The terms “health” and “well-being” mean many things, among them vigor and vitality, freedom from disease, peace of mind and a sense of feeling safe and secure. Ideally, our public health system should promote all of these dimensions.

But that job became much tougher after the terrorist strikes on September 11, 2001, and the anthrax attacks that soon followed. Suddenly, the nation’s public health system was thrust into the national spotlight. In response, the federal government invested $2.4 billion in the system to improve bioterrorism preparedness.

This dramatic shift in focus raises serious questions about balancing competing public health priorities. Does strengthening the nation’s capacity to protect against bioterrorism enhance or undermine its ability to handle emerging infectious diseases, such as SARS and West Nile virus, or to address increasing rates of chronic conditions, such as obesity, that affect tens of millions of Americans?

To ensure that the country has a viable public health system capable of protecting the public from a wide range of threats, the Foundation continues to focus its efforts across several dimensions of health.

In the last decade, the Foundation has concentrated much of its work on improving public health leadership, information infrastructure and advocacy. In 2003, the Foundation renewed the successful State Health Leadership Initiative (SHLI), which trains newly appointed state health officers to manage their complex departments, form better relationships with their state’s chief elected legislators and the media, and secure improved results from the public health programs they lead. SHLI alumni who went through the program several years ago reported that the training they received helped prepare them to respond to the terrorist attacks of 2001.

Keeping public health issues in the spotlight is an essential step in improving the system. In an effort to focus public and policy-maker attention on critical public health needs in 2003, the Foundation supported the release of three reports by the Trust for America’s Health:

(1) One report focused on the state of public health laboratories and found they were overwhelmed and unprepared to deal with a biochemical terrorist attack.

(2) Another report examined states’ cancer tracking efforts and recommended ways states could improve prevention and early detection efforts.

(3) A third report asked whether—two years after 9/11—states were any better prepared to protect residents from bioterrorism and other public health threats. The report found that while some progress has been made, much remains to be done.

The three reports and the media coverage that followed helped stakeholders advocate for a stronger public health system.

While the nation is grappling with external threats to public health, there also is a critical need to focus on what our current Surgeon General, Richard Carmona, refers to as “the terror within”—the epidemic of obesity. The Foundation in 2003 focused on learning more about the causes, potential solutions and courses of action it might pursue to help halt the rapid increase in obesity among children. Today there are nearly twice as many overweight kids (ages 6 to 11) and almost three times as many adolescents (ages 12 to 19) as there were in 1980.

The Foundation supported the development of a newspaper series, The Shape We’re In, produced by the independent Public Access Journalism group. The Shape We’re In, which ran in 77 newspapers and reached 5.8 million readers, explored the many factors that contribute to the obesity epidemic and highlighted innovative solutions. Readers learned how doctors are preventing and treating obesity, how school physical education has changed to provide kids with lifelong skills for staying active, and how residents are making their communities more walkable.