Modernization of public health laboratories in a privatization atmosphere.

Public health laboratories are essential components of the nation’s public health infrastructure. Unfortunately, the important role of such laboratories is not well recognized (4, 5). Views of the contemporary role of public health laboratories vary greatly, depending on the perspective of the observer. Advocates argue that such laboratories have experienced serious erosion and need strengthening. They cite the many historical and continuing contributions of public health laboratories, e.g., helping to improve the sanitation of food and water and to control infectious diseases, as testimony of their enduring value. Proponents of privatization recommend that some or all of the traditional public health laboratory functions be transferred to the private sector because laboratory technology is broadly available and to reduce public-sector spending. Legislatures may view public health laboratories as a commodity of increased or diminished value in an era of health reform and budgetary shortfalls. These issues are further complicated because there is no single model of a typical public health laboratory. All state health departments have laboratories, and a survey conducted in 1992 and 1993 indicated that approximately 1,700 (60%) of 2,888 local health departments perform some form of laboratory testing (2a). However, the sizes of laboratories and the scopes of their activities vary enormously (4). The public and private sectors have distinct niches and overlapping responsibilities in meeting the nation’s health needs. However, because of changing roles and responsibilities, new arrangements are needed to identify the specific functions of publicand private-sector laboratories, facilitate collaboration in areas of shared responsibility, and prevent unnecessary duplication of services. We propose that local public health institutes be formed, with public health laboratories as founding members, to improve strategic planning for public health.