Scientific Data Documentation
Profile Of State And Territorial Public Health System, 1991
ACKNOWLEDGEMENTS
Public Health Practice Program Office
Division of Public Health Systems
October 1991
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control
This document is in the public domain and may be freely copied or
reprinted. Copies of this document are available from CDC.
We invite your suggestions and comments on the utility of this
publication and ways of improving it. Comments and/or
suggestions should be directed to:
Edward H. Vaughn
Health Systems Analyst
Public Health Practice Program Office
Centers for Disease Control
Atlanta, Georgia 30333
Telephone (404) 639-1943
FOREWORD
On behalf of the Centers for Disease Control (CDC) and the Public
Health Practice Program Office (PHPPO), we are pleased to present
the Profile of State and Territorial Public Health Systems:
United States, 1990. This publication is a first effort to
describe how public health services are organized and delivered
in each state and territory. Major components of the public
health system in each jurisdiction are described, and the
relationships between these components are explored.
The cooperation of state and territorial public health officials
was invaluable to completing this project. State officials
provided much of the information used in the document and made
many suggestions for improvement. Several local public health
officials also provided information and assistance.
In Healthy People 2000: National Health Promotion and Disease
Prevention Objectives (1), an ambitious far-reaching objective is
proposed:
"By the Year 2000, increase to at least 90 percent the
proportion of people who are served by a local health
department that is effectively carrying out the core
functions of public health."
To monitor progress toward that objective, we are developing a
unique surveillance system designed to assess the status of the
public health system at the state and local levels. We have
developed these profiles, in part, to assist in this process.
Further, we also anticipate that state and local public health
officials will find these profiles useful in many ways. For
example, they could be used as a starting point for research on
the public health system, to compare and/or contrast elements of
the system, and as a source for models of organizational
structure and function. Finally, CDC personnel and those of
other Federal health agencies should find these profiles useful
as they work with state and local agencies. For example, CDC,
through its Epidemic Intelligence Service (EIS) program, provides
assistance in epidemiologic investigations. EIS officers
performing such investigations could benefit by familiarizing
themselves with the appropriate profile. Similarly, CDC Public
Health Advisors assigned to work in state and local agencies
could review their state's profile as part of their orientation
process.
We invite your comments on other uses of these profiles and ways
to improve this document in future years.
Edward L. Baker, M.D., M.P.H.
Director
Public Health Practice Program Office
Centers for Disease Control
SUMMARY
Introduction
To achieve National Health Promotion and Disease Prevention
Objective 8.14, a new surveillance system will be needed that can
measure and evaluate the status of public health practice in
state and local systems in the United States. As stated in
Objective 8.14, by the Year 2000, the nation needs to "increase
to at least 90 percent the proportion of people who are served by
a local health department that is effectively carrying out the
core functions of public health" (1).
The design of such a surveillance system requires an
understanding of how public health systems in the United States
currently are organized, and how state and local components
interact. This information is not routinely collected and
summarized, nor easily available. Also, public health systems in
the United States change so often that the available information
soon becomes out of date.
The purpose of this book is to offer a descriptive profile of how
public health systems in the United States are organized at state
and local levels, and how state and local components interact,
based on existing information available between 1989 and 1990.
Specifics are included on all 50 states, the District of
Columbia, and the 8 territories of the United States.
Methods
In 1989 and 1990, we collected existing pamphlets, brochures,
publications, reports, or other printed materials prepared by
state and territorial public health systems on selected topics
(e.g., the organization of the State Health Agency (SHA); the
head of the SHA; the state board of health or council; regional
or district health offices; and state-local relationships).
For SHAs with a Local Health Liaison Official (LHLO) (a SHA staff
member with responsibility for coordinating with the local health
departments in the state), we asked the LHLO to provide this
information. For SHAs with no LHLO, we identified other
appropriate public health officials and requested that they
provide similar information.
We simultaneously compiled information from other existing data
sources. For example, we obtained information on demographics by
state from the 1980 national census, and budget information from
the Public Health Foundation (2).
To identify local public health agencies (LPHAs), we used the
following definition:
an administrative and service unit of local or state
government, concerned with health, employing at least one
full-time person, and carrying some responsibility for
health of a jurisdiction smaller than the state.
This definition was previously used in a national survey of LPHAs
by C. Arden Miller (3). We asked SHA representatives to use the
Miller definition in reviewing information about LPHAs in their
state (e.g., the number of LPHAs; types of geographic
jurisdictions for LPHAs; and the number of LPHAs with local
boards of health and local health officers).
For determining staff and services in LPHAs, we analyzed data
from a survey of LPHAs conducted by the National Association of
County Health Officials (NACHO) and the Centers for Disease
Control (CDC) (4). For these tabulations, we used the NACHO
definition of an LPHA: "an administrative and service unit of
local or state government concerned with health and carrying some
responsibility for the health of a jurisdiction smaller than a
state" (4). The NACHO definition is less restrictive than the
Miller definition (i.e., the NACHO definition does not require
that an LPHA have a "full-time person").
We developed draft documents for each state and territory and
returned them to the SHA for review and verification.
Results
Selected Sociodemographic Indicators
Program requirements for public health agencies may differ
depending on the characteristics of the population to be served.
The demographics of the population vary considerably in different
jurisdictions. For example, the 1988 state populations ranged
from a low of about 0.5 million in Alaska to a high of about 28
million people in California. The 1988 population density ranged
from a low of about 1 per square mile in Alaska to a high of
about 1,000 per square mile in New Jersey. The proportion of the
population categorized as rural in states in 1980 ranged from a
low of 9 percent in California to a high of 66 percent in
Vermont. The percent of the population categorized as non-white
in states in 1980 ranged from a low of about 1 percent in Vermont
to a high of 67 percent in Hawaii. The median age of the
population in states in 1987 ranged from a low of about 26 years
in Utah to a high of 36 years in Florida.
Public health agencies often are health care providers for the
most needy portions of the population. The percent of the
population in a state below the poverty level in 1985 ranged from
a low of about 6 percent in New Hampshire to a high of about 25
percent in Mississippi.
Educational levels are another important consideration in
delivery of public health services. In 1980, median years of
education in state populations ranged from a low of 12.1 years
(Kentucky, South Carolina) to a high of 12.8 years (Alaska,
Colorado, Utah).
County Government Structure
The local government structure directly influences LPHA
activities and services. County governments are the most common
type of local government structure within which LPHAs operate.
The relationship between county governments and LPHAs varies
within and betwen states. Geographic jurisdictions of LPHAs are
as follows: a county in 72 percent (2,067/2,876) of LPHAs;
town/township in 11 percent (325/2,876); city in 7 percent
(212/2,876); city-county in 6 percent (158/2,876); and multi-
county in 4 percent (114/2,876).
County government authority is granted by state constitutions or
statutes. Thirty-two (64%) states and the District of Columbia
permit home rule authority, or local adoption of a home rule
option. This option provides counties with an opportunity to
enact a "local constitution" which gives the county additional
authority and powers (e.g., to levy taxes for LPHA services and
activities).
About 70 percent of counties have a county commission form of
government structure. The commission consists of an elected
board, ranging from 2 to over 100 members. The commission has
legislative powers that may include passing ordinances and
adopting budgets, and administrative powers that may include
supervising some or all departments and appointing administrative
employees. A hallmark of the commission form of government is
that "county commissioners" share administrative responsibility
with several independently elected "row officers" such as the
county clerk, auditor and recorder, assessor, treasurer,
prosecuting attorney, sheriff, and coroner.
About 20 percent of counties have a county administrator. The
county administrator position is usually appointed by and
accountable to the governing board or legislative body. Other
titles given this position include chief administrative officer,
appointed administrator, administrator, and county manager.
About 5 percent of counties have an elected executive. Similar
to the position of a mayor, the executive is elected at large and
is responsible for working with the county legislative body.
Elected executives have veto power over the legislative body.
State Health Agencies (SHAs)
All 50 states, the District of Columbia, and 8 territories have
SHAs responsible for the administration of public health services
within their jurisdictions. SHAs usually are organized as one of
two models: as a freestanding, independent agency responsible
directly to the governor or the board of health, or as a
component of a superagency. The SHA is an independent government
agency in 31 (62%) states, and a component of a state government
superagency in 19 (38%) states and the District of Columbia. Of
the seven territories for which information is available, SHAs
are independent agencies in six territories and a component of a
superagency in one territory.
Depending on how activities in a state are organized, public
health responsibilities and authority may not be located in the
SHA. For example, only 4 SHAs (8%) are the state mental health
authority, and only 15 (29%) SHAs are the lead environmental
agency for the state (Table S-1). In The Future of Public
Health, the Institute of Medicine recommended that each state
have a health department that has responsibility for all
primarily health-related functions, such as Medicaid, mental
health and substance abuse, environmental responsibilities
requiring health expertise, health planning, and regulation of
health facilities and professions (5).
Head of State Health Agency
The position of the official who appoints the head of the SHA
affects this individual's level of authority and access to key
decision makers in state government. The head of the SHA is
appointed by the governor to a cabinet-level position in 32 (64%)
states; the head of the superagency in which the SHA resides in
14 (28%); and the state board of health in 4 (8%) (Mississippi,
Oklahoma, South Carolina, and Texas). The head of the SHA is
appointed by the Mayor of the District of Columbia. The head of
the SHA is appointed by the governor in the four territories for
which this information is available.
The head of the SHA is required to have an M.D. degree in 23
(46%) states and the District of Columbia. Of the four
territories for which this information is available, two
territories require that the head of the SHA have an M.D. degree,
and two territories do not.
State Board or Councils of Health
State boards or councils of health are used for citizen input
into the operation of the SHA by 40 (80%) states. These boards
or councils function in a policy-making capacity in 21 (42%)
states, in an advisory capacity in 17 (34%), and in both
capacities in 2 (4%).
Regional or District Health Offices
A SHA may organize its jurisdiction into regions or districts to
provide closer administrative or technical support to Local
Public Health Agencies (LPHAs). Administrative regions or
districts are used in 28 (56%) states. The number of regions or
districts per SHA ranges from a low of 2 (Massachusetts, New
Jersey) to a high of 19 (Georgia). Three of the territories also
are divided into administrative regions or districts.
State-local Liaison
The organizational relationships between local public health
agencies (LPHAs) and the SHA fall into four broad categories,
ranging from one where LPHAs are semi-independent of the SHA to
one where LPHAs are sub-units of the SHA. Map S-1 shows
variation of state-local relationships by state. State-local
relationships are decentralized in 16 (32%) states (local
governments directly operate LPHAs); mixed centralized and
decentralized in 16 (32%) (local health services may be provided
by the SHA, local governmental units, boards of health, or health
departments in other jurisdictions); centralized in 10 (20%)
(LPHAs function directly under the state's authority and are
operated by the SHA or board of health); and shared in 7 (14%)
(LPHAs are under the authority of the SHA, as well as the local
government and board of health).
Budget
Total expenditures for public health by states are difficult to
compare and interpret because SHA organization and
responsibilities differ, and SHA programs vary in importance and
content. Total SHA expenditures in fiscal year 1988 ranged from
a low of $14 million (Wyoming) to a high of $793 million
(California). The total SHA expenditures for public health in
that year were less than $100 million in 25 (50%) states; from
$100 to 199 million in 15 (30%) states and the District of
Columbia; from $200 to 299 million in 4 (8%); from $300 to 399
million in 3 (6%); and more than $400 million dollars in 3 (6%)
(California, Maryland, and New York).
Local Public Health Agencies (LPHAs)
Using the Miller definition of an LPHA (except for Alaska and
Hawaii where the SHA requested that some local
administrative/service units not be classified as LPHAs),
representatives of SHAs reported 2,876 LPHAs. In the 1989 NACHO
survey, a total of 2,932 LPHAs were identified (using the less
restrictive NACHO definition) (4), a difference of only 2 percent
(56/2,932) more LPHAs.
In the 1989 NACHO survey, 2,269 (77%) of LPHAs returned completed
questionnaires. Forty-two percent of these LPHAs served less
than 25,000 population, and an additional 23 percent served less
than 50,000 population (4).
Services Provided
Activities in assessment, policy development, and assurance
reported by the respondent LPHAs in the 1989 NACHO survey are
summarized Tables S-2, S-3, and S-4. The percentage of LPHAs
reporting activity in specific functions generally increased as
the size of the population served by the jurisdiction increased.
Immunizations, reportable diseases, child health, and
tuberculosis control activities were reported by almost all (80%
or more) of LPHAs. At least half the LPHAs reported activities
in the following areas: health education; sexually transmitted
diseases; Women, Infants, and Children (WIC) program; family
planning; prenatal care; acquired immunodeficiency syndrome
(AIDS) testing and counseling; chronic diseases; and home health
care. From 35 percent to 49 percent of LHDs provided services to
handicapped children and laboratory and dental services. Less
than 25 percent provided services in the following categories:
occupational safety and health, primary care, obstetrical care,
drug and alcohol use, mental health, emergency medical services,
long-term facilities, and hospitals.
Local Board of Health
Local boards of health are used in 38 (76%) states to provide
local input into or control of the operation of LPHAs. Local
boards have policy-making responsibilities in 28 (56%) states,
advisory responsibilities in 5 (10%), both advisory and
policy-making responsibilities in 3 (6%), and different
responsibilities in different geographic areas in 2 (4%). None
of the territories reported having local boards of health.
Local Health Officer
A local health officer (or equivalent official) is assigned
responsibility to provide LPHA leadership in 48 (96%) states.
Minnesota and Rhode Island have no local health officers. Local
health officers are appointed by the local board of health in 19
(38%) states, by the local governmental authority in 16 (32%), by
the head of the SHA in 9 (18%), by the State Board of Health in 2
(4%), by the Deputy Commissioner for Health in 1 (2%), and by the
state merit system in 1 (2%). Local health officers are required
to have an M.D. degree in 22 (44%) states. An additional 3 (6%)
states require M.D. degrees in some LPHAs.
Staff
LPHA staff are employed by the LPHA in 31 (62%) states, by the
SHA in 9 (18%), and by combinations of SHA and LPHA in 9 (18%).
The number of employees per LPHA ranges from 1 to 26,000.
Additional details on the characteristics of LPHA staff are
available from the 1989 NACHO questionnaire survey (4). Forty-
six percent of 2,137 respondent LPHAs report a staff size of 9 or
fewer full-time employees. Typically, the majority of LPHAs
serving jurisdictions with less than 25,000 population report
employing a clerical or secretarial employee (89%); a registered
nurse (83%); and an engineer/sanitarian (65%). In addition to
these, the majority of LPHAs serving jurisdictions with 25,000 to
49,999 population also report employing a physician (65%). In
addition to these staff, the majority of LPHAs serving
jurisdictions with 50,000 to 99,999 population also report
employing a health educator (54%) and nutritionist/dietitian
(67%).
Budget
Total expenditures for public health in LPHAs are difficult to
compare and interpret for reasons similar to those limiting
comparison of SHA expenditures (i.e., LPHA organization and
responsibilities may differ, and LPHA programs can vary in
importance and content). Total LPHA expenditures for fiscal year
1988 by state ranged from a low of $57,000 (New Hampshire) to a
high of $439 million (California). The total LPHA expenditures
by state in that year were less than $100 million in 30 (71%) of
the 42 states which reported local health department
expenditures; from $100 to 199 million in 7 (17%); from $200 to
299 million in 3 (7%); and more than $300 million in 2 (5%)
(California and New York).
Discussion and Conclusion
This book provides a descriptive profile of how public health
systems in the United States are organized at the state and local
levels, and how state and local components interact, based on
information available in 1989 and 1990. Several general patterns
are apparent from the profiles. For example, the public health
system typically involves the following units of organization:
SHAs (100% of states); state administrative regions or districts
(56% of states); and counties (72% of states). The SHA usually
is an independent government agency (62% of states). LPHAs
commonly are operated directly by local government (32% of
states) or by a mixture of local and state government (32% of
states). Citizen input into the public health system occurs at
the state level through state boards or councils of health (80%
of states), and at the local level through local boards of health
(76% of states). Although SHAs and LPHAs typically have
physicians on staff or access to input from physicians, top
administrative leadership positions tend to be filled by non-
physicians, with only 46% of states requiring the head of the SHA
or the LPHA to have a medical degree.
