Structure of Public Health Departments

Public health departments in the United States are usually classified by whether they operate at the federal, state, or local level. The federal government plays a big role in public health in terms of regulation and funding for local public health efforts. The frontline defense for public health is found in state and local health departments, which offer services ranging from disease investigations and health education programs to immunizations.

As Barton (2010) points out, the federal component of public health is found in the U.S. Public Health Service (PHS), which traces its beginnings back to the Marine Hospital Service established in 1798 with major responsibilities for the care of merchant seamen. Since that time the federal government has carried out a public health role addressing many aspects of population health. As Johnson (2013) notes, the U.S. Department of Health and Human Services is responsible for the eight agencies that make up the PHS. These agencies have the primary responsibility for administering public health grants to the states along with gathering national health data. Probably the most famous of these eight federal agencies is the Centers for Disease Control and Prevention (CDC), located in Atlanta, Georgia. The CDC provides funding and guidance to state and local health departments involved in communicable and chronic disease prevention and control, environmental concerns, injury prevention and control, and the gathering of statistics.

There is a functioning state health department in every state in the United States. These state health departments are structured similarly and are faced with many of the same challenges and responsibilities. They spend a great deal of their time and effort gathering health statistics concerning the population of their respective state. These state health agencies also have regulatory powers over laboratories and the licensing of health professionals and many health facilities. They also provide funding and supervision for local health departments within their state. Working with the CDC, they are also responsible for the investigation of disease outbreaks within their jurisdictions.

Local health departments (LHDs) are usually organized as county or city health agencies. These LHDs have the primary responsibility for delivering public health services to the local population. According to Healey and Lesneski (2011), the LHD is an important component for fulfilling the goal of communities to provide a healthy place to live. The services most frequently provided by LHDs in this country include

• Adult immunizations

• Childhood immunizations

• Communicable or infectious disease surveillance

• Tuberculosis screening

• Food service establishment inspection or licensing

• Environmental health surveillance

• Food safety education

• Tuberculosis treatment

• High blood pressure screening

• Tobacco use prevention

• Maternal and child health services

• Injury prevention programs

• Oral health services

According to Barton (2010), there are approximately 3,000 LHDs in the United States, with their funding coming from local taxes, permits and licenses, inspection fees, and a variety of state and federal grants. These departments are usually under the direction of a director or commissioner of health who reports to an elected political official such as a mayor or a board such as the county commissioners. LHDs collaborate on public health with other local health agencies, including hospitals and health care systems. LHDs are usually given the responsibility of implementing various public health programs for disease surveillance, disease investigations, environmental inspections, immunizations, epidemiology, and public health nursing activities.

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