HealthcarePapers 7(3) March 2007 : 10-19.doi:10.12927/hcpap..18752
Invited Essay

The Public Health Enterprise: Examining Our Twenty-First-Century Policy Challenges

Hugh Tilson and Bobbie Berkowitz


This paper examines the public health enterprise and its policy challenges in the twenty-first century. Among the many challenges public health faces, we include here collaboration across a broad range of stakeholders, the public health infrastructure, agreement on public health's essential services, preparedness, accountability and measurement, workforce and a research agenda. Two Institute of Medicine reports on the future of public health have set the context for a more in-depth review of the public health workforce and infrastructure. Policy advocates must ask, however, why, if the way and the means are so clear, the public health system is still in disarray. [Health Affairs 25, no. 4 (2006): 900-910; 10.1377/hlthaff.25.4.900]
Copyrighted and published by Project HOPE/Health Affairs as: Tilson, H. and B. Berkowitz. The Public Health Enterprise: Examining Our Twenty-First-Century Policy Challenges. Health Affairs 25(4): 900-910 Aug. 2006.

The published article is available online at

About the Author(s)

Hugh Tilson ( is clinical professor of public health leadership at the School of Public Health, University of North Carolina at Chapel Hill.

Bobbie Berkowitz is the Alumni Endowed Professor of Nursing at the University of Washington in Seattle.


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