In addition, the size of the population served in a jurisdiction
is an important factor related to the organization and nature of
public health agencies. The number and nature of LPHA
activities, and the number and level of specialization of staff,
generally increase as the size of the population served by the
jurisdiction increases. In 1945, Emerson recommended that LPHAs
should serve populations of no less than 50,000 (6). Many
experts have debated the merits of this. Additional studies
would appear worthwhile, since the majority (65%) of LPHAs in the
1989 study by NACHO report that they served jurisdictions with
less than 50,000 population.
To monitor progress towards achieving Healthy People 2000
Objective 8.14, the nation must develop a surveillance system
that can measure and evaluate the status of public health
practice in state and local systems in the United States.
Surveillance information will be needed in three broad areas: 1)
the geographic boundaries of LPHA jurisdictions; 2) simple
descriptive information regarding public health agencies and the
populations which they serve (e.g., budgets, workforce, services,
demographic information, and organizational structure); and 3)
information to describe how effectively LPHAs perform the core
functions of public health in their jurisdiction (assessment,
policy development, and assurance). CDC has identified 10
organizational practices or processes that must be carried out by
a component of the public health system in each locality. These
10 practices or processes are summarized in Table S-5.
The profiles in this book represent a first step toward
developing a surveillance system for Objective 8.14. The
profiles provide information related to the first and second
areas of surveillance (i.e., geographic boundaries and simple
descriptive information). Much more will be needed. For
example, the profiles do not include any information on the 10
practices or processes, nor has any attempt been made to measure
or evaluate the effectiveness of LPHAs.
At least four challenges remain for future surveillance efforts:
The first challenge will be to operationally define the
elements of each of the 10 practices or processes for
surveillance purposes, and then to develop indicators and
validate those indicators as measures of the practices.
The second challenge will be the changes that tend to occur
in the organization of public health agencies. For example,
during the 6 months that elapsed while draft profiles were
being circulated to SHAs for review, five states modified
their SHA structure. Frequent updates will be needed to
keep information current.
The third challenge will be the diversity that exists in the
organization and activities of SHAs and LPHAs. For example,
one LPHA may have an epidemiologist as a staff member, while
another LPHA may obtain assistance from an epidemiologist
with the SHA. Similarly, environmental health may be the
responsibility of one SHA, but not another. As a result of
differences in organizational structure and activities,
different agencies may need to be evaluated independently
(i.e., while comparisons over time within a SHA may be
possible, comparisons between different SHAs may not be
possible). An area where research is definitely needed is
whether a system of classification (or typology) of SHAs and
LPHAs might be possible, which would facilitate
surveillance, comparison, and evaluation of effectiveness.
For example, while comparison of a large LPHA with a small
LPHA may be analogous to a comparison of "apples and eggs,"
comparison of a small LPHA with another small LPHA might be
meaningful.
The fourth challenge for future surveillance efforts will be
to identify the most useful data for describing and
monitoring local public health practice in the United
States. The hope is that as greater experience is gained, a
small number of measures will begin to be identified that
will allow monitoring of trends over time in a standardized
fashion, facilitate comparisons between and among
communities, identify problem areas that managers need to
investigate further, and help managers decide how to best
use resources.
Table S-1
Responsibilities of State Health Agencies (SHAs)
in 50 States and the District of Columbia, 1990.
SHAs (N=51)
Responsibilities n ( %)
State Public Health Authority 51 (100)
Institutional Licensing Agency 41 ( 80)
Institutional Certifying Authority for
Federal Reimbursement 40 ( 78)
State Agency for Children with Special
Health Care Needs 39 ( 77)
State Health Planning and
Development Agency 22 ( 43)
State Institutions/Hospitals 16 ( 31)
Lead Environmental Agency in the State 15 ( 29)
State Professions Licensing Agency 10 ( 20)
Medicaid Single State Agency 5 ( 10)
State Mental Health Authority 4 ( 8)
SOURCE:
Characteristics of State and Local Health Agencies 1988 (7).
Table S-2
Assessment and Policy Development: Activities Reported by
2,269 Local Public Health Agencies (LPHAs), 1990.
LPHAs Reporting
Activities
Activities n ( %)
Assessment
A. Data Collection/Analysis
1. Reportable Diseases 1,978 ( 87)
2. Vital Records and Statistics 1,440 ( 64)
3. Morbidity Data 1,114 ( 49)
4. Behavioral Risk Assessment 752 ( 33)
B. Epidemiology/Surveillance
1. Communicable Diseases 2,072 ( 91)
2. Chronic Diseases 1,235 ( 54)
Policy Development
A. Health Code Development
and Enforcement 1,330 ( 59)
B. Health Planning 1,299 ( 57)
C. Priority Setting 1,166 ( 51)
SOURCE:
National Association of County Health Officials 1990 (4).
Table S-3
Assurance: Inspection, Licensing, Health Education, and
Environmental Activities Reported by 2,269 Local Public
Health Agencies (LPHAs), 1990.
LPHAs Reporting
Activities
Activities n ( %)
Inspection
1. Food and Milk Control 1,639 ( 72)
2. Recreational Facility Safety/Quality 1,233 ( 54)
3. Health Facility Safety/Quality 1,063 ( 47)
4. Other Facility Safety/Quality 722 ( 32)
Licensing
1. Other Facilities 1,621 ( 71)
2. Health Facilities 489 ( 22)
Health Education 1,679 ( 74)
Environmental
1. Sewage Disposal Systems 1,785 ( 79)
2. Individual Water Supply Safety 1,742 ( 77)
3. Vector and Animal Control 1,582 ( 70)
4. Water Pollution 1,353 ( 60)
5. Public Water Supply Safety 1,311 ( 58)
6. Solid Waste Management 1,252 ( 55)
7. Hazardous Waste Management 1,048 ( 46)
8. Air Quality 739 ( 33)
9. Occupational Health and Safety 526 ( 23)
10. Radiation Control 472 ( 21)
11. Noise Pollution 458 ( 20)
SOURCE:
National Association of County Health Officials 1990 (4).
Table S-4
Assurance of Personal Health Services: Activities Reported
by 2,269 Local Public Health Agencies (LPHAs), 1990.
LPHAs Reporting
Activities
Activities n ( %)
Personal Health Services
1. Immunizations 2,089 ( 92)
2. Child Health 1,903 ( 84)
3. Tuberculosis 1,826 ( 81)
4. Sexually Transmitted Diseases 1,650 ( 73)
5. Chronic Diseases 1,570 ( 69)
6. WIC 1,564 ( 69)
7. Family Planning 1,347 ( 59)
8. Prenatal Care 1,339 ( 59)
9. AIDS Testing and Counseling 1,294 ( 57)
10. Home Health Care 1,139 ( 50)
11. Handicapped Children 1,062 ( 47)
12. Laboratory Services 983 ( 43)
13. Dental Health 851 ( 38)
14. Primary Care 501 ( 22)
15. Obstetrical Care 459 ( 20)
16. Drug Abuse 389 ( 17)
17. Alcohol Abuse 351 ( 16)
18. Mental Health 319 ( 14)
19. Emergency Medical Service 293 ( 13)
20. Long-term Care Facilities 143 ( 6)
21. Hospitals 64 ( 3)
SOURCE:
National Association of County Health Officials 1990 (4).
Table S-5
Ten Organizational Practices or Processes That Must Be
Carried Out by a Component of the Public Health System in
Each Locality.
ASSESSMENT
1. ASSESS the health needs of the community.
2. INVESTIGATE the occurrence of health effects
and health hazards in the community.
3. ANALYZE the determinants of identified health needs.
POLICY DEVELOPMENT
4. ADVOCATE FOR PUBLIC HEALTH, BUILD CONSTITUENCIES and
identify resources in the community.
5. SET PRIORITIES among health needs.
6. DEVELOP PLANS and policies to address priority health needs.
ASSURANCE
7. MANAGE resources and develop organizational structure.
8. IMPLEMENT programs.
9. EVALUATE programs and provide quality assurance.
10. INFORM and EDUCATE the public.
GUIDE FOR USING THE PROFILE
Suggested Uses
This book is intended for use by Federal, state, and local public
health officials as a reference on the public health system in
each state and territory. Federal health officials who are
working with state and local health departments can use this book
to familiarize themselves with a state or territory. For
example, Epidemic Intelligence Service (EIS) Officers or other
Federal assignees could use this book to review the public health
system before working in a state. The book also enables Federal,
state, or local health officials to compare or contrast the
public health system in different states or territories. It is a
handy source of information on the structure of public health
agencies and the interrelationships between the components of
these agencies. The book can also be used as a starting point
for future research on the public health system.
General Format
The outline that follows is used throughout the book, with only
minor variations, to describe the major components of the public
health system in each state or territory and the relationships
between the components. For territories, however, an additional
section in the outline entitled, "Location, Geography and
People," is added. Under each item in the outline is a brief
description of the type of information that will be presented for
each state or territory. The states and the District of Columbia
are presented in alphabetical order followed by the territories
in alphabetical order.
Rhode Island and Delaware state that they have no local health
departments. Hawaii and New Mexico report only a single,
autonomous local health department in each state: the city of
Honolulu for the former and Los Alamos County for the latter.
With the exception of the two small autonomous units in Hawaii
and New Mexico, these states classify their systems as completely
centralized. With the exception of Rhode Island, which delivers
or arranges all public health services from a centralized state
health agency, they do, however, deliver services from district
offices at the local level. We have included these
state-controlled service units in Delaware under the local health
department section, while at the same time recognizing that the
state does not consider these "local health departments." Hawaii
and New Mexico requested that their local service units not be
categorized as local health departments.
State Public Health System Profile
Selected Sociodemographic Indicators
State United States
Population (1988) 245,803,000
Population Density (1988) 69.4
(per/sq.mi.)
Number of Counties 3,139
Median Age (1987) 31.7
Percent Below Poverty Level (1985) 14.0
(persons)
Percent of Population Rural (1980) 26.0
Percent of Population White (1980) 83.1
Percent of Population Non-white (1980) 16.9
Median Years of Education (1980) 12.5
(25 Years of age and over)
The sources of these data for sociodemographic indicators are
Current Population Reports, County Population Estimates: July 1,
1988, 1987, 1986 (8), The State Policy Data Book 1988 (9), State
and Metropolitan Area Data Book 1986 (10), Census of Population
(11), and Census of Population (12).
County Government Structure
Home Rule or No Home Rule Authority - This section indicates
whether the state and counties have home rule. It also describes
the structure and function of county governments in each state.
The role and responsibility of key players, such as elected
executives or administrators, are described. The roles are
described because these players are often quite involved in
delivering public health services at the local level. Their
involvement may include the budget process and/or policy-making
when the governing body serves as the local board of health.
Each paragraph discussing a different form of government begins
with the form underlined and the number of counties using that
form enclosed in parentheses, i.e., Commission Form (25). The
adoption of home rule by states and counties is noted as it
relates to the ability to levy taxes for specific purposes and as
an indicator of an individual county's capacity for
self-government.
Home Rule Authority - A grant of authority from the state to
counties through statutes or constitutions allows local
self-determination. Home rule is not a form of government but an
authority to effect change in the areas of structure, function,
and fiscal powers. Charter Reform is a tool used by the counties
to achieve greater levels of home rule authority. It is the
mechanism used to form charter commissions for achieving county
reform. This is accomplished through state constitutional
amendment or legislative measures that ultimately serve as a
broader tool for home rule authority.
The following are the most common forms of local government:
Commission Form - This is the most traditional and widely used
form of county government. Under the Commission Form an elected
board of from 2 to over 100 has legislative powers, such as
passing ordinances, adopting budgets, and also administrative
powers such as supervising some or all departments and appointing
some administrative employees. A hallmark of the Commission Form
is that "county commissioners" share administrative
responsibility with several independently elected "row officers"
who frequently include a county clerk, auditor and recorder,
assessor, treasurer, prosecuting attorney, sheriff, and coroner.
County Administrator - This position is usually appointed by and
accountable to the governing board or legislative body. Other
titles given this position are chief administrative officer,
appointed administrator, administrator, and county manager.
Elected Executive - Similar to the position of a mayor, this
position is elected at large and is responsible for working with
the county legislative body. Elected executives are strong,
partially due to their veto power over the legislative body.
Other forms of county government less frequently seen in the
descriptive profiles will be briefly described by individual
state.
The source of these data for states is County Government
Structure: A State By State Report, 1989 (13). The source of
information on the government structure of territories is The
Europa World Year Book, 1990 (14). The sources of information on
the location, geography and people of the territories are The
Europa World Year Book, 1990 (14), Evaluation of Federal Support
to Health Systems of the Pacific Insular Jurisdictions of the
U.S., 1984 (15), and A Reevaluation of Health Services in
U.S.-Associated Pacific Island Jurisdictions, 1989 (16).
State Health Agency (SHA)
General
Free-standing, Independent or Component of Superagency - The SHA
is categorized as a free-standing, independent agency or a
component of a superagency. This section contains information
about the SHA, such as its name, mission statement, and some
areas of responsibility. The responsibilities are taken from a
list that includes the following areas:
State Public Health Authority
Medicaid Single State Agency
Lead Environmental Agency in the State
State Mental Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
State Professions Licensing Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
The source of these data on the responsibilities of SHAs is
Characteristics of State and Local Health Agencies, 1988 (7).
Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment - This section
indicates if an M.D. is required for the head of the SHA and
whether the position is a cabinet-level office. It identifies
the head of the SHA and includes information about the position
such as the title, method of appointment, and responsibilities.
State Board of Health/Council
Advisory or Policy-making - This section describes the State
Board of Health/Council as advisory or policy-making in nature.
The composition, method of appointment, roles, and
responsibilities of the boards and/or councils are discussed.
Regional/District Health Offices
Here is indicated whether the state has been administratively
divided into districts or regions using the terms designated by
the particular state, i.e., "management areas," "public health
areas," etc. The location of the regional/district offices and
the area served by these offices are illustrated on a state map.
The structure and types of programs administered are included, as
well as line of authority to state and local levels.
State-local Liaison
Type of Organizational Control, Formal or Informal Liaison
Function - In this section the relationship between the SHA and
local public health agencies is characterized as one of the
following types:
Centralized Organizational Control - local health
departments function directly under the state's authority
and are operated by an SHA or a board of health.
Decentralized Organizational Control - local governments
directly operate local health departments with or without a
board of health.
Mixed Centralized and Decentralized Organizational Control -
local health services may be provided by the SHA, local
governmental units, boards of health, or health departments
in other jurisdictions.
Shared Organizational Control - local health departments are
under the authority of the SHA, as well as the local
government and board of health.
Also included in this section is a discussion of the state-local
liaison function, including authority and responsibility.
The source of these data on the relationship between state and
local health departments is Characteristics of State and Local
Health Agencies, 1988 (7).
Budget
The total FY 1988 SHA expenditures, by source of funds, are
compared with total FY 1988 United States SHA expenditures. The
source of these data is Public Health Agencies 1990: An
Inventory of Programs and Block Grant Expenditures (2).
Local Public Health Agencies (LPHAs)
General
This section describes local health departments and classifies
them according to the administrative/service areas within their
jurisdictions. This classification scheme includes city,
city-county, county, multicounty, township/town, multitownship,
and borough jurisdictions. A map is included to illustrate local
public health jurisdictions in each state and territory. When
more than one city and/or township/town health department exists
in the same county, the symbol on the map designating the type of
unit will be followed by the number of units in parentheses.
To identify the number and types of local public health agencies
(LPHAs), we used the following definition developed by C. Arden
Miller:
an administrative and service unit of local or state
government, concerned with health, employing at least one
full-time person, and carrying some responsibility for
health of a jurisdiction smaller than the state (3).
We also utilized data on services provided and staff employed by
LPHAs which were obtained from a survey conducted by the National
Association of County Health Officials and the Centers for
Disease Control (unpublished survey results, 1989). For these
tabulations we used the NACHO definition of an LPHA: "an
administrative and service unit of local or state government
concerned with health and carrying out some responsibility for
the health of a jurisdiction smaller than a state" (4). The
NACHO definition is less restrictive than the Miller definition
(i.e., the NACHO definition does not require that an LPHA have a
"full-time person").
