Stronger national public health institutes for global health.

Although strengthening health-care systems is receiving increased attention, strengthening public health systems and institutions could save far more lives at lower cost. Public health institutes monitor, implement, and oversee programmes to prevent disease. Life-saving and cost-saving programmes include immunisations, control of communicable diseases including diarrhoeal disease, reduction of motor-vehicle crashes, and tobacco control. Over the past decade, many countries have considered, strengthened, or created national public health institutes (NPHIs), often following a major event such as the outbreak of severe acute respiratory syndrome. The core function of an NPHI is monitoring and responding to health threats. Monitoring requires refer ence laboratories and surveillance. Response requires outbreak control and implementation of evidence-based public health actions. NPHIs can include disease-specifi c control programmes, support to state, provincial, or local public health entities, surveillance and control for non-communicable diseases and injuries, occupational and environmental health, and vital registration (table). These functions can be done by more than one institution in a country, and some countries have collaborated to establish regional institutions. Eff ective public health responses often require a multidisciplinary team, including skills needed for communicable and non-communicable disease control programmes. For example, the response to biosecurity threats involves expertise in infectious diseases, chemical hazards, engineering, environmental remediation, and risk communication.