In 1988, the Institute of Medicine (IOM) published its landmark study The Future of Public Health. The report's principal recommendations for improving the nation's health included two challenges: current public health leaders need to develop greater leadership effectiveness, and schools of public health should increase the number of leadership development opportunities they offer their practitioner colleagues. In 2000, the US Department of Health and Human Services published Healthy People 2010. One of the stated goals was to ensure that public health agencies have the infrastructure to provide essential public health services effectively.

Since 1991, the Centers for Disease Control and Prevention (CDC) has supported the University of Illinois School of Public Health (UIC-SPH) to develop public health leadership, and address the challenges posed by The Future of Public Health and Healthy People 2010. The Mid America Regional Public Health Leadership Institute (MARPHLI) is a year-long program for state and local public health department leaders, board of health members, community leaders and legislators serving all levels of the public health system. In 1996, the Illinois Department of Public Health joined the CDC in supporting the Institute. MARPHLI is also supported by the Indiana State Department of Health and the Wisconsin Division of Health. In addition to the core states of Illinois, Indiana, Michigan and Wisconsin, MARPHLI has also trained teams from North Dakota, Massachusetts, Arkansas and Quebec.