In 1993 Assistant Secretary for Health Philip R. Lee commissioned an evaluation of U.S. Public Health Service (USPHS) activities in training and education for public health (TEPH). Findings revealed significant shortages of professionals and academic faculty in the public health fields of epidemiology, biostatistics, environmental and occupational health, public health nutrition, public health nursing, and preventive medicine. An inventory of PHS activities showed that about $217 million was spent on 151 public health and prevention training programs serving over 141,000 persons in fiscal year 1993. The $217 million amounted to about 18% of the total reported PHS training expenditures of $1.2 billion and about 1% of the total spending of $19.4 billion in fiscal year 1993. The National Institutes of Health (NIH) and Health Resources and Services Administration (HRSA) had the largest training expenditures of $655 and $445 million respectively, but spent only about 7% and 17% on public health and prevention training. Other PHS agencies had larger proportional investments in prevention, but the amounts were smaller. Priority recommendations were provided to Dr. Lee in seven key areas: advanced technology, core public health functions, policy and financing, academic-practice links, educational research, research training, and coordination. Together, these could dramatically increase the PHS proportional investment in TEPH. The PHS has a rich variety of resources for TEPH, but a lack of prioritization, coordination, and planning is causing opportunities to be missed.