Services Provided
Public health services provided by LPHAs in each state are
included. The data on services provided by LPHAs are derived,
unless stated otherwise, from a survey of LPHAs that was
conducted by the National Association of County Health Officials
and Centers for Disease Control (unpublished survey results,
1989). The percent of LPHAs reporting is calculated by dividing
the total number of LPHAs responding to the survey in each state
by the number of LPHAs reporting they provide the particular
service. The services that are provided by 70 percent of LPHAs
are underlined. The percent of units reporting will not be given
for states with five or fewer respondents. The service
information is provided in three major categories: assessment
activities, assurance activities, and policy development. The
data are presented in column format displayed as follows:
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 9 ( 23.1%)
2. Morbidity Data 25 ( 64.1%)
3. Reportable Diseases 33 ( 84.6%)
4. Vital Records and Statistics 36 ( 92.3%)
B. Epidemiology/Surveillance
1. Chronic Diseases 21 ( 53.8%)
2. Communicable Diseases 38 ( 97.4%)
II. Policy Development
A. Health Code Dev. and Enforcement 24 ( 61.5%)
B. Health Planning 13 ( 33.3%)
C. Priority Setting 21 ( 53.8%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 37 ( 94.9%)
2. Health Facility Safety/Quality 20 ( 51.3%)
3. Rec. Facility Safety/Quality 16 ( 41.0%)
4. Other Facility Safety/Quality 11 ( 28.2%)
B. Licensing
1. Health Facilities 7 ( 17.9%)
2. Other Facilities 34 ( 87.2%)
C. Health Education 27 ( 69.2%)
D. Environmental
1. Air Quality 6 ( 15.4%)
2. Hazardous Waste Management 11 ( 28.2%)
3. Individual Water Supply Safety 34 ( 87.2%)
4. Noise Pollution 3 ( 7.7%)
5. Occupational Health and Safety 4 ( 10.3%)
6. Public Water Supply Safety 20 ( 51.3%)
7. Radiation Control 7 ( 17.9%)
8. Sewage Disposal Systems 39 (100.0%)
9. Solid Waste Management 34 ( 87.2%)
10. Vector and Animal Control 38 ( 97.4%)
11. Water Pollution 17 ( 43.6%)
E. Personal Health Services
1. AIDS Testing and Counseling 39 (100.0%)
2. Alcohol Abuse 2 ( 5.1%)
3. Child Health 38 ( 97.4%)
4. Chronic Diseases 28 ( 71.8%)
5. Dental Health 12 ( 30.8%)
6. Drug Abuse 2 ( 5.1%)
7. Emergency Medical Service 1 ( 2.6%)
8. Family Planning 39 (100.0%)
9. Handicapped Children 3 ( 7.7%)
10. Home Health Care 38 ( 97.4%)
11. Hospitals 1 ( 2.6%)
12. Immunizations 39 (100.0%)
13. Laboratory Services 19 ( 48.7%)
14. Long-term Care Facilities 10 ( 25.6%)
15. Mental Health 2 ( 5.1%)
16. Obstetrical Care 19 ( 48.7%)
17. Prenatal Care 36 ( 92.3%)
18. Primary Care 22 ( 56.4%)
19. Sexually Transmitted Diseases 38 ( 97.4%)
20. Tuberculosis 39 (100.0%)
21. WIC 38 ( 97.4%)
Local Health Officer
M.D. Requirement, Appointment - This section shows if an M.D.
requirement exists and how the health officer is appointed.
The authority and responsibilities that this position holds are
described.
Local Board of Health
Advisory or Policy-making - This section is used to indicate
whether the local board of health has advisory or policy-making
responsibility. The existence, composition, terms of office, and
responsibilities of local boards of health are discussed.
Staff
This section contains a discussion of the staff of LPHAs.
Included is information about the employer of the staff,
supervision, and a range of staff size. The sources of these
data on the range of staff size are the National Association of
County Health Officials and the Centers for Disease Control
(unpublished survey results, 1989).
Budget
The total FY 1988 LPHA expenditures for each state and the United
States are provided. The source of funds is also provided. The
source of these data is Public Health Agencies 1990: An
Inventory of Programs and Block Grant Expenditures (2).
Following this outline will be a table of organization for the
SHA and a map of the state depicting the type and number of local
health departments, administrative regions/districts if they
exist, and the location of regional/district offices.
ALABAMA
Public Health System Profile
I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 4,103,000 245,803,000
Population Density (1988) 80.8 69.4
(per/sq.mi.)
Number of Counties 67 3,139
Median Age (1987) 31.0 31.7
Percent Below Poverty Level (1985) 20.6 14.0
(persons)
Percent of Population Rural (1980) 40.0 26.0
Percent of Population White (1980) 73.8 83.1
Percent of Population Non-white (1980) 26.2 16.9
Median Years of Education (1980) 12.2 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The source of power for Alabama counties is state statutes, which
establish the legal framework of county government and delineate
the authority and duties of the governing bodies.
Commission Form - (67) - This form is the basis of all county
governments in the state and is made up of three to seven members
usually elected from districts. About one-third of the counties
elect a probate judge, at large, who serves as the chair of the
commission. As chairman and presiding officer the judge is
responsible for recording proceedings of the commission, issuing
all necessary orders, administering finances, and generally
maintaining county authority. The chair is permitted to vote
only in tie-breaking situations. Other counties have a chair
that is elected from the commission with duties and authority
that are similar to those that general law confers on probate
judges who serve as chairs of county commissions. Counties that
have this arrangement have adopted it through local legislation.
Finally, there are 31 other counties that have appointed
administrators which assist the commission in daily
administration of the county.
Data for this state were updated February 1991.
II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Alabama Department of Public Health, the SHA, is a
free-standing, independent agency. The mission of the SHA is to
serve the people in Alabama by assuring conditions in which they
can be healthy. The SHA, under the direction of the State Board
of Health, has the following general responsibilities:
1. To exercise general control over the enforcement of the laws
relating to public health.
2. To investigate the causes, modes of propagation, and means
of prevention of diseases.
3. To investigate the influence of localities and employment on
the health of the people.
4. To inspect all schools, hospitals, asylums, jails, theaters,
opera houses, courthouses, churches, public halls, prisons,
stockades where convicts are kept, markets, dairies, milk
depots, slaughter pens or houses, railroad depots, railroad
cars, street railroad cars, lines of railroads and street
railroads, industrial and manufacturing establishments,
offices, stores, banks, club houses, hotels, rooming houses,
residences and other similar places. Whenever insanitary
conditions in any of these places, institutions or
establishments or conditions prejudicial to health, or
likely to become so, are found, proper steps are taken by
the proper authorities to have such conditions corrected or
abated.
The following are some specific areas of responsibility for the
SHA:
State Public Health Authority
Institutional Licensing Authority
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The State Health Officer is appointed by and functions under the
direction of the State Committee of Public Health. Statutes
require this individual to be a physician. The State Health
Officer acts as the executive officer of the Department of Public
Health on behalf of the Committee, when the Committee is not in
session. The State Health Officer also exercises general
supervision over county boards of health and county health
officers. It is the responsibility of the Health Officer to keep
abreast of all diseases which may be in danger of invading the
state, and to take prompt measures to prevent such invasions and
keep the Governor and the Legislature informed as to health
conditions prevailing in the state, especially as to outbreaks of
any notifiable diseases; and submit to the Governor and
Legislature recommendations for controlling the outbreaks.
C. State Board of Health/Council
Policy-making
The Medical Association of the state of Alabama serves as the
State Board of Health. There is also a State Committee of Public
Health which is composed of 12 members of the Board of Censors of
the Medical Association and the chairmen of 4 councils:
1) Council of Dental Health; 2) Council on Animal and
Environmental Health; 3) Council on the Prevention of Disease and
Medical Care; and 4) Council on Health Costs, Administration, and
Organization. Physician members of the Committee are selected by
the State Board of Health, one from each congressional district
in the state and the remainder from the state-at-large.
The "State Board of Health" is the same as the "State Committee
of Public Health" except when the State Board of Health is
actually in session. The State Committee of Public Health
possesses all of the prerogatives, powers, and duties prescribed
by law for the State Board of Health. The State Board of Health
may, by a three-fifths vote, alter or amend any action of the
State Committee of Public Health, but only when the board is in
session.
The duty of the four councils is to provide public health
information, evaluation of data, research, advice and
recommendation to the State Committee of Public Health and
perform other functions requested by the Committee.
D. Regional/District Health Offices
Alabama is divided into nine administrative regions called Public
Health Areas (see attached map). Area offices are commonly
staffed by individuals who fill the following positions:
Assistant State Health Officer
Clinicians
Area Disease Coordinator
Area Health Educator Coordinator
Area Nutrition Coordinator
Area Social Worker Coordinator
Area Nursing Director
Area Environmental Director
Area Administrator
Assistant Area Administrator
Area Clerical Director
Area Office Clerks
Most of the staffs of the area offices are in the chain of
command and involved in the supervision of the local health
department staffs. The Assistant State Health Officers supervise
the county and area health officers within their geographic area
of responsibility. In some counties the Assistant State Health
Officer for the Area will be appointed as the county health
officer, while in other areas the county will appoint someone
else as county health officer.
Alabama also has four district health departments. The district
health departments are Northwest Alabama Regional Health
Department (Colbert, Franklin, and Lauderdale counties),
Tri-county District Health Department (Cullman, Lawrence, and
Limestone counties), West Alabama District Health Department
(Bibb, Greene, Lamar, Pickens, and Tuscaloosa counties), and Gulf
Coast District Health Department (Baldwin, Conecuh, and Escambia
counties). These are historical, multicounty units which
function as units for some issues, such as funding, but generally
the counties in these districts have administrative functions
which are similar to other counties under the supervision of the
area office. While these units still exist, the current focus is
on the Public Health Areas rather than district health
departments.
E. State-local Liaison
Shared Organizational Control, Informal Liaison Function
The liaison function between the SHA and local health agencies is
accomplished through the formal chain of command that extends
from the SHA to Public Health Areas and to local health
departments.
The interaction between state and local public health agencies in
Alabama may be characterized as shared organizational control.
Under this arrangement local health departments are under the
authority of the state as well as the local government and board
of health.
F. Budget
Total FY 1988 SHA expenditures were $90,564,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $52,550,000
State Funds $34,906,000
Local Funds 0
Fees and Reimbursements $2,383,000
Other $726,000
III. Local Public Health Agencies (LPHAs)
A. General
The 67 county health departments in Alabama function as the LPHAs
in the state. They are staffed by State Merit System employees.
While general supervision and direction comes from the state,
there is also input from the local board of health. Budgets are
developed for each county and presented to the State Health
Officer for approval. These budgets are made up of a mixture of
local and state funds. State-appropriated funds are allocated to
the counties according to need.
B. Services Provided
The following information on services provided by local health
departments in Alabama is derived from a survey conducted by
NACHO during 1989. Thirty-nine of the 67 local health
departments in Alabama responded to the survey. Services
provided by 70 percent of health departments in the state
responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 9 ( 23.1%)
2. Morbidity Data 25 ( 64.1%)
3. Reportable Diseases 33 ( 84.6%)
4. Vital Records and Statistics 36 ( 92.3%)
B. Epidemiology/Surveillance
1. Chronic Diseases 21 ( 53.8%)
2. Communicable Diseases 38 ( 97.4%)
II. Policy Development
A. Health Code Dev. and Enforcement 24 ( 61.5%)
B. Health Planning 13 ( 33.3%)
C. Priority Setting 21 ( 53.8%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 37 ( 94.9%)
2. Health Facility Safety/Quality 20 ( 51.3%)
3. Rec. Facility Safety/Quality 16 ( 41.0%)
4. Other Facility Safety/Quality 11 ( 28.2%)
B. Licensing
1. Health Facilities 7 ( 17.9%)
2. Other Facilities 34 ( 87.2%)
C. Health Education 27 ( 69.2%)
D. Environmental
1. Air Quality 6 ( 15.4%)
2. Hazardous Waste Management 11 ( 28.2%)
3. Individual Water Supply Safety 34 ( 87.2%)
4. Noise Pollution 3 ( 7.7%)
5. Occupational Health and Safety 4 ( 10.3%)
6. Public Water Supply Safety 20 ( 51.3%)
7. Radiation Control 7 ( 17.9%)
8. Sewage Disposal Systems 39 (100.0%)
9. Solid Waste Management 34 ( 87.2%)
10. Vector and Animal Control 38 ( 97.4%)
11. Water Pollution 17 ( 43.6%)
E. Personal Health Services
1. AIDS Testing and Counseling 39 (100.0%)
2. Alcohol Abuse 2 ( 5.1%)
3. Child Health 38 ( 97.4%)
4. Chronic Diseases 28 ( 71.8%)
5. Dental Health 12 ( 30.8%)
6. Drug Abuse 2 ( 5.1%)
7. Emergency Medical Service 1 ( 2.6%)
8. Family Planning 39 (100.0%)
9. Handicapped Children 3 ( 7.7%)
10. Home Health Care 38 ( 97.4%)
11. Hospitals 1 ( 2.6%)
12. Immunizations 39 (100.0%)
13. Laboratory Services 19 ( 48.7%)
14. Long-term Care Facilities 10 ( 25.6%)
15. Mental Health 2 ( 5.1%)
16. Obstetrical Care 19 ( 48.7%)
17. Prenatal Care 36 ( 92.3%)
18. Primary Care 22 ( 56.4%)
19. Sexually Transmitted Diseases 38 ( 97.4%)
20. Tuberculosis 39 (100.0%)
21. WIC 38 ( 97.4%)
C. Local Health Officer
M.D. Requirement, County Board of Health Appointment
The county health officer is elected by the county board of
health subject to the approval of the State Committee of Public
Health. The local health officer, under the direction of the
State Health Officer and the county board of health, has sole
direction of all sanitary and public health work within the
county and incorporated municipalities.
D. Local Board of Health
Policy-making
The boards of censors of county medical societies, in affiliation
with the Medical Association of the state of Alabama and
organized in accordance with the provisions of its constitution,
are constituted county boards of health of their respective
counties under the supervision of the State Board of Health.
The duties of the county boards of health subject to the
supervision and control of the State Board of Health are as
follows:
1. To supervise the enforcement of the health laws of the
state, including all ordinances or rules and regulations of
municipalities or of county boards of health or of the State
Board of Health, and to supervise the enforcement of the law
for collection of vital and mortuary statistics and to adopt
and promulgate, if necessary, rules and regulations for
administering the health laws of the state and rules and
regulations of the State Board of Health, which rules and
regulations of the county boards of health have the force
and effect of law and are executed and enforced by the same
bodies, officials, agents and employees as in the case of
health laws.
2. To investigate, through county health officers or quarantine
officers, cases or outbreaks of any notifiable diseases and
to enforce such measures for the prevention or extermination
of said diseases as are authorized by law.
3. To investigate, through county health officers or quarantine
officers, all nuisances to public health and, through said
officers, to take proper steps for the abatement of such
nuisances.
4. To exercise, through county health officers or quarantine
officers, special supervision over the sanitary conditions
of schools, hospitals, asylums, jails, theaters, opera
houses, courthouses, churches, public halls, prisons,
markets, dairies, milk depots, slaughter pens or houses,
railroad depots, railroad cars, dining cars, street railroad
cars, lines of railroads and street railroads, airports,
industrial and manufacturing establishments, offices,
stores, banks, club houses, hotels, rooming houses,
residences and the sources of supply, tanks, reservoirs,
pumping stations and avenues of conveyance of drinking water
and other institutions and places of like character and,
whenever unsanitary conditions are found, to use all legal
means to have the same abated.
E. Staff
Staffs of local health departments belong to the State Merit
System. They may be employed locally and paid with funds from a
variety of sources, but they are technically state employees.
The number of full-time employees for local health departments
ranges from 7 to 694.
