Over the 20th century, the US public health system witnessed a gradual change in national public health priorities as the burden of disease shifted from infectious disease to chronic disease. In sharp contrast, in the first 5 years of the 21st century, public health professionals experienced a dramatic shift in priorities as the long-neglected field of public health was thrust into the spotlight with the events of the September 11, 2001, terrorist attacks, the subsequent anthrax attacks, the SARS and monkeypox epidemics of 2003, and the devastating hurricanes of 2005. In a matter of just a few years, across the country, public health emergency preparedness became a focus of public health officials at local, state, and federal levels. The challenge for the public health workforce is to keep sight of the overarching goal of public health: to protect and improve the health of all in our community through assessment, policy development, and assurance even as national priorities shift.

To best understand how this shift in priorities has affected public health in the United States, it is important that there should be a common understanding of what is meant by the term "preparedness." Over the past several years, the terms "emergency preparedness," "disaster preparedness," "bioterrorism preparedness," "public health preparedness," and "community preparedness" have been commonly used to describe similar activities to protect a community's health in the event of a threat to the public's health. In February 2007, the RAND Corporation convened a panel of experts to define "public health emergency preparedness" and its key elements.1 The panel defined public health emergency preparedness as follows: "The capability of the public health and health care systems, communities and individuals to prevent, protect against, quickly respond to and recover from health emergencies, particularly those whose scale, timing or unpredictability threatens to overwhelm routine capabilities. Preparedness involves a coordinated and continuous process of planning and implementation that relies on measuring performance and taking corrective action." This definition and other findings of this panel are available in an editorial in the American Journal of Public Health.1

The emphasis on public health priorities has affected public health professionals in many ways. The fundamental organizational structure of health departments is changing to accommodate new positions and programs in public health emergency preparedness. Strategies and tools needed to rapidly and efficiently identify, assess, and monitor the impact of a public health threat are being critically reexamined and restructured. More attention is being brought to the need for redundant systems to keep the public informed and educated about public health activities, especially during an emergency. Community partnerships, particularly with emergency management, first responders, law enforcement, and the healthcare delivery system are being revisited and strengthened. And finally, training needs for the public health workforce (eg, mandated compliance with National Incident Management System training) are dramatically expanding.

Although federal funding for public health emergency preparedness has concomitantly increased with the demands outlined above, relatively small amounts are directed to state and local public health agencies. For example, with respect to planning efforts for pandemic influenza preparedness, in December 2005, Congress provided $3.3 billion dollars in emergency supplemental appropriations to the Department of Health and Human Services, including $2.6 billion for vaccine development and stockpiling, but only $350 million to the Centers for Disease Control and Prevention for state and local public health capacity.2 Public health leaders have the responsibility of ensuring that the funds directed at public health emergency preparedness (whether specifically for pandemic influenza or bioterrorism preparedness) are used to strengthen the public health infrastructure to benefit the public's health, not just for the threats of tomorrow but for the threats that face our communities today.

There are many ways in which public health leaders can improve public health infrastructure and address the daily needs of the public health system by enhancing public health emergency preparedness. An example of this occurred in November 2006 when more than 960 people were sickened by norovirus after eating at a local dining establishment over Thanksgiving weekend in Syracuse, New York (see the article in this issue, Seagel, Morrow et al). To manage the outbreak and accurately inform the public of the ongoing investigation, the Onondaga County Health Department rapidly implemented surveillance, disease reporting activities, and media communication plans that were previously developed as part of pandemic influenza preparedness efforts. Several of the articles in this issue of the Journal of Public Health Management and Practice either directly or indirectly address the benefits that comprehensive public health emergency preparedness can have on daily public health activities.

As other articles in this issue demonstrate, a disaster can happen anywhere, at any time. From a global perspective, disasters have a profound impact on the public's health. In 2004, more than 241 000 people died as a consequence of natural disasters, more than 1.45 million people were affected by disasters, and more than $100 billion was lost in damages.3 It is imperative that public health leaders use the political will gained in the past few years to do what they can to prepare for and plan for public health emergencies; however, we cannot forget that in the same year, more than 650 000 Americans lost their lives to heart disease and another 550 000 lost their lives to cancer.4 Many of these deaths were preventable.

As we continuously strive to improve our community's health, we must focus our daily efforts on working with community partners to minimize the impact of the preventable burden of disease whether by ensuring clean water, improving immunization rates, tightening tobacco control, and improving access to healthful food choices or whether by developing plans for point of dispensing sites in our community and improving our risk communication systems. We must strike a balance in managing the current threats to the public's health while planning for theoretical threats.

In his 2003 speech, "An address to state and local public health officials," William Foege5 defined the philosophy of public health as follows: "The philosophy of science is to find truth. The philosophy of medicine is to use that truth for your patient. The philosophy of public health is to use that science for everyone for social justice in health." In the age of public health emergency preparedness, let us remember this. Let us work together to build a stronger public health system for today and tomorrow.

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