Roles of local public health agencies within the state public health system.

OBJECTIVES: In this study we assessed the structure and function of local and district health agencies throughout the United States. We compared these findings with those from a previous national assessment done a decade earlier. METHODS: We surveyed the state health officers of all 50 states in the summer of 2001 in regard to the structures and functions of their state's local and district health agencies. RESULTS: Forty-seven states completed the survey for a 94 percent response rate. Forty-three percent have a regional or district structure in place. According to more than 80 percent of the respondents, local health departments serve all areas of their state. Local boards of health provide guidance and oversight in two thirds of the states. Most local health departments continue to perform a variety of traditional public health functions, as well as a variety of newly emerging responsibilities. Many local functions varied by geographic regions, population size, and organizational type. CONCLUSIONS: The study identified structural and functional changes in the local and district health agencies of state public health systems over the last decade. The stage is set for future work on the relationship between public health structure and function, and performance in the 21st century.

Implementation of an Internet-based geographic information system: the Florida experience.

Increasingly, Web-based data dissemination systems are being used to provide public health information. This article describes Florida's experience in augmenting a Web-based data query system, Florida CHARTS, with a geographic information system component. As with any systems development, users' needs guide the product. With a focus on community health assessment and improvement planning, several methods of data display have been established. A variety of issues are explored including the impact of small numbers of events on data display and data confidentiality, the selection of geographic units of analysis, and techniques for geographically coding data.

Structure and functions of state public health agencies.

OBJECTIVES: We assessed the structure and functions of state health departments throughout the United States and compared our findings with those from a previous national assessment conducted in 1990. METHODS: In 2001, we sent a survey to the state health officers of all 50 states. The survey asked about the structure and functions of the state health agency. RESULTS: The survey was completed by state health officers from 47 states (a 94% response rate). More than half of the states responding had a freestanding state public health agency and a state board or council of health. Forty-four percent had a regional or district structure. Although some traditional public health functions have been curtailed, important new public health functions have emerged since 1990. CONCLUSIONS: Our current findings confirm core changes in the structure and functions of state public health systems over the past decade and emphasize the need for more research into these systems to maximize their organizational performance.