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This chapter is a review of the current state of public health in light of the social, political, economic, scientific, and technological changes buffeting the United States. As an assessment of progress in current public health efforts, we address the five major issues in public health for the 1990s raised by Breslow (8): reconstruction of public health; setting objectives for public health; from disease control to health promotion; determinants of health and health policy; continuing social inequities and their impacts on health; and the health implications of accelerating developments in technology. Finally, we look to the twenty-first century and provide five clear paths necessary to strengthen the capacity of public health agencies to protect and improve the health status of the population.

(RELs) were available for 59 of these substances. The ratio of PEL to REL ranged up to 1,000, with a median of 2.5 and a mean of 71.4. OSHA excluded 42 substances from the standard altogether despite the availability of NIOSH RELs, solely because no TLV had been established.