The paper describes the New York City and New York State public health plan as one of the strongest in the country. While the system cannot be replicated nationwide, certain elements or capacities can be adopted to improve preparedness in other systems. The paper identifies seven priority areas for capacity-building. The first priority is a well trained, well staffed, and fully prepared workforce. Second is laboratory capacity to produce timely and accurate results for diagnosis and investigation. Third is epidemiology and surveillance to rapidly detect health threats. Fourth is secure, accessible information systems to analyze and interpret health data and provide public access to health information. Fifth is a swift, secure, two-way communication system to provide timely, accurate information to the public and advice to policymakers in public health emergencies. Next is an effective policy and evaluation capability to help establish priorities for health improvement and develop plans to address those priorities. Finally, a preparedness and response capability that includes response plans, testing, and maintaining a high level of preparedness.