key: cord-0708936-2djlm6nz authors: Frieden, Thomas R; Koplan, Jeffrey P title: Stronger national public health institutes for global health date: 2010-11-18 journal: Lancet DOI: 10.1016/s0140-6736(10)62007-7 sha: ce8e8537346cd58edadb0711d04a7e69b3488d19 doc_id: 708936 cord_uid: 2djlm6nz nan Rapid response to suspected outbreaks of disease Requires close coordination with state and local health departments, and ability to mobilise response within hours or less Disease-specifi c infectious disease programmes Immunisation, tuberculosis control, malaria prevention and control, HIV/AIDS, prevention and control of sexually transmitted diseases, etc Some countries maintain disease-specifi c control programmes in diff erent institutes for historical or other reasons; there are potential synergies among programmes The evolution of one NPHI-the US Centers for Disease Control and Prevention (CDC)-illustrates key issues. 4, 5 The CDC grew out of a 1940s domestic malaria-control programme and initially focused on infectious disease control through laboratory and epidemiological expertise. Over decades, it expanded to include surveillance, prevention, and control of non-communicable diseases, injuries, and birth defects as well as occupational and environmental health. The CDC has been increasingly involved in global health activities since the 1950s. Emergency prepared ness and response, always a core function, received increased attention after the 9/11 World Trade Center and anthrax attacks. CDC's role in the US health-care system continues to evolve with the passage of health-reform legislation and increased focus on prevention through clinical care. To be eff ective, an NPHI must have credibility and be independent, technically expert, and apolitical, which requires independence from parent ministries of health on technical issues. But if an NPHI is seen as being too independent, it might not be able to address important health challenges. A related issue is whether the entity has regulatory authority-the US CDC has limited regulatory authority but provides guidance to other federal agencies and state and local public health agencies which have more. In other countries, the role of the NPHI can include regulation of pharmaceutical production or sale, and of medical care. Supporting state/provincial and local public health entities is critically important; providing funds and personnel (through training, staffi ng, or short-term and long-term staff deployed from the NPHI) is the most eff ective way to increase implementation of technical guidance. NPHIs can provide only reference laboratory services or can also provide oversight, technical support, and materials to subnational laboratories. There is potential for tension between service provision, training, and research. In the USA, this was addressed through the Epidemic Intelligence Service, in which trainees learn by doing. 4, 6 The US CDC and international partners have helped start 37 similar programmes. 7 These programmes provide public health leadership and contribute to the development of the NPHI. Some NPHIs do basic research; in the USA, this function is more often done by the National Institutes of Health. NPHIs might also seek to improve individual and community health directly. Health-communication eff orts often include websites, targeted to both medical staff and the public, and active media outreach to provide prompt and accurate health inform ation. Policy changes, such as laws to promote immunisations or reduction of behavioural and environmental risks, can be eff ective, although critics might see such eff orts as too directly political. Some NPHIs lead community mobilisation, such as immunisation and anti-tobacco campaigns. NPHIs can provide crucial expertise to protect the public's health. Increasing the number, scope, and eff ectiveness of NPHIs in developing countries will enable better prevention and control of infectious diseases and reduce the burden of non-communicable diseases and injuries. Success will depend on accurate collection, analysis, and dissemination of data to implement and monitor evidence-based programmes. NPHIs require more staff and resources, although on a much smaller scale than the need for additional clinical personnel. Stronger NPHIs enable countries to implement and monitor health programmes that save money and lives by basing decisions on country-specifi c data on health burden, effi cacy of interventions, and implementation status of health programmes. To improve both health and health systems, developing countries need to greatly increase resources and authority of NPHIs. Offi ce of the Director, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA (TRF); and Emory Global Health Institute, Emory University, Atlanta, GA, USA (JPK) We thank Kevin De Cock, Richard Garfi eld, Patricia Simone, and Donald Shriber for helpful comments, and Kimberly Dills for assistance with manuscript preparation. TRF is the Director of the Centers for Disease Control and Prevention. JPK declares that he has no confl icts of interest. International Association for National Public Health Institutions. Framework for the creation and development of National Public Health Institutes Public health requirements for rapid progress in global health The Epidemic Intelligence Service of the Center for Disease Control Sentinel for health: a history of the Centers for Disease Control Epidemic intelligence service of the Centers for Disease Control and Prevention: 50 years of training and service in applied epidemiology Centers for Disease Control and Prevention. Field epidemiology (and laboratory) training program (FE(L)TP). 2010 Binder S, Adigun L, Dusenbury C, Greenspan A, Tanhuanpa P. National Public Health Institutes: contributing to the public good.