Table.

Core and potential functions of a national public health institute

	Characteristics	Considerations
Collection and dissemination of surveillance information	Core information includes reportable conditions, including reporting for compliance with international health regulations	Can include vital registration, community surveys, phone surveys; new technologies include mobile devices for data collection and internet-based information collection
Reference laboratory	Definitive confirmation of diseases and conditions	Can include infectious, environmental, biomarker, and other laboratory tests
Infectious disease outbreak detection and control	Rapid response to suspected outbreaks of disease	Requires close coordination with state and local health departments, and ability to mobilise response within hours or less
Disease-specific infectious disease programmes	Immunisation, tuberculosis control, malaria prevention and control, HIV/AIDS, prevention and control of sexually transmitted diseases, etc	Some countries maintain disease-specific control programmes in different institutes for historical or other reasons; there are potential synergies among programmes
Surveillance and control of non-communicable diseases	Tobacco control, nutrition, reproductive and maternal and child health, cancer, cardiovascular disease	Interactions with civil-society groups and other parts of national government (finance, revenue, planning, etc) are crucial
Surveillance and control of injuries	Includes both intentional (homicide, suicide, civil conflict, sexual violence) and unintentional (road traffic, falls, drug misuse, etc)	Transportation policy, addressing both prevention and response, with epidemiological analysis to identify opportunities for prevention, are all essential
National public health leadership	Priority setting, policy analysis and implementation, public health research agenda, technical guidelines, and recommendations	Responsibility often shared with other national and subnational entities
Support to state, provincial, or local public health entities	Can include funding, guidance, technical support, or provision of some or all staff to subnational public health agencies	Arrangements vary from countries in which state or provincial health staff are employed by NPHI to others where there are limited interactions
Occupational health	Monitoring and establishing science-based guidelines to promote workers' safety and health	Regulation might be done by other entities; mediating between worker and union and business and industrial interests can be challenging
Environmental health and safety	Water and sanitation, food safety, air quality	Community concerns often drive activities, and highest risk exposures might not be those that receive most attention
Regulation of pharmaceuticals and biologicals	Can include standard setting, testing, approval, and safety monitoring	Some institutes, currently or previously, produced drugs and vaccines
Workforce training and development	Internal to agency at all levels (programme, epidemiology, laboratory, specialty), other public health agencies, medical staff, and others	Distance learning increasingly important and effective
Emergency preparedness and response	Generally via organised incident-management system with specific sections addressing epidemiological, clinical, communications, logistical, and other elements of response	Coordination with other national, international, and subnational response units is key
Prevention of birth defects	Fortification of foods with iodine and folic acid particularly important; surveillance and support to affected populations	Scaling up effective interventions is key; better understanding burden and amenability to intervention in birth defects is needed to further reduce incidence
Health communications	Communication with the general public, mass media, electronic media, specific risk/interested groups, policy makers, and health-care workers	Speed, clarity, and credibility are key; electronic media bring new risks and opportunities
Monitoring and improvement of health-care quality	Ongoing community surveys and surveys of health-care institutions, with focus on adherence to and results of prevention efforts	Can be facilitated by electronic health records; community surveys are expensive but generally essential to complement surveillance of health-care system