-Local health departments must create a shared ownership for our Vision.

-Reductions in categorical and third party funding challenge our abilities to provide services when welfare reform and managed care may increase the number of citizens we need.

-Local health departments are challenged to develop a personnel system that is responsive to the needs of employees, the agency and our community.

-Local health departments face the challenge to improve public health leadership and technical support.

-Effective communications are needed internally and externally to advance the public health mission.

- Local health departments are challenged to ensure a strong public health infrastructure and prevent negative outcomes in the face of uncertainties in the health care arena.