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Nurs Outlook. 2016 Nov - Dec;64(6):557-565. doi: 10.1016/j.outlook.2016.05.013. Epub 2016 Jul 1.

Assuring a strong foundation for our nation's public health systems.

Author information

  • 1Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA. Electronic address:
  • 2University of Wisconsin-Madison, School of Nursing, Madison, WI.
  • 3University of Virginia, School of Nursing, Charlottesville, VA.
  • 4Biomedical Informatics at Columbia University Medical Center, New York, NY.
  • 5Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, MD.



A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them.


This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health.


National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession.


We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.


Affordable Care Act; Prevention systems; Public health policy; Public health systems

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