F. Budget
Total FY 1988 LPHA expenditures were $52,557,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts 0
State Funds $8,101,000
Local Funds $13,999,000
Fees and Reimbursements $29,639,000
Other Sources 0
Source Unknown $818,000
2Alabama Department Of Public Health, 1990
State Government
State Board of Health
State Committee of Public Health
State Health Officer
General Counsel
Staff Assistant for Legislative Affairs
State Assistant for Capital Expansion
Staff Assistant for Professional Services
Public Health Nursing
Office of Administrative Services
Office of Health Promotion and Information
Office of Internal Audit
Office of Management Services
Bureau of Clinical Laboratories
Division of Administrative Support Services
Division of Microbiology
Division of Microbacteriology/Mycology
Division of Scientific Services
Division of Serology
Birmingham Division
Decatur Division
Dothan Division
Mobile Division
Bureau of Environmental and Health Service Standards
Division of Environmental Health
Division of Licensure and Certification
Public Health Areas
County Health Departments
Bureau of Disease Control and Rehabilitative Services
Division of Disease Control
Division of Epidemiology
Division of Long-Term Care and Rehabilitation
Division of AIDS Prevention and Control
Bureau of Family Health Services
Division of Family Planning
Division of Maternity Services
Division of Child Health
Division of WIC
Dental Health Section
Division of Family Planning
Bureau of Vital Statistics
Division of Record Preservation and Certification Services
Division of Record Services
Division of Registration Services
Division of Statistical Analysis Services
2Types of Local Health Departments by Jurisdiction
Alabama, 1990
Jurisdiction Co
Autauga X
Baldwin X
Barbour X
Bibb X
Blount X
Bullock X
Butler X
Calhoun X
Chactaw X
Chambers X
Cherokee X
Chilton X
Clark X
Clay X
Cleburne X
Coffee X
Colbert X
Conecuh X
Coosa X
Covington X
Crenshaw X
Cullman X
Dale X
Dallas X
De Kalb X
Elmore X
Escambia X
Etowah X
Fayette X
Franklin X
Geneva X
Greene X
Hale X
Henry X
Houston X
Jackson X
Jefferson X
Lamar X
Lauderdale X
Lawrence X
Lee X
Limestone X
Lowndes X
Macon X
Madison X
Marengo X
Marion X
Marshall X
Mobile X
Monroe X
Montgomery X
Morgan X
Perry X
Pickens X
Pike X
Randolph X
Russell X
Shelby X
St. Clair X
Sumter X
Talladega X
Tallapoosa X
Tuscaloosa X
Walker X
Washington X
Wilcox X
Winston X
Co = County HD
1ALASKA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 524,000 245,803,000
Population Density (1988) 0.9 68.8
(per/sq.mi.)
Number of Counties 0 3,139
Median Age (1987) 28.4 31.7
Percent Below Poverty Level (1985) 8.8 14.0
(persons)
Percent of Population Rural (1980) 36.0 26.0
Percent of Population White (1980) 77.1 83.1
Percent of Population Non-white (1980) 22.9 16.9
Median Years of Education (1980) 12.8 12.5
(25 years of age and over)
B. Local Government Structure
Home Rule Authority
The organization of local government in Alaska is governed by the
state constitution and statutes. Cities and boroughs are legal
entities (municipalities) which perform both regulatory and
proprietary functions. Alaska has three types of general law
boroughs and two types of general law cities. In addition, both
boroughs and cities may also adopt charters providing for home
rule. General law cities may adopt charters providing for home
rule. General law cities and boroughs can perform only those
functions permitted by law, while home rule cities and boroughs
can perform functions that are not prohibited by law or charter.
Unified home rule municipalities are entities composed of an
organized borough and all the cities within the geographic limits
of that borough.
Alaska currently has 14 organized boroughs that include about 40
percent of the state's land mass and 85 percent of the
population. The remainder of the state consists of a single
unorganized borough.
Data for this state were updated February 1991.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Division of Health, the SHA, is a component of the
superagency, the Department of Health and Social Services
(DHSS). The Department is under the direction of a Commissioner
who is appointed by the Governor and is a member of his cabinet.
The Division of Public Health exists to prevent disease and
premature mortality through promotion of positive health
practices and to minimize disability and the need for
institutionalization through the early detection of disease and
appropriate intervention. Programs are directed from the central
office in Juneau and supervisory offices in Juneau, Anchorage,
Fairbanks, and Bethel. Activities of the Division run the gamut
from genetic screening to training of emergency medical services
personnel. The Division's programs are both directly operated by
state employees and by grants and contracts with non-profit
entities.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
B. Head of State Health Agency
No M.D. Requirement, Commissioner Appointment
The Director of the Division of Public Health is the head of the
SHA. This official is appointed by the Commissioner of Health
and Social Services and is not required to be a physician. The
Director's responsibilities include overall policy and
operational direction of the Division.
C. State Board of Health/Council
Alaska does not have a State Board or Council of Health.
D. Regional/District Health Offices
Public health nursing programs have regional offices in
Anchorage, Bethel, and Juneau. No single regional official or
office has jurisdiction over all public health programs within
the geographic limits of the region. Although local governmental
units generally can choose to provide public health services,
most have not done so because of small populations and tax bases
and the high cost of providing such services.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
No single individual or office has responsibility for state-local
liaison functions. Communications between these levels usually
follow the chain of command.
The interaction between state and local public health agencies in
Alaska may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement
local health services may be provided by the SHA in some
jurisdictions and by local governmental units or by non-profit
agencies which receive grants from the SHA to provide specific
services.
F. Budget
Total FY 1988 Alaska SHA expenditures were $29,403,000. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $5,377,000
State Funds $23,733,000
Local Funds 0
Fees and Reimbursements $292,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Alaska has two LPHAs: the North Slope Borough and the Anchorage
Municipal Health Department. These units receive financial
assistance from the state for specified public health
activities. In addition, some public health services, often in
the realm of personal health services, are provided by the
Regional Native Health Corporations. The state provides grant
funds for these services in response to specific grant
applications. In the case of two such corporations, the state
grants include funds for public health nursing services. For
both local governmentally sponsored and corporation sponsored
systems, the state continues to provide certain direct services
such as epidemiology.
In areas that are not served by local health departments, the
state provides direct health services through the Section of
Nursing in the Division of Public Health. The Section of Nursing
supports 21 health centers which are staffed by public health
nurses and itinerate public health nurses. The staff of these
centers consist of state employees who are under state direction
and who report within the state chain of command. While these
health centers probably meet the Miller definition for local
health departments, the state prefers not to include them in this
category.
In Alaska has evolved a unique system of health care which
provides services to the state's ethnically diverse and
geographically scattered population. This system is composed of
the State Division of Public Health, the Indian Health Service
(IHS), Native Regional Health Corporations, and private
physicians.
Public health nursing supports 21 health centers. The public
health nurse network, which currently consists of 100 nurses,
provides the first line of primary care by delivering services to
over 200 communities.
The U.S. Public Health Service plays an important role in the
state's health care system. The IHS operates a system of eight
service units. Each service unit's field hospital or clinic
serves as the activity hub for health centers. Although public
health nursing and IHS serve many of the same people, a general
agreement regarding responsibilities avoids service duplication.
Under powers granted in the Alaska Native Claims Settlement Act
of 1971, Native corporations have established regional health
authorities. Each of the 12 regional health corporations have
assumed administrative responsibility for the village-based
community health aides (CHAs). The CHAs work in village health
clinics and are guided by radio and/or telephone communications
with IHS physicians. CHAs comprise a significant portion of the
rural primary health care network.
To prevent service duplication of effort, public health nursing,
the IHS, and the Native Regional Health Corporations work to
coordinate services at three levels. DHSS program managers, IHS
service unit administrators, and the regional health authorities
consult with each other on long-range planning. Public health
nurses, IHS medical staff and CHA program coordinators meet at
regular intervals to coordinate efforts. Moreover, when public
health nurses and IHS physicians visit a village, they join the
CHAs in a team effort to deliver necessary services.
B. Services Provided
The following information on services provided by local health
departments in Alaska is derived from a survey conducted by NACHO
during 1989. Both local health departments in Alaska responded
to the survey.
Services Provided by LPHAs Number of LPHAs
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment -
2. Morbidity Data -
3. Reportable Diseases 1
4. Vital Records and Statistics 1
B. Epidemiology/Surveillance
1. Chronic Diseases -
2. Communicable Diseases 2
II. Policy Development
A. Health Code Dev. and Enforcement 2
B. Health Planning 2
C. Priority Setting 2
III. Assurance Activities
A. Inspection
1. Food and Milk Control 1
2. Health Facility Safety/Quality 1
3. Rec. Facility Safety/Quality 2
4. Other Facility Safety/Quality 2
B. Licensing
1. Health Facilities -
2. Other Facilities 1
C. Health Education 2
D. Environmental
1. Air Quality 1
2. Hazardous Waste Management 2
3. Individual Water Supply Safety 2
4. Noise Pollution 1
5. Occupational Health and Safety -
6. Public Water Supply Safety 1
7. Radiation Control -
8. Sewage Disposal Systems 2
9. Solid Waste Management 1
10. Vector and Animal Control 2
11. Water Pollution 2
E. Personal Health Services
1. AIDS Testing and Counseling 2
2. Alcohol Abuse 2
3. Child Health 2
4. Chronic Diseases 1
5. Dental Health 2
6. Drug Abuse 1
7. Emergency Medical Service 1
8. Family Planning 2
9. Handicapped Children 1
10. Home Health Care 1
11. Hospitals 1
12. Immunizations 2
13. Laboratory Services 1
14. Long-term Care Facilities -
15. Mental Health 1
16. Obstetrical Care 1
17. Prenatal Care 1
18. Primary Care 1
19. Sexually Transmitted Diseases 2
20. Tuberculosis 2
21. WIC 2
C. Local Health Officer
The Municipality of Anchorage is the only area in Alaska with a
local health officer. The health officer is appointed by the
local governing body and is not required to be a physician.
Responsibility of the health officer includes overall management
of the department and its programs.
D. Local Board of Health
Some communities have formal or informal health councils or
boards with membership drawn from the general population and
representative of voluntary and official agencies.
E. Staff
The staffs of local health departments range in size from 120 to
200. The staff of the Municipality of Anchorage Health
Department and the North Slope Borough Health Department are
employed and supervised by the local jurisdiction.
F. Budget
Total FY 1988 LPHA expenditures were $1,388,000*. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts 0
State Funds $1,388,000
Local Funds 0
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
* These data include only state funds that were given to the
2Alaska Department Of Health And Social Services, 1990
Commissioner, Department of Health and Social Services
Director, Division of Public Health
Family Health Section
Early Prevention Program
Infant Learning Program
Handicapped Children's Program
Communicable Disease Unit
Genetics Services
Maternal and Adolescent Health Unit
WIC
Nutrition Services
Nursing Section
Bethel Nursing
Northern Region Nursing
Southeast Region Nursing
Southcentral Region Nursing
Contract Services
Home Health
EPSDT
Record Patient Management System
Emergency Medical Services Section
Statewide Coordination and Administration
Training/Licensing
Injury Prevention Education
Epidemiology Section
Disease Reporting, Survey and Investigation
Chronic Diseases
Data Processing and Statistical Analysis
Infectious Diseases
Administrative Support
Occupational Health/Environmental
Risk Assessment/Injury Prevention
Laboratory Section
Public Health Lab-Juneau
Public Health Lab-Anchorage
Public Health Lab-Fairbanks
Radiological Health
Vital Statistics
Records
Research
Training
2Types of Local Health Departments by Jurisdiction
Alaska, 1990
Jurisdiction Bu C
Anchorage X
North Slope X
Bu = Burrough HD
C = City HD
1ARIZONA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 3,487,000 245,803,000
Population Density (1988) 30.7 69.4
(per/sq.mi.)
Number of Counties 15 3,139
Median Age (1987) 31.0 31.7
Percent Below Poverty Level (1985) 10.7 14.0
(persons)
Percent of Population Rural (1980) 16.0 26.0
Percent of Population White (1980) 82.4 83.1
Percent of Population Non-white (1980) 17.6 16.9
Median Years of Education (1980) 12.7 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The Arizona Constitution and Statutes establish and empower the
county governments. They also give the legislature
responsibility for establishing the mission for counties.
Commission Form - (15) - All 15 county governments are based on
the Commission Form. The commissions are made up generally of
three-member Boards of Supervisors. Five counties have chosen to
increase the number of supervisors on their boards from three to
five. The Boards of Supervisors and other elected county
officials fulfill the executive function for counties since there
are no elected executive officers. All 15 counties appoint an
administrator to handle the administrative responsibilities of
the counties, even though this position is not supported by the
constitution or statutes.
Arizona counties are administrative arms of the state and do not
have any authority that is not granted them by the constitution
and statutes. They have no authority to adopt home rule
provisions or charters.
Data for this state were updated December 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Arizona Department of Health Services (ADHS), the SHA, is a
free-standing, independent agency. Its mission is to protect and
improve the health status of residents by identifying health
issues and developing interventions to prevent disease,
disability, and premature death.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Mental Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal
Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Director of ADHS is appointed by and responsible to the
Governor. The Director is responsible for formulating policies,
plans, and programs to effectuate the mission and purpose of the
Department. Requirements for office include administrative
experience and an educational background that prepares the
Director for the administrative responsibilities assigned to the
position.
C. State Board of Health/Council
There is no State Board of Health.
D. Regional/District Health Offices
Although the state is not divided into districts or regions,
ADHS does have two satellite offices located in Flagstaff and
Tucson. The staffs in these offices are employees of the ADHS.
Typical positions in these offices are for purposes of
monitoring, i.e., certification and licensure surveyors.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The Office of Local Health Services has the responsibility for
state-local liaison activities. Major functions that fall within
the liaison role are communication, coordination, and
representing the local health department perspective to the SHA.
Other activities include generalized public health consultation,
technical assistance, facilitation, and education.
The interaction between state and local public health agencies in
Arizona may be characterized as decentralized organizational
control. Under this arrangement, local government directly
operates a health department with or without a board of health.
F. Budget
Total FY 1988 Arizona SHA expenditures (data provided by SHA)
were $170,276,332. Total FY 1988 United States SHA expenditures
were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $40,676,564
State Funds $112,655,609
Local Funds 0
Fees and Reimbursements $3,976,483
Other $15,622,651
3III. Local Public Health Agencies (LPHAs)
A. General
Arizona has 15 LPHAs that exist in the form of county health
departments. Local health departments are each independent and
separate from the ADHS. The local health agency selectively
accepts delegation and agrees to perform the functions, conferred
in accordance with standards of performance established by the
Director of the ADHS. In summary, the local health department is
the direct service extension of the ADHS to insure mandatory
services are provided at the local level.
State funds are provided to local health departments mainly in
the form of contracts for services; however, some funds are
available through grant mechanisms.
B. Services Provided
The following information on services provided by local health
departments in Arizona is derived from a survey conducted by
NACHO during 1989. All 15 of the local health departments in
Arizona responded to the survey. Services provided by 70 percent
of the local health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 6 ( 40.0%)
2. Morbidity Data 4 ( 26.7%)
3. Reportable Diseases 15 (100.0%)
4. Vital Records and Statistics 5 ( 33.3%)
B. Epidemiology/Surveillance
1. Chronic Diseases 7 ( 46.7%)
2. Communicable Diseases 15 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 12 ( 80.0%)
B. Health Planning 11 ( 73.3%)
C. Priority Setting 12 ( 80.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 13 ( 86.7%)
2. Health Facility Safety/Quality 9 ( 60.0%)
3. Rec. Facility Safety/Quality 12 ( 80.0%)
4. Other Facility Safety/Quality 9 ( 60.0%)
B. Licensing
1. Health Facilities 2 ( 13.3%)
2. Other Facilities 13 ( 86.7%)
C. Health Education 13 ( 86.7%)
D. Environmental
1. Air Quality 4 ( 26.7%)
2. Hazardous Waste Management 5 ( 33.3%)
3. Individual Water Supply Safety 9 ( 60.0%)
4. Noise Pollution 1 ( 6.7%)
5. Occupational Health and Safety 2 ( 13.3%)
6. Public Water Supply Safety 10 ( 66.7%)
7. Radiation Control 3 ( 20.0%)
8. Sewage Disposal Systems 14 ( 93.3)
9. Solid Waste Management 9 ( 60.0%)
10. Vector and Animal Control 13 ( 86.7%)
11. Water Pollution 8 ( 53.3%)
E. Personal Health Services
1. AIDS Testing and Counseling 13 ( 86.7%)
2. Alcohol Abuse -
3. Child Health 11 ( 73.3%)
4. Chronic Diseases 8 ( 53.3%)
5. Dental Health 2 ( 13.3%)
6. Drug Abuse -
7. Emergency Medical Service 1 ( 6.7%)
8. Family Planning 13 ( 86.7%)
9. Handicapped Children 4 ( 26.7%)
10. Home Health Care 7 ( 46.7%)
11. Hospitals -
12. Immunizations 14 ( 93.3%)
13. Laboratory Services 6 ( 40.0%)
14. Long-term Care Facilities 1 ( 6.7%)
15. Mental Health 2 ( 13.3%)
16. Obstetrical Care 1 ( 6.7%)
17. Prenatal Care 7 ( 46.7%)
18. Primary Care 2 ( 13.3%)
19. Sexually Transmitted Diseases 15 (100.0%)
20. Tuberculosis 15 (100.0%)
21. WIC 12 ( 80.0%)
C. Local Health Officer
No M.D. Requirement, Board of Supervisors Appointment
The local health officer is appointed by the County Board of
Supervisors. Each county establishes individual requirements,
experience, and education for the health officer. Authority and
responsibilities of local health officers include: providing
full-time public health services; employing qualified personnel
and utilizing local, state, Federal, and other funds, or any
combination of funds to provide services at the local level in
conformity with the rules, regulations and policies of the State
Health Department.
