Health promotion and education components of state health agencies are at the center of the application of modern public health practice. Two reports on the future of public health, issued 15 years apart, detailed the changing nature and systemic problems of public health in the late 20th century (1) and identified the challenges in improving the public's health as we head into the 21st century (2). State health agencies — in collaboration with federal partners, community organizations, and health care systems — clearly play a critical role in ensuring the public's health. In response to these contemporary public health issues, the health promotion and education components of state health agencies have rapidly evolved, gaining the capacity to address newly recognized public health problems and become key players in ensuring that community and public health problems are addressed through cutting-edge public health strategies. These strategies include community mobilization, coalition building, and community-based interventions; integration of policy advocacy and media advocacy into comprehensive interventions; collaborations with academic institutions and other partners to advance the translation of research into practice; and the adoption of the social–ecological approach to public health interventions, in which the interplay of multiple interventions at multiple levels of society combine to provide the impact necessary to address deep problems.

This issue of Preventing Chronic Disease highlights several innovative health promotion and education initiatives conducted by state health agencies, showing not only the breadth of public health issues addressed by these agencies but also the scope of complex strategic issues undertaken by the leadership of these organizations.

In the early 1980s, the health promotion and education units at state health agencies were small, often one-person programs, if present at all. With funding from the Health Education–Risk Reduction program, the growth of these enterprises began in earnest. Support from the Centers for Disease Control and Prevention's (CDC's) Center for Health Promotion and Education and the National Heart, Lung, and Blood Institute's (NHLBI's) National High Blood Pressure Education Program helped to build the capacity of the staff and provide program support for health promotion and education infrastructure. The Healthy People Objectives for the Nation (3) were embraced and became part of public health planning both nationally and in many states. Subsequent funding, including the Preventive Health and Health Services Block Grant, and various initiatives, such as cancer prevention and control, tobacco control, and injury prevention, contributed to both the capacity of the organization and the improvement of the public's health.

With the emergence of HIV/AIDS as a serious public health problem, public health education and school health became recognized as key components of an overall strategy that, when combined with disease prevention and control methods such as epidemiology, testing, and counseling, would strengthen an existing overall public health strategy. Development of public health programs in numerous areas such as environmental health and immunizations reinforced the integration of health promotion and education into comprehensive public health interventions. Professional organizations such as SOPHE (The Society for Public Health Education) and the Directors of Health Promotion and Education (DHPE), formerly the Association of State and Territorial Directors of Health Promotion and Public Health Education (ASTDHPPHE), contributed to the development of the professional staff and advocated for national- and state-level health promotion public policies and funding for health promotion programs.

The health promotion and education leadership, staff, and programs initiated by state health agencies have synthesized and integrated the best of modern public health practice. In collaboration with the CDC, other federal agencies, and professional organizations, they have taken the best approaches available and worked with communities to implement them through state-level systems and public policies. Brief descriptions of the strategies used follow.

I have had the privilege of being a participant in the growth of health promotion and education in state health agencies as director of the Division of Community and Family Health at the state health agency in Maine for almost two decades prior to working at the American Cancer Society. The world of public health changed dramatically during that time, and health promotion practice rapidly evolved to meet such challenges. Partnership with and support by federal agencies, especially the CDC, and professional organizations, especially ASTDHPPE/DHPE and SOPHE, were essential to the division's continued quality and innovation with one goal in mind — improving the public's health. The collection of articles in this issue provides a glimpse into some of those innovative initiatives. These articles and others published in such journals as Health Promotion Practice help continually to advance the use of innovative and promising practices in real-world settings. The savvy practitioner can take the best of these examples and continue to evolve new and innovative approaches to their application in a variety of settings.