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This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

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OBJECTIVES: To assess Healthy People 2010 Objective 23-13 and its related sub-objectives measuring comprehensive laboratory services in support of essential public health programs, the Association of Public Health Laboratories (APHL) collaborated with the Centers for Disease Control and Prevention (CDC) to create and administer a survey of state public health laboratories (PHLs). METHODS: A committee of APHL, with representation from CDC, constructed the survey based on the 11 Core Functions of State Public Health Laboratories (hereafter, Core Functions)--the premise being that the extent to which they fulfilled these Core Functions would represent their level of providing or assuring comprehensive laboratory services in support of public health. The survey was distributed biennially to all state health agencies from 2004 to 2008, and respondents were given two months to complete it. RESULTS: The response rate for all surveys was > or = 90.2%. State PHLs were more likely to meet the sub-objectives relating to traditional functions (e.g., disease surveillance and reference testing) than other areas (e.g., food safety and environmental testing). Emergency preparedness fell in between. Overall, but most notably in the areas of food safety and training and education, there was improvement from 2006 to 2008, with the percentage of respondents who met more than half of the sub-objectives increasing from 58.7% in 2006 to 61.2% in 2008. CONCLUSIONS: The comprehensive laboratory services survey has been a valuable tool in measuring the laboratory infrastructure that underpins public health in the U.S. It will be necessary to continue monitoring laboratory infrastructure in this way to determine where the gaps in services exist and how they can best be addressed.

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In November 2004, the Association of Public Health Laboratories (APHL) conducted a Comprehensive Laboratory Services Survey of State Public Health Laboratories (SPHLs) in order to establish the baseline data necessary for Healthy People 2010 Objective 23-13. This objective aims to measure the increase in the proportion of health agencies that provide or assure access to comprehensive laboratory services to support essential public health services. This assessment addressed only SPHLs and served as a baseline to periodically evaluate the level of improvement in the provision of laboratory services over the decade ending 2010. The 2004 survey used selected questions that were identified as key indicators of provision of comprehensive laboratory services. The survey was developed in consultation with the Centers for Disease Control and Prevention National Center for Health Statistics, based on newly developed data sources. Forty-seven states and one territory responded to the survey. The survey was based on the 11 core functions of SPHLs as previously defined by APHL. The range of performance among individual laboratories for the 11 core functions (subobjectives) reflects the challenging issues that have confronted SPHLs in the first half of this decade. APHL is now working on a coordinated effort with other stakeholders to create seamless state and national systems for the provision of laboratory services in support of public health programs. These services are necessary to help face the threats raised by the specter of terrorism, emerging infections, and natural disasters.

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Emerging natural and man-made threats to the health of the nations population require development of a seamless laboratory network to address preventable health risks; this can be achieved only by defining the role of public health laboratories in public and private laboratory service delivery. Establishing defined core functions and capabilities for state public health laboratories will provide a basis for assessing and improving quality laboratory activities. Defining public health laboratory functions in support of public health programs is the beginning of the process of developing performance standards for laboratories, against which state public health laboratories, and eventually local public health and clinical laboratories, will establish and implement best laboratory practices. Public health is changing, and as apart of that change, public health laboratories must advocate for and implement improvements for public health testing and surveillance. These changes are outlined also in the Association of Public Health Laboratories consensus report (Association of Public Health Laboratories. Core functions and capabilities of state public health laboratories: a white paper for use in understanding the role and value of public health laboratories in protecting our nation's health. Washington, DC: Association of Public Health Laboratories, 2000).

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