D. Local Board of Health
Advisory
The size of the board of health of each county is dependent upon
the number of supervisory districts. The board must include a
member of the board of supervisors, a licensed physician, and
citizen members. The term served by each member is 4 years. The
local health department director serves as an ex officio member.
The board acts in an advisory capacity to the Board of
Supervisors and the local health department.
E. Staff
Staffs of the local health departments are employed and
supervised by the local health jurisdiction. Some local staff
are part of the State Merit System, but most belong to local
systems. Authority of the staff is determined at the local level
in accordance with policy, rules, and regulations set at the
state level. The number of employees of local health departments
ranges from 7 to 500.
F. Budget
Total FY 1988 LPHA Expenditures (data provided by SHA) were
$220,556,000. Total FY 1988 United States LPHA expenditures were
$3,978,948,000.
Source of Funds
Federal Grants and Contracts $6,077,000
State Funds 5,010,000
Local Funds $86,681,000
Fees and Reimbursements $101,901,000
Other Sources $2,571,000
Source Unknown $19,000,000
The SHA reported that there were additional fees and
reimbursements not retained by the local health departments, but
which reverted to the general revenues of the local or state
government. The SHA also reported that these figures include the
total amount of additional local health department monies
expended by all local health departments.
2Arizona Department Of Health Services, 1990
Governor
Director
Disease Control Research Commission
Deputy Director
Division of Disease Prevention Services
Chronic Disease Epidemiology
Infectious Disease Services
Health Education
Risk Assessments and Investigations
Division of Laboratory Services
Chemistry
Lab Certification
Microbiology
Regional Labs
Division of Family Health Services
Children's Rehabilitation Services
Dental Health
Maternal and Child Health
Nutrition
Division of Emergency Medical Services and Health Care
Facility
Emergency Medical Services
Child Day Care Licensing
Health Facilities Licensure
Health Economics and Facility Development
Director/Departmental Support Services
Affirmative Action
Planning and Health Status Monitoring
Local and Border Health
Public Information
Operations
Division of Behavioral Health Services
Arizona State Hospital
South Arizona Mental Health Clinic
Community Behavioral Health
Chronically Mentally Ill
Behavioral Health Licensure
2Types of Local Health Departments by Jurisdiction
Arizona, 1990
Jurisdiction Co
Apache X
Cochise X
Coconino X
Gila X
Graham X
Greenlee X
La Paz X
Maricopa X
Mohave X
Navajo X
Pima X
Pinal X
Santa Cruz X
Yavapai X
Yuma X
Co = County HD
1ARKANSAS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 2,395,000 245,803,000
Population Density (1988) 46.0 69.4
(per/sq.mi.)
Number of Counties 75 3,139
Median Age (1987) 32.2 31.7
Percent Below Poverty Level (1985) 22.9 14.0
(persons)
Percent of Population Rural (1980) 48.0 26.0
Percent of Population White (1980) 82.7 83.1
Percent of Population Non-white (1980) 17.3 16.9
Median Years of Education (1980) 12.2 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
Arkansas counties receive their structure and authority from what
is known as the County Government Code. This Code is actually a
part of the constitution that was amended in 1975 (Amendment 55)
and Act 742 that was passed in 1977.
Quorum Court Form - (75) - Under this type of government the
legislative body is made up of 9 to 15 justices of the peace who
are elected from single-member districts. A county judge who is
elected at large serves as chairman of the legislative body and
administers the affairs of the government.
Home Rule - While it is not called home rule, Chapter 37 of the
County Government Code gives county governments authority that is
similar to home rule. It provides counties with options to
establish different governmental organizations and structures,
such as consolidations. Also, the constitution empowers Quorum
Courts to enact any legislation that is not prohibited by the
constitution or state statutes.
Data for this state were updated October 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Arkansas Department of Health (ADH) is a free-standing,
independent agency. The agency's mission is to promote and
protect the public health and well-being of the citizens of
Arkansas. Efforts are directed in the areas of direct provision
of preventive, environmental, and personal health care services;
certification and monitoring of certain health facilities,
systems, and providers; and serving as a catalyst to improve the
state's health care system and environmental quality.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Professions Licensing Authority
Institutional Licensing Authority
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The head of the SHA is the Director of the ADH. This office is a
cabinet-level appointment that is made by the Governor. The
Director is required to be a physician and also serves as
Secretary of the State Board of Health. The role of the Director
is to oversee the general operations of the agency and to promote
public health in Arkansas.
C. State Board of Health/Council
Policy-making
The State Board of Health is a policy-making body made up of 21
members, appointed by the Governor. The Governor selects the
members from lists of names submitted by organizations, such as
the State Medical Society, that are represented on the Board.
The following professions or groups are represented on the
Board: seven licensed medical doctors; one licensed, registered
dentist; one registered, professional engineer; one licensed,
professional nurse; one licensed pharmacist; one licensed
veterinarian; one registered sanitarian; one hospital
administrator; one licensed, registered optometrist; one licensed
chiropractor; one restaurant operator; one consumer
representative; one licensed doctor of podiatric medicine; one
member of the Arkansas Public Health Association; and one member
over 60 who is not actively engaged in or retired from any
occupation, profession, or industry to be regulated by the State
Board of Health.
D. Regional/District Health Offices
The ADH has divided the state into 10 management areas, each with
an area office. These area offices are responsible for the
day-to-day administrative oversight of the local health units and
for the oversight of programs, operations, and professional
standards in the health units. The administrative structure of
the area office consists of an area manager and his/her core
team. The core team includes a nursing supervisor, sanitarian
supervisor, and a records and clerical supervisor.
E. State-local Liaison
Centralized Organizational Control, Formal Liaison Function
The Bureau of Community Health Services is ADH's liaison with the
area offices and local health units. The Bureau has line
authority over the area offices and local health units (field
operations). The Bureau provides direction and general
supervision to the area offices which, in turn, provide the same
to local health units.
The interaction between state and local public health agencies in
Arkansas may be characterized as centralized organizational
control. Under this arrangement, local health departments
function directly under the state's authority and are operated by
the SHA or State Board of Health.
F. Budget
Total FY 1988 SHA expenditures were $67,265,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $29,150,000
State Funds $26,101,000
Local Funds 0
Fees and Reimbursements $10,694,000
Other $1,321,000
3III. Local Public Health Agencies (LPHAs)
A. General
Ninety-seven LPHAs, called local health units in Arkansas,
provide various services throughout the state. The basic
administrative/service jurisdiction is the county. Several
counties, however, have more than one local health unit.
B. Services Provided
The following information on services provided by local health
departments in Arkansas is derived from a survey conducted by
NACHO during 1989. Fifty of the 97 local health departments in
Arkansas responded to the survey. The services provided by 70
percent of the local health units in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 14 ( 28.0%)
2. Morbidity Data 19 ( 38.0%)
3. Reportable Diseases 45 ( 90.0%)
4. Vital Records and Statistics 46 ( 92.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases 29 ( 58.0%)
2. Communicable Diseases 49 ( 98.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 13 ( 26.0%)
B. Health Planning 24 ( 48.0%)
C. Priority Setting 19 ( 38.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 46 ( 92.0%)
2. Health Facility Safety/Quality 22 ( 44.0%)
3. Rec. Facility Safety/Quality 34 ( 68.0%)
4. Other Facility Safety/Quality 9 ( 18.0%)
B. Licensing
1. Health Facilities 3 ( 6.0%)
2. Other Facilities 27 ( 54.0%)
C. Health Education 34 ( 68.0%)
D. Environmental
1. Air Quality 6 ( 12.0%)
2. Hazardous Waste Management 15 ( 30.0%)
3. Individual Water Supply Safety 42 ( 84.0%)
4. Noise Pollution 2 ( 4.0%)
5. Occupational Health and Safety 4 ( 8.0%)
6. Public Water Supply Safety 27 ( 54.0%)
7. Radiation Control 9 ( 18.0%)
8. Sewage Disposal Systems 44 ( 88.0%)
9. Solid Waste Management 16 ( 32.0%)
10. Vector and Animal Control 37 ( 74.0%)
11. Water Pollution 22 ( 44.0%)
E. Personal Health Services
1. AIDS Testing and Counseling 43 ( 86.0%)
2. Alcohol Abuse 1 ( 2.0%)
3. Child Health 50 (100.0%)
4. Chronic Diseases 37 ( 74.0%)
5. Dental Health 10 ( 20.0%)
6. Drug Abuse 3 ( 6.0%)
7. Emergency Medical Service 4 ( 8.0%)
8. Family Planning 48 ( 96.0%)
9. Handicapped Children 9 ( 18.0%)
10. Home Health Care 46 ( 92.0%)
11. Hospitals 1 ( 2.0%)
12. Immunizations 50 (100.0%)
13. Laboratory Services 21 ( 42.0%)
14. Long-term Care Facilities 1 ( 2.0%)
15. Mental Health 2 ( 4.0%)
16. Obstetrical Care 15 ( 30.0%)
17. Prenatal Care 42 ( 84.0%)
18. Primary Care 5 ( 10.0%)
19. Sexually Transmitted Diseases 49 ( 98.0%)
20. Tuberculosis 50 (100.0%)
21. WIC 50 (100.0%)
C. Local Health Officer
M.D. Requirement, State Board of Health Appointment
Arkansas law created the position of county health officer and
describes the duties. The statute requires the State Board of
Health to appoint a county health officer for each county. The
appointment is subject to the approval of the county judge. The
State Board of Health appoints the county health officers for
2-year terms, but has very limited interaction with them. The
county health officer is directed by the Local Health Unit
Administrator, the Director of ADH, and the State Board of
Health. The county health officer was used more in the past
during quarantines, but because quarantines are now rare, the
health officer is much less active. Specific duties set by
statute and by the health department for a county health officer
include the following:
Requirements Set by ADH
1. Maintain interest and knowledge of health unit activities
and of county's health needs; represent needs to those in
power; serve as an advocate for the health unit in the
community and as a liaison between health unit and peers
(medical society), State Board of Health, state medical
officer and political leadership.
2. Uphold and observe ADH standards, policies, and procedures.
3. Have a role in planning, coordinating, and approving
community services; serve on health advisory board.
4. Assist and act as medical consultant in handling epidemics;
report contagious diseases to the ADH in an effort to
prevent communicable disease.
5. Maintain good rapport and regular contact with health unit
staff.
6. Be available for consultation in event of public disaster or
emergency.
Requirements Set by Statute
1. Caring for prisoners in county jails.
2. Caring for inmates of county poor farms and hospitals.
3. County quarantine.
4. Assist the ADH and State Board of Health in the following:
a. Matters of local quarantine
b. Inspection for sanitary purposes
c. Prevention and suppression of disease
d. General sanitation
e. Vital statistics
f. Submission of reports to the Board of Health where
required
D. Local Board of Health
There are no local boards of health in Arkansas.
E. Staff
The staffs of the area offices and local health units are
employed by ADH. The number of employees in a local health unit
ranges from 2 to 65.
F. Budget
Since Arkansas does not consider the local service units to be
local health departments, expenditure data are not available.
2Arkansas Department Of Health, 1990
Director
Deputy Director
Deputy Director Health Promotion and Services
Bureau of Administrative Support Services
Division of Data Processing
Division of Financial Management
Division of Maintenance
Division of Personnel Management
Office of Legal Services
Division of Central Supply and Services
Bureau of Public Health Program
Section of Maternal and Child Health
Division of Infant and Child Health
Division of Perinatal Health
Division of Reproduction Health
Office of Hearing, Speech and Vision
Division of WIC
Section of In-Home Service
Division of Home Health
Division of Personal Care
Office of Home Care
Office of Hospice
Office of Independence Plan
Office of Blood Alcohol
Office of Dental Health
Section of Health Maintenance
Division of AIDS/STD
Division of Communicable Disease and Immunization
Division of Tuberculosis
Division of Chronic Diseases and Disabilities Prevention
Bureau of Community Health Services
10 Area Offices (with Support Teams)
97 Local Health Units
Office of Policies and Procedures
Office of Quality Assurance
Division of Epidemiology
Office of Epizootic Diseases
Bureau of Health Resources
Division of Health Education and Promotion
Division of Medical Social Services
Division of Nursing Services
Division of Nutrition Services
Division of Pharmacy and Drug Control
Division of Records and Clerical
Section of Health Facilities Services and Systems
Division of Vital Records
Center for Health Statistics
Bureau of Environmental Health Services
Division of Engineering
Division of Radiation Control and Emergency Management
Division of Public Health Laboratories
Division of Sanitarian Services
Division of Plumbing and Natural Gas Control
2Types of Local Health Departments by Jurisdiction
Arkansas, 1990
Jurisdiction Co
Arkansas X
Ashley X
Baxter X
Benton X
Boone X
Bradley X
Calhoun X
Carroll X
Chicot X
Clark X
Clay X
Cleborne X
Cleveland X
Columbia X
Conway X
Craighead X
Crawford X
Crittenden X
Cross X
Dallas X
Desha X
Drew X
Faulkner X
Franklin X
Fulton X
Garland X
Grant X
Greene X
Hemstead X
Hot Spring X
Howard X
Independence X
Izard X
Jackson X
Jefferson X
Johnson X
Lafayette X
Lawrence X
Lee X
Lincoln X
Little River X
Logan X
Lonoke X
Madison X
Marion X
Miller X
Mississippi X
Monroe X
Montgomery X
Nevada X
Newton X
Ocachita X
Perry X
Phillips X
Pike X
Poinsett X
Polk X
Pope X
Prairie X
Pulaski X
Randolph X
Saline X
Scott X
Searcy X
Sebastian X
Sevier X
Sharp X
St. Francis X
Stone X
Union X
Van Buren X
Washington X
White X
Woodruff X
Yell X
Co = County HD
1CALIFORNIA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 28,314,000 245,803,000
Population Density (1988) 181.1 69.4
(per/sq.mi.)
Number of Counties 58 3,139
Median Age (1987) 31.3 31.7
Percent Below Poverty Level (1985) 13.6 14.0
(persons)
Percent of Population Rural (1980) 9.0 26.0
Percent of Population White (1980) 76.2 83.1
Percent of Population Non-white (1980) 23.8 16.9
Median Years of Education (1980) 12.7 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
County governments in California are given two options under the
state constitution: General Law or Charter status.
General Law - (46) - Authority for the operation of General Law
counties is found in Article XI of the California Constitution
and Law found in the Government Code.
Charter - (12) - Charter counties operate under the authority of
the Charter. A charter may be proposed by a County Board of
Supervisors or by a Charter Commission.
Commission Form - (7) - Both General Law and Charter governments
have several options they can chose as to the structure of their
governments. They can operate under a "pure" Commission with a
Board of Supervisors which serves as the legislative and
executive bodies for the county.
County Administrator - (50) - Fifty counties have appointed
County Administrators.
Elected Executive - (1) - San Francisco is the only county
operating with an elected executive (mayor). This option is open
only to Charter counties. San Francisco is also the only
Data for this state were updated October 1990. city-county
consolidation. Another unique feature of this government is the
presence of two executive officers. The mayor is elected at large
and the chief administrative officer is appointed. The legislative
body for the county is made up of an 11-member Board of Supervisors.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Department of Health Services is a component of the
superagency called the California Health and Welfare Agency. The
mission of the Department is to protect the health of all
Californians. The goals set to accomplish this mission are to:
promote an environment that will contribute to human health and
well-being; assure the availability to equal access to
comprehensive health services; emphasize prevention-oriented
health care programs; promote the development of knowledge
concerning the causes and cures of illness and the means of
delivering health services to the public; assure economic
expenditure of public funds to serve those with the greatest
need. These goals are carried out through the following 11
programs:
Preventive Medical Services
Toxic Substance Control
Environmental Health
AIDS
Family Health Services
Laboratory Services
Rural and Community Health
Medical Care Services
Licensing and Certification
Audits and Investigations
Special Projects
The following are some areas of responsibility for the SHA:
State Public Health Authority
Medicaid Single State Agency
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The head of the SHA is the Director of Health Services. This
individual is appointed by the Governor and approved by the
legislature. There is no M.D. requirement. The responsibilities
are to administer the activities of the Department of Health.
C. State Board of Health/Council
No State Board of Health
There is no state board of health. Several advisory groups,
however, have been formed that have no mandated authority (the
California Conference of Local Health Officers is an example).
