Public health laboratory

A public health laboratory is a laboratory that serves regional, national, or in some cases global communities by providing clinical diagnostic testing, environmental testing, disease diagnosis and evaluation, emergency response support, applied research, regulation and standards recommendations, laboratory training, and other essential services to the communities they serve.

A public health laboratory is unlike the average commercial laboratory because it is "integrated into the broader public health system." The public health laboratory must typically meet more stringent requirements, including adhering to the Clinical Laboratory Improvement Amendments (CLIA) (for labs in the United States) as well as regulations laid out by the departments, agencies, and other regulatory bodies of local, state, and/or national governments. Finally, the private medical laboratory focuses on tests focused on diagnosing the diseases of individuals, while the functions of the public health laboratory serve entire populations.

Activities of a public health laboratory

A 2002 Association of Public Health Laboratories (APHL) report helped identify 11 core functions state public health laboratories in the United States should accomplish, giving clearer insight into how the average public health laboratory in most parts of the world should operate. Note that this is not a guarantee every lab will perform these tasks, but its a standard of what the lab should be responsible for doing. Those suggested 11 core functions are:

• disease prevention, control, and surveillance: provide timely and accurate analytical results for the assessment and surveillance of exposures; rapidly recognize and prevent the spread of communicable diseases; detect and identify biologic agents of significance in human disease; provide specialized tests for low-incidence, high-risk diseases;
• integrated data management: accumulate, blend, and disseminate scientific information in support of public health programs; collect, monitor, and analyze laboratory data using national database systems; assist state epidemiologists, other laboratories, and practitioners with data needs
• reference and specialized testing: serve as a primary reference microbiology laboratory for a wide variety of needs
• environmental health and protection: conduct scientific analyses of potentially threatening environmental samples; detect, identify, and quantify toxic contaminants in environmental and biological specimens; provide air, water, soil, and other environmental laboratory testing services; provide environmental chemistry testing; determine the relationship between environmental hazards and human health; determine extent of a community's exposure to environmental hazards; rovide industrial hygiene/occupational health testing
• food safety: test specimens implicated in foodborne illness outbreaks to identify causes and sources; detect, identify, and quantify toxic contaminants in food specimens; monitor radioactive contamination of water, milk, shellfish, and other foods
• laboratory improvement and regulation: coordinate and promote quality assurance programs in other laboratories; act as a standard and leader for other laboratories; develop and oversee quality assurance and laboratory improvement programs; oversee the licensure, certification, and accreditation of other laboratories
• policy development: assist the development of state and federal public health policy; assist in the development of standards for all health-related laboratories
• emergency response: provide laboratory support to state and national disaster preparedness plans and environmental or health emergencies
• public health-related research: evaluate and implement new technologies and analytical methodologies in support of public health and healthcare communities; adapt emerging technologies to public health laboratories; conduct applied studies into new and improved analytical methods and services; assist the private sector with newly marketed tests
• training and education: sponsor training opportunities for public health laboratory staff; provide or facilitate training and workshops for laboratory staff in private and public sectors; provide training opportunities for careers in public health laboratory practice; provide continuing eduction opportunities to staff
• partnerships and communication: develop and strengthen partnerships among state, county, and city entities public and private; emphasize the role and value of the public health laboratory to state public health programs; participate in strategic policy planning and development processes; build and strengthen diverse communication networks

Organization, support, and regulation

In the United States

Organization

At the national level, public health laboratories are often embedded in federal agencies like the Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA), Food and Drug Administration (FDA), and the U.S. Department of Agriculture (USDA). These labs often assist state and local labs with outbreaks, special testing, training, and guidance.

At the state level, public health laboratories are typically organized in one of three ways: within a state health department, within or affiliated with a university, or as a consolidated laboratory within another state agency. Regardless of organization, the laboratories are part of both a state public health system and a national public health network. Information from the laboratories may trickle down to the local level, move up to the national level, or be shared with other entities at the state level. State labs most often work with national entities like the CDC, while local labs most often coordinate with state labs.

At the local level, public health laboratories are almost always organized within city or county health departments, and they distribute laboratory-based disease reports and related specimens to state counterparts. Local units may appear in large cities and often rival state-level public health labs in size, complexity, and services.

Funding

In 2002, unpublished survey data from the Association of Public Health Laboratories (APHL) showed 50 percent of funding of public health laboratories came from states, 33 percent from fee-for-service transactions, and 15 percent from the federal government. Funding at this time trended away from the states and towards fee-for-service transactions, with federal funding remaining study but with evidence to support the idea of increased funding in the future. That expanded federal funding came to pass with an increase of bioterrorism preparedness activities which expanded from the CDC to the state labs, in addition to other homeland security efforts.

Internationally

World Health Organization

The World Health Organization (WHO) has supported and expanded the needed skills and infrastructure for world governments to better detect, investigate, and report public health threats. Public health laboratories and/or governments around the world have been targeted by WHO with at least three different programs:

• Health Laboratory Strengthening: strengthen national laboratory systems; support quality laboratory system implementations; improve networking between public health labs and surveillance and response systems; increase domestic testing capacity; support laboratory workforce development
• Biosafety and Laboratory Biosecurity: promote the advancement of biorisk management, including biosafety and laboratory biosecurity; provide tools to better protect people in and around laboratory environments; promote a culture towards responsible biorisk management worldwide
• Laboratory Twinning Initiative: "strengthen laboratory capacity through the establishment of twinning projects between resource limited laboratories and specialized institutions"

Association of Public Health Laboratories

Though primarily a U.S.-based association, the Association of Public Health Laboratories (APHL) has a Global Health Program that aids resource-strapped countries with:

• building national laboratory networks
• implementing laboratory training programs
• planning and managing renovation projects
• implementing laboratory information systems
• procuring laboratory equipment and supplies
• providing advanced training to senior laboratory professionals

The APHL and its Global Health Program are also partners in the WHO's Laboratory Twinning Initiative.