Omar Bennett
In the US, the government has overall responsibility for public health, as many public health activities curtail the rights of individuals. However, under the US Constitution, states retain the power to protect the health and welfare of their residents and, therefore, have primary responsibility for public health functions. Local health departments are the front line of public health agencies, delivering direct public health services to the population. They are responsible for communicable disease control programs, health education services, sanitation programs, and more. State health agencies collect and analyze information, conduct inspections, set policies, and carry out mandates.
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What You'll Learn
State health agencies collect and analyse data
The US Constitution holds that states have the primary constitutional responsibility and authority for the protection of the health, safety, and general welfare of the population. This responsibility falls largely on state health departments.
State health agencies collect data on individual vaccinations, especially for childhood vaccines, to track immunization rates, identify communities that may lack access, and investigate cases and outbreaks of vaccine-preventable diseases. They also collect health statistics, provide health education services, and run school health programs. They may also provide mental health services, and other home care and ambulatory care services.
State health agencies also collect data on health manpower, conduct food and drug inspections, and collect statistics on prevention activities and the population's health status. They also collect data on inpatient and outpatient mental health services, and the use of health services.
State health agencies are empowered by the state with delegated authority, but cities and towns may exercise powers autonomously, as chartered by the state. State legislatures may delegate power to local agencies to conduct activities in the state interest, and may also delegate local health departments to carry out administrative functions of the state, such as enforcing the state public health code.
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Local health departments deliver public health services
The US Constitution designates states and the people as the repository of all government powers not explicitly assigned to the federal government, as per the Tenth Amendment. States have the primary constitutional responsibility and authority for the protection of the health, safety, and general welfare of the population.
Local health departments (LHDs) are the "front line" of public health agencies, delivering basic public health services to most communities in the country. There are nearly 3,000 LHDs in the US, serving diverse communities with varying geographic sizes, populations, economic circumstances, and governmental structures.
LHDs are responsible for the direct delivery of public health services, including communicable disease control programs, screening and immunizations, health education, sanitation programs, school health programs, and maternal and child health services. They work with community partners to address population health needs, develop policies, and implement programs and services. LHDs also play a critical role in educating public health professionals and ensuring health equity through community partnerships.
The services provided by LHDs vary across states and between urban and rural areas, adapting to local priorities. State legislatures may delegate authority to LHDs to enforce state public health codes or empower them with regulatory powers. Cities and towns may also exercise autonomous powers, impacting the governance structure and resource allocation within LHDs.
LHDs are essential in protecting and improving community well-being by preventing disease, addressing social and economic factors impacting health, investigating health hazards, and responding to public health emergencies. They are the backbone of public health service, addressing diverse community needs and ensuring safer and healthier communities.
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State health departments protect health, safety and welfare
Under the US Constitution, states have the primary responsibility for protecting and promoting public health. This power is generally understood to include the essential role of protecting and promoting health through population-wide actions. State health departments are responsible for the health, safety, and welfare of their populations. They have a wide range of responsibilities, including policy development, resource stewardship, and legal compliance.
State health departments play a critical role in promoting and protecting the health of residents within their jurisdictions. They provide population-based public health services related to primary prevention, screening, and treatment of diseases and conditions. State health agencies collect and analyze information, conduct inspections, plan, set policies and standards, carry out national and state mandates, manage and oversee environmental, educational, and personal health services, and ensure access to healthcare for underserved residents. They also respond to health hazards and crises, such as communicable diseases, environmental risks, and public health emergencies.
State health departments often work in collaboration with local health departments and community health boards to deliver public health services. Local health departments are typically empowered by the state with delegated authority, but cities and towns may also exercise powers autonomously. They are responsible for the direct delivery of public health services, including communicable disease control programs, screening and immunizations, health education, sanitation programs, and school health programs, and various health services such as maternal and child health, mental health, and home care.
The public health system in the US is a complex network of people and organizations in both the public and private sectors, collaborating at national, state, and local levels to promote and protect public health. State health departments are a crucial part of this network, working to ensure the health, safety, and welfare of their residents through a range of activities and services.
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Public health funding is low
The US Constitution designates states and the people as the repository of all government powers not specifically designated to the federal government. States carry out most of their responsibilities through their police power, which includes the power to enact and enforce laws to protect and promote the health, safety, morals, order, peace, comfort, and general welfare of the people.
State health departments are funded by a varying mix of federal and state tax money, with some states providing resources to local departments, which also receive money from counties, cities, or towns. Some large cities receive direct federal funding for their health departments. Local health departments are generally responsible for the direct delivery of public health services to the population. They conduct disease control and immunisation programs, provide health education services, conduct sanitation programs, run school health programs, and deliver maternal and child health services, public health nursing services, mental health services, and other home care and ambulatory care services.
However, public health funding in the US is facing significant challenges. Deep cuts in funding are eroding the foundations of the public health system, threatening to put lives at risk. These cuts are particularly damaging because health departments are funded differently from other government agencies, with funding pouring in during emergencies but slowing down significantly during non-emergency periods. The COVID-19 pandemic has also highlighted the issue of underfunding, with one-time COVID grants making up a significant portion of health department budgets in some cities, and their ending leading to staff reductions and the scaling back of various programs.
The overburdened network of national, state, and local public health agencies in the US is struggling to address various issues, including the national opioid epidemic, growing rates of chronic diseases, and racial/ethnic health disparities. Budget cuts at all levels of the public health system have left these agencies less equipped with the funding, governance structure, and resources needed to address these pressing issues.
Furthermore, federal spending on programs that improve health for people with low or moderate incomes is projected to decrease through 2029, and federal budgets continue to shift costs to states. These funding challenges are impacting the ability of public health agencies to carry out their responsibilities effectively, potentially compromising the health and well-being of communities across the country.
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Local health departments are funded by local, state and federal sources
Local health departments are the "front line" of public health agencies, delivering basic public health services to most communities in the United States. There are nearly 3,000 local health departments across the country, varying in size, population, economic circumstances, and government structure. These departments are funded by local, state, and federal sources, with the exact mix of funding differing between departments.
Local health departments are primarily funded by local sources, including property and sales taxes, as well as fees charged for certain services. They may also receive funding from their respective state governments, which receive federal funds through block grants that are distributed to local agencies. The federal government has provided funding for state health departments through agencies like the CDC and the Health Resources and Services Administration. Additionally, local health departments receive revenues from various sources, such as fees for environmental health and clinical services, grants, and Medicare reimbursements for specific care services.
The funding of public health departments faces challenges due to eroding revenue bases and growing long-term commitments. There is a need to increase and stabilize funding, with estimates suggesting an additional $20 billion annually is required to adequately fund public health at the federal, state, and local levels. The variability in funding sources and amounts across jurisdictions results in highly variable per capita public health spending, which is often quite low compared to spending on personal healthcare.
Local health departments are empowered by the state with delegated authority, but cities and towns may exercise autonomous powers as chartered by the state. State legislatures may grant regulatory or rule-making powers to local health departments, enabling them to enforce public health codes and ordinances. States carry out their responsibilities for public health through their police power, which includes protecting and promoting the health, safety, and welfare of the people.
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Frequently asked questions
States retain the primary responsibility for health under the US Constitution.
Local health departments are responsible for the direct delivery of public health services to the population. These include communicable disease control programs, health education services, sanitation programs, and maternal and child health services.
Funding for local health departments comes from a combination of local, state, and federal funds. Local sources of revenue include taxes or levies, while state and federal governments may provide direct funding or pass funding through the states.
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