D. Regional/District Health Offices
California is not regionalized nor does it have district health
offices in relationship to the Department of Health Services.
The state does have field offices which are solely an
administrative arm of the state to provide a closer
administrative structure for the purpose of authorizing treatment
and fielding provider problems. No patient or health services
are provided from these offices.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The Chief of the County Health Services Branch, Division of Rural
and Community Health Services, is designated as the state-local
liaison. In addition there is support from the Office of
External Affairs which is responsible for organizing the
Conference of Local Health Officers. These two organizational
units also are responsible for the dissemination of information
and issues surrounding local health departments.
The interaction between state and local public health agencies in
California may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement,
local health services in the state may be provided by the SHA in
some jurisdictions and by local governmental units in others.
F. Budget
Total FY 1988 California SHA expenditures (excluding Medi-Cal and
so forth) were $792,670,000. Total FY 1988 United States SHA
expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $259,746,000
State Funds $531,076,000
Local Funds 0
Fees and Reimbursements 0
Other $1,848,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 61 local public health agencies in California. These
consist of 58 county and 3 city health departments (see map).
There are 12 contract counties which, due to their small
population, are supplied with public health nurses and
sanitarians by the state. The county is responsible for the
building and health officer. These offices usually consist of a
staff of two to four. All local health departments receive funds
from a local tax base. The state then subsidizes this by
matching county costs for public health on a dollar for dollar
basis, up to a maximum amount. This includes inpatient and
outpatient services since California's counties are considered
providers of last resort.
B. Services Provided
The following information on services provided by local health
departments in California is derived from a survey conducted by
NACHO during 1989. Fifty-two of the 61 local health departments
responded to the survey. Services provided by 70 percent of the
local health departments in the state responding to the survey
are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 15 ( 28.8%)
2. Morbidity Data 40 ( 76.9%)
3. Reportable Diseases 49 ( 94.2%)
4. Vital Records and Statistics 46 ( 88.5%)
B. Epidemiology/Surveillance
1. Chronic Diseases 26 ( 50.0%)
2. Communicable Diseases 50 ( 96.2%)
II. Policy Development
A. Health Code Dev. and Enforcement 34 ( 65.4%)
B. Health Planning 38 ( 73.1%)
C. Priority Setting 36 ( 69.2%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 35 ( 67.3%)
2. Health Facility Safety/Quality 24 ( 46.2%)
3. Rec. Facility Safety/Quality 35 ( 67.3%)
4. Other Facility Safety/Quality 21 ( 40.4%)
B. Licensing
1. Health Facilities 9 ( 17.3%)
2. Other Facilities 37 ( 71.2%)
C. Health Education 43 ( 82.7%)
D. Environmental
1. Air Quality
2. Hazardous Waste Management 41 ( 78.8%)
3. Individual Water Supply Safety 39 ( 75.0%)
4. Noise Pollution 18 ( 34.6%)
5. Occupational Health and Safety 23 ( 44.2%)
6. Public Water Supply Safety 42 ( 80.8%)
7. Radiation Control 16 ( 30.8%)
8. Sewage Disposal Systems 41 ( 78.8%)
9. Solid Waste Management 40 ( 76.9%)
10. Vector and Animal Control 38 ( 73.1%)
11. Water Pollution 40 ( 76.9%)
E. Personal Health Services
1. AIDS Testing and Counseling 49 ( 94.2%)
2. Alcohol Abuse 24 ( 46.2%)
3. Child Health 50 ( 96.2%)
4. Chronic Diseases 43 ( 82.7%)
5. Dental Health 25 ( 48.1%)
6. Drug Abuse 24 ( 46.2%)
7. Emergency Medical Service 41 ( 78.8%)
8. Family Planning 44 ( 84.6%)
9. Handicapped Children 43 ( 82.7%)
10. Home Health Care 15 ( 28.8%)
11. Hospitals 9 ( 17.3%)
12. Immunizations 51 ( 98.1%)
13. Laboratory Services 42 ( 80.8%)
14. Long-term Care Facilities 7 ( 13.5%)
15. Mental Health 17 ( 32.7%)
16. Obstetrical Care 16 ( 30.8%)
17. Prenatal Care 28 ( 53.8%)
18. Primary Care 18 ( 34.6%)
19. Sexually Transmitted Diseases 51 ( 98.1%)
20. Tuberculosis 50 ( 96.2%)
21. WIC 38 ( 73.1%)
C. Local Health Officer
M.D. Requirement, Board of Supervisors' Appointment
The local health officer is appointed by the county board of
supervisors. He/she must be an M.D. Responsibilities include
hiring, firing, and supervising the staff.
D. Local Board of Health
Some counties have boards but the state does not require them.
The authority of the boards also varies.
E. Staff
There is a full range of laboratory, clinical, and field staffs.
Office staff size ranges from 2 to 2,600, with the average being
from 50 to 100. They are all under local administration, except
for the nurses and sanitarians who work in public health contract
counties as stated previously.
F. Budget
Total FY 1988 LPHA expenditures were $439,343,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $179,517,000
State Funds $259,772,000
Local Funds 0
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
The SHA reported that there were additional fees and
reimbursements not reported by local health departments, but
which reverted to the general revenues of the local or state
government.
2Calfornia Department Of Health Services, 1990
Secretary of Health and Welfare
Chief Deputy Director
Office of Civil Rights
Office of Legal Services
External Affairs
Office of Quality Improvement
Public Health
Deputy Director
Assistant Deputy Director
Office of AIDS
Environmental Health
Family Health Division
Division of Laboratories
Preventive Medical Services Division
Rural and Community Health Division
Chief Deputy Director
Director of Health Services
Assistant Director
2Types of Local Health Departments by Jurisdiction
California, 1990
Jurisdiction Co C
Alameda X
Alpine X
Amador X
Berkeley X
Butte X
Calavaras X
Colusa X
Contra Costa X
Del Norte X
El Dorado X
Fresno X
Glenn X
Humboldt X
Imperial X
Inyo X
Kern X
Kings X
Lake X
Lassen X
Long Beach X
Los Angeles X
Madera X
Marin X
Mariposa X
Mendocino X
Merced X
Modoc X
Mono X
Monterey X
Napa X
Nevada X
Orange X
Pasadena X
Placer X
Plumas X
Riverside X
Sacramento X
San Benito X
San Bernardino X
San Diego X
San Francisco X
San Joaquine X
San Luis Obispo X
San Mateo X
Santa Barbara X
Santa Clara X
Santa Cruz X
Shasta X
Sierra X
Siskiyou X
Solano X
Sonoma X
Stanislaus X
Sutter X
Tehama X
Trinity X
Tulare X
Tuolumne X
Ventura X
Yolo X
Yuba X
Co = County HD
C = City HD
1COLORADO
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) * 3,300,000 245,803,000
Population Density (1988) 31.9 69.4
(per/sq.mi.)
Number of Counties 63 3,139
Median Age (1987) 30.8 31.7
Percent Below Poverty Level (1985) 10.3 14.0
(persons)
Percent of Population Rural (1980) 19.0 26.0
Percent of Population White (1980) 89.0 83.1
Percent of Population Non-white (1980) 11.0 16.9
Median Years of Education (1980) 12.8 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The Colorado Constitution, Colorado Revised Statutes, and case
law developed in state and Federal courts serve as the basis for
the structure and function of county governments. Most counties
have boards of commissioners that serve as the legislative and
administrative bodies. The counties for the most part have
three-member boards with the option for five-member boards. The
boards are elected at large but have district residency
requirements.
Several options for the structure and function of county
governments are available in Colorado.
City-county Consolidation - (1) - This form is authorized and has
been selected by Denver city-county.
Home Rule Charters - (2) - These are available and have been
selected by two counties. Home rule authority in Colorado
provides little additional authority, but it does allow counties
to provide some additional services.
* These data were provided by the SHA.
Data for this state were updated October 1990.
Appointed Administrator - (45) - Still another option that is
available to counties is the possibility of appointing an
administrator.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Colorado Department of Health (CDH), the SHA, is an
independent, free-standing agency. Major functions of the
Department are managed under the Office of Health and
Environmental Protection, Office of Administration and Support,
Office of Health Care and Prevention. CDH is dedicated to
protecting and improving the health and environment of the people
of Colorado; to prevent disease, disability, and premature death;
to protect and improve the quality of Colorado's air, land and
water; to promote public policies and individual lifestyles which
maintain and improve personal and environmental health; and to
provide health services to Coloradans with special needs.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Executive Director is the head of the CDH. The position is a
cabinet-level appointment that is made by the Governor and
requires an M.P.H. or equivalent degree.
Responsibilities and powers of the Executive Director include the
following: serving as secretary to the State Board of Health;
appointing authority for all SHA staff; formulating policy for
public health; and serving as chief executive officer for the
Department.
C. State Board of Health/Council
Policy-making
The State Board of Health is composed of nine members appointed
by the Governor. One member is appointed from each of the six
congressional districts, with consent of the Senate, and the
remaining positions are appointed from the state-at-large. No
more than five members can be from the same political party, and
no business or professional group may constitute a majority. The
law also requires that one member be a county commissioner. The
board adopts rules and regulations to carry out public health
laws and functions in an advisory capacity to the Executive
Director of the CDH.
D. Regional/District Health Offices
Although CDH has not divided the state into administrative
regions or districts, two regional offices are located in Pueblo
and Grand Junction. These offices are extensions of the central
office and exist to make the services of the central office more
assessable to the local health departments.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The Local Health Services Director administers financial support
for and maintains close liaison with local health departments to
develop and implement state public health policy and to resolve
local and statewide issues. Departmental technical staffs work
with their local counterparts to assure the public access to
essential health services.
The interaction between state and local public health agencies in
Colorado may be characterized as decentralized organizational
control. Under this arrangement local government directly
operates health departments with a local board of health.
F. Budget
Total FY 1988 Colorado SHA expenditures were $109,099,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $71,980,000
State Funds $23,590,000
Local Funds 0
Fees and Reimbursements $8,083,000
Other $5,447,000
3III. Local Public Health Agencies (LPHAs)
A. General
Colorado has 52 local health departments, consisting of four
multicounty health departments (called regional and district
health departments in Colorado) and 48 county health
departments. Colorado counts 10 county health departments and
the regional and district health departments as full-fledged
health departments. These local health departments provide
services to 23 counties and 90 percent of the state's population.
Thirty-eight counties use county nursing services and county
sanitarian and environmentalist services to provide public health
services and function as the local health department. The county
commissioners serve as the board of health. Thirty-eight
counties have county nursing services. The nurses offer basic
public health care such as immunizations, communicable and
chronic disease control, maternal and child health, home care of
the sick, preventive assessments of children and elderly. The
CDH, through the Community Nursing Section, provides training,
technical assistance, and supervision to these nurses.
Additionally, the Department assists the local areas by
reimbursing for a portion of the nurse's salary. Fifteen boards
of county commissioners and the city of Vail employ public health
sanitarians to provide public health services. Three additional
counties purchase the services of sanitarians from nearby
counties. The sanitarians work under contract with the Consumer
Protection Division and perform inspections of restaurants,
grocery stores, motels, child care centers, schools and summer
camps. They also provide services mandated by local laws and
regulations and provide advice to local elected officials on
matters related to environmental health issues. The Department
reimburses local governments for part of the sanitarians'
salaries. One county (Hinsdale) with a population of about 400
does not have a health department.
B. Services Provided
The following information on services provided by local health
departments in Colorado is derived from a survey conducted by
NACHO during 1989. Thirty-six of the 54 local health departments
in Colorado responded to the survey. Services provided by 70
percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 8 ( 22.2%)
2. Morbidity Data 15 ( 41.7%)
3. Reportable Diseases 27 ( 75.0%)
4. Vital Records and Statistics 14 ( 38.9%)
B. Epidemiology/Surveillance
1. Chronic Diseases 14 ( 38.9%)
2. Communicable Diseases 31 ( 86.1%)
II. Policy Development
A. Health Code Dev. and Enforcement 12 ( 33.3%)
B. Health Planning 22 ( 61.1%)
C. Priority Setting 20 ( 55.6%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 19 ( 52.8%)
2. Health Facility Safety/Quality 13 ( 36.1%)
3. Rec. Facility Safety/Quality 16 ( 44.4%)
4. Other Facility Safety/Quality 20 ( 55.6%)
B. Licensing
1. Health Facilities 4 ( 11.1%)
2. Other Facilities 21 ( 58.3%)
C. Health Education 25 ( 69.4%)
D. Environmental
1. Air Quality 18 ( 50.0%)
2. Hazardous Waste Management 17 ( 47.2%)
3. Individual Water Supply Safety 22 ( 61.1%)
4. Noise Pollution 8 ( 22.2%)
5. Occupational Health and Safety 10 ( 27.8%)
6. Public Water Supply Safety 15 ( 41.7%)
7. Radiation Control 9 ( 25.0%)
8. Sewage Disposal Systems 20 ( 55.6%)
9. Solid Waste Management 15 ( 41.7%)
10. Vector and Animal Control 21 ( 58.3%)
11. Water Pollution 19 ( 52.8%)
E. Personal Health Services
1. AIDS Testing and Counseling 20 ( 55.6%)
2. Alcohol Abuse 6 ( 16.7%)
3. Child Health 28 ( 77.8%)
4. Chronic Diseases 23 ( 63.9%)
5. Dental Health 8 ( 22.2%)
6. Drug Abuse 6 ( 16.7%)
7. Emergency Medical Service 6 ( 16.7%)
8. Family Planning 21 ( 58.3%)
9. Handicapped Children 28 ( 77.8%)
10. Home Health Care 18 ( 50.0%)
11. Hospitals 2 ( 5.6%)
12. Immunizations 29 ( 80.6%)
13. Laboratory Services 15 ( 41.7%)
14. Long-term Care Facilities 5 ( 13.9%)
15. Mental Health 2 ( 5.6%)
16. Obstetrical Care 6 ( 16.7%)
17. Prenatal Care 27 ( 75.0%)
18. Primary Care 6 ( 16.7%)
19. Sexually Transmitted Diseases 21 ( 58.3%)
20. Tuberculosis 22 ( 61.1%)
21. WIC 28 ( 77.8%)
C. Local Health Officer
No M.D. Requirement, Local Governing Body Appointment
Local health officers are appointed by the local governing body.
They must have an M.P.H. degree or equivalent and, when not an
M.D., must appoint a medical advisor. The candidate must have
had experience in the management or supervision of a public
health program or its equivalent. The titles for local health
officers in Colorado are Public Health Administrator I and II. A
Public Health Administrator I can serve a local health department
in a jurisdiction under 100,000 population and a Public Health
Administrator II serves jurisdictions that are over 100,000
population.
The administrators are responsible for managing full-time health
departments. This includes the direction and supervision of all
programs and activities; interpretation and administration of
their purposes; enforcement of public health laws, rules, and
regulations; provision of or arrangement for medical services in
public health clinics and school health programs.
D. Local Board of Health
Policy-making
Full service departments have boards of health appointed by
county commissioners. Boards are policy setting bodies. They
also appoint health officers who serve at the pleasure of the
board. In the 40 counties without full service departments, the
commission serves as the board.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdiction. The number of employees
for local health departments ranges from 1 to 200.
F. Budget
Total FY 1988 LPHA expenditures were $27,897,000. Total FY 1988
United States LPHA expenditures were $ 3,978,948,000.
SHA funds are distributed to local health agencies on a per
capita basis. In counties that have no local health departments,
the state pays 20 percent of the public health nurses' salaries
and 40 percent of the sanitarians' salaries.
Source of Funds
Federal Grants and Contracts $425,000
State Funds $3,969,000
Local Funds $18,476,000
Fees and Reimbursements $1,155,000
Other Sources $3,873,000
Source Unknown 0
The SHA reported that there were additional fees and
reimbursements not retained by local health departments, but
which reverted to the general revenues of the local or state
government. The SHA also reported that these figures include the
total of additional local health department monies expended by
all local health departments.
