The origins of modern public health can be traced back to infectious disease epidemics of now uncommon diseases such as cholera, plague, and leprosy.1 As these diseases were controlled through a combination of improved sanitation and hygiene, the discovery of antibiotics, and vaccination programs, chronic diseases such as heart disease, cancer, and diabetes became increasingly prevalent over the 20th century. In 1900, the three leading causes of death were pneumonia and influenza; tuberculosis; and gastritis, enteritis, and colitis. These diseases accounted for nearly one-third of all deaths. Today, heart disease, cancer, and stroke are the three leading causes of death, accounting for almost two-thirds of all deaths. These and other chronic diseases are characterized by a complex interaction of risk factors, a non-contagious origin, a long latent period between risk factor exposure and clinical occurrence of disease, a long period of illness, and multiple risk factor etiology.
2Among the 10 greatest public health achievements of the 20th century, five relate directly to the prevention of chronic diseases: 3• Control of work-related health problems, such as coal workers' pneumoconiosis (black lung) and silicosis;• Decline in deaths from coronary heart disease and stroke;• Development of and access to safer and healthier foods;• Fluoridation of drinking water to prevent tooth decay;• Recognition of tobacco use as a health hazard and subsequent public health anti-smoking campaigns.Due to their ability to assess a public health problem, develop an appropriate program or policy, and assure that programs and policies are effectively delivered and implemented, 4 state and local public health departments are in unique positions to control chronic diseases. 5,6 But public health agencies face several challenges in developing and implementing chronic disease control programs. First, chronic diseases are often not seen as a crisis and the "pay-off" for prevention efforts occurs in future years. Second, the public often shows