This chapter reviews the performance of the public health system, which can be evaluated at the micro-level of programs, policies, and services that are targeted at defined populations, and at the system level using population health indicators such as infant mortality rate, life expectancy, and premature death rate for geographic locales and subpopulations. The criteria for evaluating the public health system, as a whole, as well as its component programs, policies, and services, are effectiveness, equity, and efficiency. There is strong evidence from the report card initiatives that the effectiveness and equity of the system are not satisfactory, and, therefore, the efficiency of the system cannot be acceptable either. Evaluation of the public health system is increasingly important in this era of accountability and finite budgets. Effectiveness focuses on whether the desired benefits of public health practices—programs, policies, services—are achieved.