An impossible responsibility has been placed on America's public health agencies: to serve as stewards of the basic health needs of entire populations, but at the same time avert impending disasters and provide personal health care to those rejected by the rest of the health system.¹

Problems within the domain of public healthsuch as tuberculosis, diagnosis and management of sexually transmitted diseases, immunization programs, violence, substance and drug abuse, and the emergence of AIDSpresent daunting challenges. There is compelling evidence that asthma prevalence and morbidity is increasing for children in the United States.^2-4 Furthermore, a number of studies now demonstrate the disproportionate impact of asthma on persons living in poverty within urban environments.⁵ Given the direct link of poverty to adverse asthma outcomes, this common chronic health condition has now become one more item on the list of "impossible responsibilities" for our public health system.

In this issue of Pediatrics, Evans et al⁶ provide us with practical insights into a successful public-private effort aimed at addressing the problem of asthma within a group of public health clinics in New York City. In this study, academic medical center investigators teamed up with administrators from the largest municipal Board of Health program in the United States to test a method by which they could give public health practitioners the appropriate mix of knowledge, confidence, and skills to provide asthma care for children that meets the quality standards set by the National Asthma Education Program. To heighten their own challenge, this public-private partnership chose to conduct this initiative under the close scrutiny . . . [Full Text of this Article]