OF SOME $600 billion in total health care expenditures in the United States this year, the amount available through state and local agencies for public health programs is approximately $60 billion— 1% of the total—according to Dennis Tolsma, the CDC's assistant director for public health practice. Quite a bit more must come from the federal government. That's one reason he has his job, Tolsma says—he is "a sort of vice president for strategic planning, to help the agency think through what the next decade is going to require from us to strengthen public health in America."
Tolsma says the Institute of Medicine report entitled "The Future of Public Health" and a report of the President's National Commission on AIDS both "expressed alarm" and "pointed to a lot that's disconcerting" about the public health infrastructure. "The sense is that all is not what the public thinks it is, that people are