2Colorado Department of Health, 1990
Governor
Colorado Department of Health
State Board of Health
Executive Director
Office of External Affairs
Public Relations
Governmental Liaison
Local Health Services
Office of Health and Environmental Protection
Rocky Flats Program Unit
Air Pollution Control Division
Technical Services
Stationary Sources
Mobile Sources
Water Quality Control Division
Field Support
Permits and Enforcement
Ground Water and Standards
Drinking Water
Disease Control and Environmental Epidemiology Division
Communicable Disease Control
Environmental Epidemiology
STD/AIDS
Hazardous Waste Management Division
Hazardous Waste Control Section
Solid Waste and Incident Management Section
Remedial Programs Section
Consumer Protection Division
Field Services
Technical Assistance
Radiation Control Division
X-Ray Regulation and Inspection
Uranium and Special Projects
Environmental Surveillance
Radioactive Materials Licensure and Inspection
Office of Administration and Support
Administrative Services Division
Business Management
Human Resources
Data Services
Support Services
Emergency Medical Services Division
Laboratory Division
Microbiology
Chemistry
Toxicology
Newborn Screening
Health Facilities Division
Administrative Services
Program Development Evaluation
Long-Term Care Hospital
Medicare
Residential
Investigations
Office of Health Care and Prevention
Health Statistics & Vital Records Division
Certification
Health Statistics
Data Management
Alcohol and Drug Abuse Division
Prevention/Intervention
Treatment Services
Administrative Support/Planning and Evaluation
Prevention Programs Division
Chronic Disease Control
Injury Prevention
Colorado Action for Healthy People
Family and Comm. Health Services Division
Family Health Services
Childrens' Health Services
Migrant Health
Dental Health
Nutrition Services
Community Services
Medical Affairs and Special Programs
Cooperative Agreement/Primary Care
2Types of Local Health Departments by Jurisdiction
Colorado, 1990
Jurisdiction Co M/Co N/Co
Adams X
Alamosa X
Arapahoe X
Archuletta X
Baca X
Bent X
Boulder X
Chaffee X
Cheyenne X
Clear Creek X
Conejos X
Costilla X
Crowley X
Custer X
Delta X
Denver X
Dolores X
Douglas X
Eagle X
El Paso X
Elbert X
Fremont X
Garfield X
Gilpin X
Grand X
Gunnison X
Hinsdale X
Huerfano X
Jackson X
Jefferson X
Kiowa X
Kit Carson X
La Plata X
Lake X
Larimer X
Lincoln X
Logan X
Los Animas X
Mesa X
Mineral X
Moffat X
Montezuma X
Montrose X
Otero X
Ourey X
Park X
Phillips X
Pitkin X
Prowers X
Pueblo X
Rio Blanco X
Rio Grande X
Routt X
Saguache X
San Juan X
San Miguel X
Sedgwick X
Summit X
Teller X
Washington X
Weld X
Yuma X
Co = County HD
M/Co= Multicounty HD
N/Co =No County HD
1CONNECTICUT
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 3,233,000 245,803,000
Population Density (1988) 663.6 69.4
(per/sq.mi.)
Number of Counties 8 3,139
Median Age (1987) 33.9 31.7
Percent Below Poverty Level (1985) 7.6 14.0
(persons)
Percent of Population Rural (1980) 21.0 26.0
Percent of Population White (1980) 90.1 83.1
Percent of Population Non-white (1980) 9.9 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
Connecticut has no functioning county governments. Counties are
used for geographic designation only.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent Agency
The Connecticut Department of Health Services (CDHS), the SHA, is
a free-standing, independent agency. The mission of CDHS is to
become the best state health department in the nation. In doing
so, the CDHS will promote and enhance the public's health by
employing the most efficient and practical means to prevent and
suppress disease.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
Data for this state were updated February 1991.
State Health Planning and Development Agency
State Professions Licensing Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
The Department encourages the development and expansion of
full-time local health services by subsidizing the cost of such
services to local communities. Grants-in-aid are made to all
departments and districts with full-time health officers. To be
eligible for funding, the local health departments must comply
with funding regulations in the public health code.
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
As the chief executive officer of the CDHS, the Commissioner is
appointed by the Governor for a term of office concurrent with
the gubernatorial term and required to have M.D./M.P.H or M.P.H.
degrees.
It is the duty of the Commissioner of CDHS to use the most
efficient and practical means for prevention and suppression of
disease, and administer the health laws and the public health
code. The Commissioner is also responsible for the overall
operation and administration of CDHS.
C. State Board of Health/Council
No State Board of Health
Although Connecticut has no State Board or Council of Health, it
does have a statewide advisory committee on public health. The
advisory committee is composed of 25 members who are health care
professionals, providers, and consumers.
D. Regional/District Health Offices
CDHS has two regional offices located in Norwich and Bridgeport
which are extensions of the central office and have only
managerial functions. The offices do not have specific
geographic areas of service.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The Office of Local Health Administration has responsibility for
state-local liaison. This function began in the fall of 1989
when CDHS began a major local health initiative to focus on the
needs of local health officers, their departments, and districts
in the state by establishing an Office of Local Health
Administration. An objective of this office is to enhance
communication between the Department and other state agencies
with local health officers through periodic forums, resource
materials, advisory groups, and other mechanisms.
The interaction between state and local public health agencies in
Connecticut may be characterized as decentralized organizational
control. Under this arrangement local governments directly
operate health departments with or without local boards of
health.
F. Budget
Total FY 1988 Connecticut SHA expenditures were $72,983,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $35,225,000
State Funds $37,758,000
Local Funds 0
Fees and Reimbursements 0
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Connecticut has 49 local health departments, consisting of full
and part-time local health departments and district health
departments. The districts consist of towns, cities, and
boroughs which have voted to combine their health services into a
district health department. Currently there are 13 districts, 28
full-time, and 8 part-time health departments. The designation
of full- or part-time depends on the presence or absence of a
full-time health officer. There are 70 other jurisdictions in
Connecticut which have health services but do not have at least
one full-time position.
B. Services Provided
The following information on services provided by local health
departments in Connecticut is derived from a survey conducted by
NACHO during 1989. Seventy of the local health jurisdictions in
Connecticut responded to the survey. These respondents include
several service units known as part-time health departments,
which do not meet our definition of a local health department.
Services provided by at least 70 percent of health departments in
the state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 14 ( 20.0%)
2. Morbidity Data 24 ( 34.3%)
3. Reportable Diseases 63 ( 90.0%)
4. Vital Records and Statistics 18 ( 25.7%)
B. Epidemiology/Surveillance
1. Chronic Diseases 22 ( 31.4%)
2. Communicable Diseases 61 ( 87.1%)
II. Policy Development
A. Health Code Dev. and Enforcement 58 ( 82.9%)
B. Health Planning 35 ( 50.0%)
C. Priority Setting 30 ( 42.9%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 58 ( 82.9%)
2. Health Facility Safety/Quality 32 ( 45.7%)
3. Rec. Facility Safety/Quality 46 ( 65.7%)
4. Other Facility Safety/Quality 32 ( 45.7%)
B. Licensing
1. Health Facilities 17 ( 24.3%)
2. Other Facilities 61 ( 87.1%)
C. Health Education 43 ( 61.4%)
D. Environmental
1. Air Quality 26 ( 37.1%)
2. Hazardous Waste Management 43 ( 61.4%)
3. Individual Water Supply Safety 57 ( 81.4%)
4. Noise Pollution 25 ( 35.7%)
5. Occupational Health and Safety 23 ( 32.9%)
6. Public Water Supply Safety 34 ( 48.6%)
7. Radiation Control 20 ( 28.6%)
8. Sewage Disposal Systems 66 ( 94.3%)
9. Solid Waste Management 31 ( 44.3%)
10. Vector and Animal Control 42 ( 60.0%)
11. Water Pollution 61 ( 87.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 18 ( 25.7%)
2. Alcohol Abuse 8 ( 11.4%)
3. Child Health 34 ( 48.6%)
4. Chronic Diseases 22 ( 31.4%)
5. Dental Health 15 ( 21.4%)
6. Drug Abuse 11 ( 15.7%)
7. Emergency Medical Service 16 ( 22.9%)
8. Family Planning 8 ( 11.4%)
9. Handicapped Children 8 ( 11.4%)
10. Home Health Care 15 ( 21.4%)
11. Hospitals -
12. Immunizations 53 ( 75.7%)
13. Laboratory Services 11 ( 15.7%)
14. Long-term Care Facilities 5 ( 7.1%)
15. Mental Health 11 ( 15.7%)
16. Obstetrical Care 4 ( 5.7%)
17. Prenatal Care 8 ( 11.4%)
18. Primary Care 5 ( 7.1%)
19. Sexually Transmitted Diseases 33 ( 47.1%)
20. Tuberculosis 32 ( 45.7%)
21. WIC 18 ( 25.7%)
C. Local Health Officer
No M.D. Requirement, Local Governing Body Appointment
Local health officers are hired by the municipality or health
district and approved by the Commissioner of CDHS. Local health
officers are not required to be physicians. They are, however,
required to have a graduate degree in public health as a result
of at least 1 year's training that has included at least 60 hours
in local health administration. The health officers are
responsible for all duties assigned by the local board of health
as well as those required by statutes and the public health code.
D. Local Board of Health
Policy-making
District boards of health represent districts that are formed
when a group of local jurisdictions (towns, cities, and boroughs)
vote to form district departments of health. Each town, city,
and borough which voted to become part of the district may
appoint one member to the board. Jurisdictions with populations
of more than 10,000 are entitled to an additional representative
for each 10,000 population, with a limit of five
representatives. The members are appointed by the governing
bodies of the respective jurisdictions to terms of 3 years. The
terms are staggered so that approximately one-third of the terms
expire each year. The board is responsible for managing the
affairs of the district health department.
Some towns and municipalities have boards of health that function
in an advisory capacity to the local governing body. The board
members are appointed by the local governing body. The number of
members vary greatly for these boards.
E. Staff
The staffs of the local health departments are employed and
supervised by the local jurisdiction. The number of staff
employed by local health departments ranges from 1 to 140.
F. Budget
Total FY 1988 LPHA expenditures were $29,957,000*. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $2,696,000
State Funds $5,748,000
Local Funds $21,513,000*
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
* The SHA reported that these figures were estimated.
2Connecticut Department of Health Services, 1990
Advisory Committee
Commissioner
Commission on Long-Term Care
Commission on Hospitals and Health Care
Center for Chronic Disease Urban/Rural Health
Executive Secretary
Center for Governmental Relations
Center for Communications Internal/External
Deputy Commissioner
Bureau of Health Promotion
Environmental Epidemiology and Occupational Health
Environmental Health Services
Infectious Disease Epidemiology
Local Health Administration
Health Surveillance and Planning
Bureau of Community Health
Child/Adolescent Health Division
Community Health Systems Division
Family/Reproductive Health Division
Executive Assistant
Executive Assistant
Executive Assistant
Deputy Commissioner
Bureau of Health System Regulation
Community Nursing and Home Health
Emergency Medical Services
Hospitals and Medical Care
Medical Quality Assurance
Regulations
Administrative Services
Affirmative Action
Data Processing
Personnel Services
Program Monitoring and Fiscal Review
Bureau of Laboratory Services
Biological Sciences
Environmental Chemistry
Laboratory Standards
Organic Chemistry
Toxicology and Criminology
2Types of Local Health Departments by Jurisdiction
Connecticut, 1990
Jurisdiction N/Co T/T M/T
Avon X
Bethel X
Bloomfield X
Brigdeport X
Bristol-Burlington X
Chesprocott Dist. X
Clinton X
Danbury X
Durham X
East Hartford X
East Shore Dist. X
Fairfield X
Fairfield X
Farmington X
Farmington Valley X
Glastonbury X
Greenwich X
Groton X
Hartford X
Hartford X
Litchfield X
Manchester X
Meriden X
Middlesex X
Middletown X
Milford X
Naugatuck Valley X
New Britain X
New Fairfield X
New Haven X
New Haven X
New London X
New Milford X
New Tolland X
Newtown X
North Central Dist. X
Northeast Dist X
Norwalk X
Old Lyme X
Pomeraug Dist. X
Quinnipiack Valley X
Southington X
Stafford Dist. X
Stamford X
Stratford X
Tolland X
Tolland X
Torrington Area X
Uncas Region Dist. X
Wallingford X
Waterbury X
West Hartford X
West Haven X
Weston-Westport X
Windham X
Windsor X
N/Co = No county HD
T/T = Town/Township
HD
M = Multitownship
HD
1DELAWARE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 660,000 245,803,000
Population Density (1988) 341.6 69.4
(per/sq.mi.)
Number of Counties 3 3,139
Median Age (1987) 31.6 31.7
Percent Below Poverty Level (1985) 11.4 14.0
(persons)
Percent of Population Rural (1980) 29.0 26.0
Percent of Population White (1980) 82.1 83.1
Percent of Population Non-white (1980) 17.9 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The state constitution and statutes establish the authority and
structural framework for the three counties of Delaware.
Council Form - (2) - New Castle and Sussex counties use the
Council Form of government with only slight variations between
them. They both have a six-member council elected from
districts. New Castle has a seventh member who is elected from
the county at large. New Castle also has an elected executive
officer and an appointed administrative officer who is
responsible to the executive officer. Sussex county appoints a
county administrator to fulfill the administrative functions of
the county.
Levy Court System - (1) - Kent county operates under a Levy Court
System which has five Levy Court Commissioners and an appointed
county administrator.
Data for this state were updated December 1990.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Delaware Division of Public Health, the SHA, is a component
of a superagency called the Department of Health and Social
Services (DHSS). For the well-being of Delaware families and
communities, the Division of Public Health provides leadership
and fosters partnerships to promote healthy lifestyles, prevent
disease, disability and premature death, protect human health
from environmental hazards, and provide or assure access to
health care for vulnerable populations in need.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The Director of the Division of Public Health is the head of the
SHA. The Director is appointed by the Secretary of the
Department of Health and Social Services with the Governor's
approval and serves at the will of the administration. Law
requires that the Director be a physician, preferably with an
M.P.H. and at least 5 years of increasing administrative
responsibility. The Director is the chief administrative officer
of the Division and a member of the State Board of Health, where
the regulatory and enforcement authority is derived. Membership
in several committees and task forces result from both
appointment and law. These include:
1. Authority on Radiation Control
2. Controlled Substance Abuse Committee
3. Delaware Emergency Medical Services Advisory Committee
4. Title XIX Medical Advisory Committee
5. Developmental Disabilities Advisory Committee
Direct supervision of two deputies and the Directors of the State
Laboratory, Offices of Narcotics and Dangerous Drugs, Health
Facilities Standards and Licensing Office, and Office of
Emergency Medical Services are part of the Director's
responsibilities.
C. State Board of Health/Council
Policy-Making
The State Board of Health consists of two members, the Secretary
of DHSS and the Director of the Division of Public Health. The
Secretary of DHSS serves as Chair, and the Director acts as the
secretary of the board, responsible for the agenda, minutes, and
preparation of agenda items.
D. Regional/District Health Offices
The SHA does not divide the state into administrative regions or
districts.
E. State-local Liaison
Centralized Organizational Control, No Liaison Function
The local service units are elements of the SHA so there is no
need for a liaison function.
Delaware is a state that has achieved the highest level of
centralization. All of the service units are elements of the SHA
and function without any local funds or input.
The interaction between state and local public health agencies in
Delaware may be characterized as centralized organizational
control. Under this arrangement local health departments
function directly under the state's authority and are operated by
the SHA or State Board of Health.
F. Budget
Total FY 1988 Delaware SHA expenditures were $52,806,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $7,916,000
State Funds $43,613,000
Local Funds $49,000
Fees and Reimbursements $563,000
Other $666,000
3III. Local Public Health Agencies (LPHAs)
A. General
Delaware does not consider the three service units to be local
health departments. The SHA, however, has a branch office
located in each county to provide public health services in that
jurisdiction. We recognize that these units are part of the SHA
and receive no local funding or input, but they are providing
public health services in local jurisdictions.
B. Services Provided
The following information on services provided by local health
departments in Delaware is derived from a list of state-mandated
services that are carried out by the three regional offices.
Since Delaware does not consider the regional offices to be local
health departments, they did not respond to the NACHO survey of
local health departments.
