摘要：I describe variations in the structure and in the practice of rural public health and how rural communities meet the challenges of current public health practice, including primary methods of service delivery and partnership development. I present examples of promising models for the creation of rural public health capacity—the ability of local health departments to carry out core public health responsibilities. WHO PROTECTS THE PUBLIC’S health? Ask 10 individuals and you may get 10 different answers. It is likely that local public health will be mentioned because of a recent series of public health challenges, including the anthrax events in October 2001 and concerns about severe acute respiratory syndrome and West Nile virus. Although the provision of public health services often takes a partnership approach (with the involvement of many nongovernmental organizations), the Institute of Medicine prompted a nationwide dialogue about government-based public health with its report on the future of American public health. 1 The institute’s report stated that the government’s role consists of 3 overarching functions: assessment, which is directed at the health status of our people; policy development, which guides how and what structures and practices will best serve the public’s health; and assurance, which includes the systems, services, programs, and quality of public health. Public Health in America 2 provided a framework, “Essential Public Health Services,” that has prompted a number of initiatives designed to concentrate attention on public health infrastructure, which consists of organizational capacity, workforce capacity and competency, and information and data systems. 3 A goal of Healthy People 2010 4 is to ensure that local health agencies have the necessary infrastructure for providing essential services effectively. If a healthy infrastructure contributes to healthy people, then all local health departments—rural and urban—need the basic elements of public health infrastructure.
