sufficient numbers of well-trained public health physicians are available to provide the scientific and clinical input along with the leadership and management necessary to link and coordinate the efforts of the many participants of a strong public health system, as described in The Future of the Public’s Health (IOM, 2003a). Third, in the face of public health emergencies, the committee envisions a future with sufficient numbers of well-trained public health professionals, including physicians, to plan for and prevent these emergencies or to respond to them. Such emergencies would include disasters, such as hurricanes and threats of bioterrorism, or emerging or reemerging infectious diseases, such as pandemic influenza and multiple-antibiotic-resistant tuberculosis.

PUBLIC HEALTH IN THE UNITED STATES

Industrialization, population growth, and increasing urbanization led to worsening public health conditions in the United States in the late 1700s and early 1800s. “The mixing of dense populations living in unsanitary conditions and working long hours in unsafe and exploitative industries with wave after wave of cholera, smallpox, typhoid, tuberculosis, yellow fever, and other diseases was a formula for disaster” (Turnock, 2004). The devastating yellow fever epidemic in New York City in 1798 led the state legislature to grant the city authority to pass its own health laws (Rosen, 1963). Also in 1798, the U.S. Congress passed an “act for the relief of sick and disabled seamen” (Parascandola and Robinson, 2005) that established a federal network of hospitals for the care of merchant seamen. John Maynard Woodworth, the first Supervising Surgeon (a position later designated Surgeon General), put together a medical staff of physicians who could be assigned to the various marine hospitals on the basis of need. In 1870 these marine hospitals were reorganized into the Marine Hospital Service, which, as services and activities expanded, became the U.S. Public Health Service in 1912. Federal Public Health Service commissioned officers engaged in activities aimed at controlling the spread of contagious diseases, conducted biomedical research, and provided health care and assistance following disasters, as well as numerous other activities (USPHS, 2006).

In 1850, Lemuel Shattuck issued the Report of the Sanitary Commission of Massachusetts, which called for the establishment of state and local health departments to focus on improving sanitation, controlling communicable diseases, providing services for infants and children, and collecting data on the public’s health (Turnock, 2004). The development of local health departments spread rapidly to address the public health needs of local communities.

The dawn of the 20th century marked the beginning of an era bur-



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