in the hospitals just up the roads-and you build the case for a failed fiscal enterprise.

Public health's greatest strength is our strong tradition in states' rights and responsibilities and local delivery and responsiveness; but how strongly these detract from a sense of national accountability. Couple these aspects with one other compelling reality of public health-our inherently public and political nature, which regularly and cheerfully reviles "bloated bureaucracy" and "administrative fat"-and, rational or not, it becomes easier to explain the sad fate of prior efforts to develop national approaches to uniform data systems for public health accountability, including expenditures, which is nicely summarized in this issue of JPHMP in the report of Barry and Bialek.

Consider what is your favorite alibi for not collecting performance data and the fiscal data to allow for strategic investment decisions in improved health outcomes? Is it that "our community is too different to use standard approaches?" Or perhaps, "we don't work for the federal government." Maybe it's: "every statistician at the desk is a nurse not in the field." How about: "you can't put a price-tag on health." Or, "I can't be accountable for outcomes I can't control; if I show how badly we're doing, I'll be the one on the street." Trust me, I've used all of them-and more-myself!! But they, and we, are forces from the "dark side" and perpetuate the conspiracy not to know.

Into this dark vale, however, new beacons are shining, promising for the first time in decades, with the unprecedented likelihood of success, to bring enlightenment to the public decision making, which has for too long conspired to keep us in the dark.

The exciting new report of the Institute of Medicine (IOM), The Future of the Public's Health,1 brings new focus to the prior insights of the landmark 1988 report, The Future of Public Health.2 Coming as the report does from the prestigious and respected IOM of the National Academies of Sciences-the institutions chartered in 1863 by our nation's Congress to provide us with the evidence base for enlightened public policy-the report's evidence-based recommendations are timely and welcome. The IOM Committee notes the urgent need, not solely for public health programs available in "every community, no matter how small or remote[horizontal ellipsis]," but for a revitalized, organized, empowered, and adequately financed infrastructure "[horizontal ellipsis]which is possible only through the local component of an organized public health system."2^(p144) And further, the committee notes that the failures of prior such recommendations accrue at least in part to our nation's failure to build proper accountabilities for the system. To that end, the Future of the Public's Health1 calls for an annual mandatory report card on our progress.

Three exceedingly powerful sources for this light now shining in our dark corners are cited in the new IOM report and form the basis for the insights and recommendations of much of the work included in the pages of this issue as well.

First, to agree on investment strategies, it is critical to have confidence in the data describing both inputs (including financial ones) and outputs-data upon which to base comparisons. In the business world, uniform principles of accounting are applied uniformly across ventures, and people go to jail when they play fast and loose with the principles. For public health, this means that we must now rise above our favorite alibi for irresponsible ("no-account") behavior.

The IOM report, shining its first beacon, calls for systems that can assure every citizen that the protections, which they have the right to demand, are in place and meet, at least, minimum standards. To that end, uniform principles of and approaches to counting our assets and their outputs must be in place, accommodating (even celebrating) our local uniqueness, but building toward a national commonality.

Again, the IOM report provides the basis for a national consensus to that end, in its support of the emerging powerful tools from the brave national demonstrations over the early years of this century-the Public Health Systems Performance Standards.3 As outlined in the materials by Mays et al and Moulton et al in this issue of JPHMP, these standards are based upon the agreed formulation of the "10 essential services" of public health-the efforts that every citizen has the right to expect in every community. The genius of performance standards is that they recognize the inherent systemic nature of public health-that many of the government institutions' efforts are complementary to those otherwise in place. The expenditures for all of these services and activities, irrespective of who provides them, represent the essential investment.

Further, the efforts for which we must turn to government are those that ensure that both the protections against the terrors of nature and, alas, man-made threats are in place and that the community, working together, is delivering on the promise that every citizen has the right to expect. The accountabilities of public health and the policy making powers of government when the free-market system falls short add to the convening powers all of "which cannot be delegated."2

The IOM report, shining a second beacon, calls for a competent public health workforce to deliver upon this promise-one trained and competent to ensure the essential services and, as well illustrated in the work of Kurz et al in this issue of JPHMP, to help the communities and states to hold themselves properly accountable for these efforts, including, it must not go unsaid, the competence to understand and develop strategic investment in these efforts.

Finally, the IOM report shines a third bright light by recognizing, as well reflected here in two proposals of Honore et al, the "tenth essential service" of public health, namely the research agenda. We must not wait for all the evidence to be assembled before we move to put in place a fiscal accountability system that will let every citizen know how our community stacks up against all others in our performance, what we spend for it, and our ROI (return on investment). We need to adopt the spirit of continuous process improvement, demonstrating best (and most cost-effective) processes and practices, using the best of what our automated systems, sophisticated sampling, survey, and modeling techniques can provide-as well illustrated by at least four of the descriptions in this issue-and applying what we learn as we go.

[horizontal ellipsis][T]he committee recommends that DHHS be accountable for assessing the state of the nation's governmental public health infrastructure and its capacity to provide the essential public health services to every community and for reporting that assessment annually to Congress and the nation. The assessment should include a thorough evaluation of federal, state, and local funding for the nation's governmental public health infrastructure and should be conducted in collaboration with state and local officials. The assessment should identify strengths and gaps and serve as the basis for plans to develop a funding and technical assistance plan to assure sustainability. The public availability of these reports will enable state and local public health agencies to use them for continual self-assessment and evaluation.1^(p150)

Surely the time has never been better for us to do just this-not just be the best bargain in the public service today, but prove it. We must shine our own bright lights into the evidentiary darkness, put our money where our mouths have been, and invest in a solid strategy to plan and manage our finances for public health to prove our worth to our shareholders. The return for our investment in proper financial management will be the solid financial future that the field so certainly needs, and the solid infrastructure that the public so clearly deserves.

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