Services Provided by LPHAs Number of LPHAs
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 3
2. Morbidity Data -
3. Reportable Diseases 3
4. Vital Records and Statistics 3
B. Epidemiology/Surveillance
1. Chronic Diseases 3
2. Communicable Diseases 3
II. Policy Development
A. Health Code Dev. and Enforcement -
B. Health Planning -
C. Priority Setting -
III. Assurance Activities
A. Inspection
1. Food and Milk Control 3
2. Health Facility Safety/Quality -
3. Rec. Facility Safety/Quality -
4. Other Facility Safety/Quality -
B. Licensing
1. Health Facilities -
2. Other Facilities -
C. Health Education -
D. Environmental
1. Air Quality -
2. Hazardous Waste Management -
3. Individual Water Supply Safety 3
4. Noise Pollution -
5. Occupational Health and Safety -
6. Public Water Supply Safety 3
7. Radiation Control 3
8. Sewage Disposal Systems -
9. Solid Waste Management -
10. Vector and Animal Control -
11. Water Pollution -
E. Personal Health Services
1. AIDS Testing and Counseling 3
2. Alcohol Abuse -
3. Child Health 3
4. Chronic Diseases -
5. Dental Health -
6. Drug Abuse -
7. Emergency Medical Service -
8. Family Planning 3
9. Handicapped Children 3
10. Home Health Care -
11. Hospitals -
12. Immunizations 3
13. Laboratory Services -
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care 3
18. Primary Care -
19. Sexually Transmitted Diseases 3
20. Tuberculosis 3
21. WIC 3
C. Local Health Officer
No M.D. Requirement, State Merit System Appointment
Assistant State Health Officers are in charge of each of the
three local health units. They may be physicians but are not
required to be. They are responsible for enforcing public health
regulations in their county and supervising activities in their
area, including contracting for the local services. These
Assistant State Health Officers are State Merit System employees
and are appointed through the standard process for hiring state
employees. Their responsibilities resemble those of the State
Director except for formulating budget and proposing legislation.
D. Local Board of Health
There are no local boards of health in Delaware.
E. Staff
The staffs for the local service units are employees of the SHA
and part of the State Merit System. The number of employees in
the local service units range from 40 to 100.
F. Budget
Funding for providing local public health services in Delaware is
handled entirely by the SHA without the input of any local funds.
2Delaware Division of Public Health, 1990
Governor
Department of Health and Social Services
Board of Health
Office of the Secretary
Division of Aging
Division of Alcohol, Drug Abuse and Mental Health
Division of Business Administration and General Services
Division of Child Support Enforcement
Division of Medical Examiner
Division of Public Health
Director
Long-Term Care Section
Community Health Section
Office of Narcotics and Dangerous Drugs
Office of Emergency Medical Services
Office of Health Facilities Standards and Licensing
Laboratory
Division of Mental Retardation
Division of Social Services
Division of State Services Centers
Division of Visually Impaired
Division of Planning and Research Evaluation
2Types of Local Health Departments by Jurisdiction
Delaware, 1990
Jurisdiction Co
Kent X
New Castle X
Sussex X
Co = County HD
1DISTRICT OF COLUMBIA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 617,000 245,803,000
Population Density (1988) 9,793.7 69.4
(per/sq.mi.)
Number of Counties 0 3139
Median Age (1987) 32.9 31.7
Percent Below Poverty Level (1979) 18.6 12.4
(persons)
Percent of Population Rural (1980) 0.0 26.0
Percent of Population White (1980) 26.9 83.1
Percent of Population Non-white (1980) 73.1 16.9
Median Years of Education (1980) 12.7 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The government of the District of Columbia is unique among local
governments in the United States in that it functions as a state,
a county, a city, a school district and special districts
combined.
Home Rule Charter - The District of Columbia is also different
from other local governments because it was chartered by
Congress. In 1973 Congress passed the District of Columbia
Self-Government Reorganization Act, which is commonly called home
rule. With the Home Rule Charter, Congress retained the
authority to review legislation passed by the District of
Columbia Council and to control policy through the appropriation
process. The tax base for the District of Columbia is different
because the charter restricts the ability of the government to
tax. It prohibits non-resident income tax and property tax on 56
percent of the land. Each year the Federal government makes a
payment to the District government to compensate for costs
incurred in delivering services to the Federal establishment, for
revenue lost to the District because of the presence of the
Federal government and for the Federal restrictions on the
District tax authority. The Federal payment, which began when
the District was established as the Nation's capital in 1800, is
determined each year by the President and Congress through the
Data for the District of Columbia were updated February 1991.
legislative process. Despite the intended purpose of the Federal
payment, it has not kept pace with the revenue lost due to
Federal restrictions on the District's taxing authority.
Council Form - The District of Columbia Council, which is the
legislative body, is composed of a 13-member board including a
Council Chairman. Terms of office for the Council members are
4 years. Eight Council members are elected from each of eight
wards, with four others and the Council Chairman elected
at-large. Only two of the at-large members may be from the same
political party (excluding the Chairman). Terms of office are
staggered so that the terms of six members expire and 2 years
later terms of the other six members plus the Chairman expire.
The Chairman is the chief executive for the Council, conducting
all meetings and signing all legislation on behalf of this body.
This official is responsible for referring all bills to the
appropriate committee and transmitting all approved bills to the
Mayor for signature and to the Congress. The Chairman nominates
council officers, Chairman pro tempore, committee chairmanships,
committee members, and others such as auditor and representatives
for independent boards.
The Executive Officer of the District of Columbia government is
the Mayor.
The District has a non-voting delegate to the U.S. House of
Representatives. This delegate is elected by popular vote every
2 years.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Commission of Public Health is the SHA for the District of
Columbia. The Commission has SHA responsibility, including
providing local health services. It is a component of a
superagency called the Department of Human Services. The mission
of the Commission of Public Health is to assure equitable access
to comprehensive, high quality public health services to all
residents and visitors and to monitor and improve their health
status. The following is a list of areas of responsibility for
the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Emergency Medical Services State Agency (included by SHA)
Local Public Health Responsibility
Responsibility for Institutions/Hospitals (public long-term
care only)
B. Head of State Health Agency
M.D. Requirement, Mayoral Appointment
The Commissioner of Public Health, the title for director of the
SHA, is appointed by the Mayor. The Office of Commissioner is
responsible for the formulation, implementation and evaluation of
health care services delivered to both residents and visitors.
The Commissioner has responsibility to manage in an effective and
efficient manner and to provide the public with preventive and
treatment programs that will help the sick and reduce suffering.
C. State Board of Health/Council
The District of Columbia does not have a Council or Board of
Health.
D. Regional/District Health Offices
The Commission of Public Health in the Department of Human
Services functions as both the state and local public health
agency (LPHA) for the District. The Commission provides public
health services through a network of 25 public health care
clinics. The clinics provide a range of specialized and primary
health services on an outpatient basis. The clinics are not
uniform in services provided or in staffing patterns. Individual
clinics tend to specialize in specific areas of service such as
control of sexually transmitted diseases, tuberculosis, drug
abuse, or ambulatory care. The following is a list of services
provided by the Commission of Public Health:
Services Provided by LPHA Number of LPHA
Reporting
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 1
2. Morbidity Data 1
3. Reportable Diseases 1
4. Vital Records and Statistics -
B. Epidemiology/Surveillance
1. Chronic Diseases 1
2. Communicable Diseases 1
II. Policy Development
A. Health Code Dev. and Enforcement -
B. Health Planning 1
C. Priority Setting 1
III. Assurance Activities
A. Inspection
1. Food and Milk Control -
2. Health Facility Safety/Quality -
3. Rec. Facility Safety/Quality -
4. Other Facility Safety/Quality -
B. Licensing
1. Health Facilities -
2. Other Facilities -
C. Health Education 1
D. Environmental
1. Air Quality -
2. Hazardous Waste Management -
3. Individual Water Supply Safety -
4. Noise Pollution -
5. Occupational Health and Safety -
6. Public Water Supply Safety -
7. Radiation Control -
8. Sewage Disposal Systems -
9. Solid Waste Management -
10. Vector and Animal Control 1
11. Water Pollution -
E. Personal Health Services
1. AIDS Testing and Counseling 1
2. Alcohol Abuse 1
3. Child Health 1
4. Chronic Diseases 1
5. Dental Health 1
6. Drug Abuse 1
7. Emergency Medical Service 1
8. Family Planning 1
9. Handicapped Children 1
10. Home Health Care 1
11. Hospitals (long term care) 1
12. Immunizations 1
13. Laboratory Services 1
14. Long-term Care Facilities 1
15. Mental Health -
16. Obstetrical Care 1
17. Prenatal Care 1
18. Primary Care 1
19. Sexually Transmitted Diseases 1
20. Tuberculosis 1
21. WIC 1
E. State-Local Liaison
The District of Columbia performs the functions of both state and
local government. Hence, there is no need for a liaison
function.
F. Budget
Total 1987 District of Columbia SHA expenditures were
$194,329,000. Total 1987 United States SHA expenditures were
$8,148,511,000.
Source of Funds
Federal Grants and Contracts $37,074,000
State Funds $155,114,000
Local Funds 0
Fees and Reimbursements $2,140,000
Other 0
2District of Columbia Comission of Public Health, 1990
Commissioner
Deputy Commissioner
Office of Management and Budget
Office of Health Care Access
Office of Chief Medical Examiner
Alcohol and Drug Abuse Services
Office of Emergency Health and Medical Services
Ambulatory Health Care
Office of Medical Affairs for Social Services
Long-Term Care
Office of Health Planning and Development
Preventive Health Services
Bureau of Sexually Transmitted Disease Control
Bureau of Laboratories
Bureau of Epidemiology and Disease Control
Bureau of Cancer Control
Bureau of Tuberculosis Control
Office of AIDS Activities
Office of Dental Health
Office of Maternal and Child Health
Office of Nutrition
2Types of Local Health Departments by Jurisdiction
District of Columbia, 1990
Jurisdiction C N/Co
District X
C = City HD
1FLORIDA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) * 12,503,800 245,803,000
Population Density (1988) * 230.8 69.4
(per/sq.mi.)
Number of Counties 67 3,139
Median Age (1987) 36.0 31.7
Percent Below Poverty Level (1985) 13.4 14.0
(persons)
Percent of Population Rural (1980) 16.0 26.0
Percent of Population White (1980) 84.0 83.1
Percent of Population Non-white (1980) 16.0 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
Florida counties derive their power from the state constitution
and state statutes. The general form of county government is a
five-member board of commissioners that is elected at large.
Exceptions to this rule are Volusia and Jacksonville-Duval which
have county councils and Hillsborough and Dade which have seven-
and nine-member county commissions. Dade also has a county
mayor.
County governments in Florida fall into either Charter or
non-Charter status. Both Charter and non-Charter counties have
the legal option of utilizing a county administrator position to
perform administrative affairs of the board. At the present time
40 counties have chosen to utilize some form of appointed county
administrator.
Charter Form - (12) - In charter governments the commission
retains legislative and policy-making roles, but executive
functions may be delegated to an appointed or elected official.
The counties may utilize a County Manager, a County
Chairman-Administrator, or a County Executive to fulfill the
executive function.
* These data were provided by the SHA.
Data for this state were updated October 1990.
Non-Charter Form - (55) - Counties utilizing this form of
government have many of the same powers granted to charter
counties. Non-Charter counties, however, do not have the option
of changing the structure or the manner of selection for the
governing body and county officers.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Department of Health and Rehabilitative Services (HRS) is
responsible for the provision of state-supported public health
services in Florida. The purpose of HRS is to integrate the
delivery of all health, social, and rehabilitative services
offered by the state. As a result, HRS is the primary provider
of public assistance services. Public health activities
represent only a fraction of the Department's overall
activities. The Department is headed by a Secretary appointed by
the Governor and confirmed by the Senate. The Secretary is
served by five Deputy Secretaries responsible for the major
organizational units that comprise the Department (see attached
table of organization).
The following are some of the areas of responsibility for the
SHA:
State Public Health Authority
State Institutions/Hospitals
Environmental health activities are divided between HRS and the
Department of Environmental Regulation.
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The Deputy Secretary for Health is the State Health Officer. The
State Health Officer is appointed by and serves at the pleasure
of the Secretary of HRS. The State Health Officer must be a
licensed physician or hold a master's degree or doctorate in
public health from an accredited university, and must have
specialized training and experience in public health service and
administration. The State Health Officer is responsible for
defining the mission and setting the policy direction for the
state public health system, directing and coordinating the
activities of four assistant health officers, providing
leadership to public health staffs, conveying the public health
mission and program to the public and the legislature, ensuring
coordination and interaction between the public health system and
related programs within HRS and the external community, and
providing medical supervision to the HRS county public health
units. The State Health Officer provides policy guidance for
public health unit staff, but does not have line authority over
employees in the public health units. The State Health Officer
directs the State Health Office.
C. State Board of Health/Council
Advisory
Florida has two state health councils. However, neither is a
board of health in the traditional sense. Both are strictly
advisory. They are the Advisory Council on Health and the
Statewide Health Council. The Advisory Council on Health serves
in an advisory capacity to the State Health Officer. It is
composed of 11 members who are appointed by the Secretary of HRS
in consultation with the State Health Officer. Members of this
council must include three physicians; the Secretary of the
Department of Environmental Regulation; the Dean of the College
of Public Health at the University of South Florida; a dentist; a
registered nurse; a veterinarian; an individual with professional
expertise in environmental health; and a consumer or
representative of an advocacy group. In addition to advising the
State Health Officer on general policies affecting public health
in the state, the Council recommends programs to carry out the
purposes of the Department.
The second council, the Statewide Health Council, advises the
Governor, Legislature, and Department on state health policy
issues, health planning activities, and regulation programs. The
Statewide Health Council is composed of the chairman of the 11
local health councils, 2 individuals appointed by the Speaker of
the House of Representatives, and 2 individuals appointed by the
President of the Senate. Much of the Statewide Health Council's
work involves collating the information and planning materials
gathered by 11 local health planning councils. However, the
Statewide Health Council also reviews district health plans for
consistency with the state health goals and policies, prepares a
state report on the adequacy, appropriateness, and effectiveness
of state funds distributed to meet the needs of the medically
indigent, and assists the local health councils in developing an
analysis of service and facility needs of persons with
AIDS-related illnesses.
D. Regional/District Health Offices
HRS service areas in Florida are divided into 11 districts. Each
district is headed by a District Administrator. The District
Administrator is appointed by the Secretary and is directly
responsible to the Deputy Secretary for Operations. The District
Administrator has line authority over all Department programs
assigned to the district. The Deputy District Administrator for
Health and district administrators in each district have direct
supervisory authority over the public health unit directors and
administrators.
Although staffing levels in the different district offices vary,
district staff with responsibility for public health activities
generally include the following:
District Administrator
Deputy Assistant Administrator for Health
Environmental Health Consultant
Nursing Consultant
Human Services Program Manager(s)
Human Services Program Analysts
E. State-local Liaison
Centralized Organizational Control, Informal Liaison Function
State-local liaison activities are primarily handled by District
Administrators and County Public Health Unit Directors and
Administrators. There are no positions allocated for purely
liaison purposes. The majority of day-to-day contact between
state public health officials and local officials is handled by
the county public health unit directors and administrators.
The interaction between state-local public health agencies in
Florida may be characterized as centralized organizational
control. Under this arrangement, local health departments
function directly under the state's authority and are operated by
the SHA.
F. Budget
Total FY 1988 SHA expenditures were $366,796,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $98,553,000
State Funds $198,694,000
Local Funds $29,358,000
Fees and Reimbursements $38,439,000
Other $1,752,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 67 county health departments in Florida. HRS enters
into contracts with the 67 counties in Florida to identify
funding for the services that will be provided by the public
health units. All contracts are negotiated and approved by the
appropriate local governing bodies and the appropriate district
administrators on behalf of the Department. The county public
health units are part of the Department of Health and
Rehabilitative Services. County health unit employees are HRS
employees.
B. Services Provided
The following information on services provided by local health
departments in Florida is derived from a survey conducted by
NACHO during 1989. Sixty-three of the 67 local health
departments in Florida responded to the survey. Services
provided by at least 70 percent of health departments in the
state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 26 ( 41.3%)
2. Morbidity Data 40 ( 63.5%)
3. Reportable Diseases 62 ( 98.4%)
4. Vital Records and Statistics 62 ( 98.4%)
B. Epidemiology/Surveillance
1. Chronic Diseases 48 ( 76.2%)
2. Communicable Diseases 62 ( 98.4%)
II. Policy Development
A. Health Code Dev. and Enforcement 36 ( 57.1%)
B. Health Planning 45 ( 71.4%)
C. Priority Setting 42 ( 66.7%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 51 ( 81.0%)
2. Health Facility Safety/Quality 46 ( 73.0%)
3. Rec. Facility Safety/Quality 38 ( 60.3%)
4. Other Facility Safety/Quality 25 ( 39.7%)
B. Licensing
1. Health Facilities 20 ( 31.7%)
2. Other Facilities 47 ( 74.6%)
C. Health Education 52 ( 82.5%)
D. Environmental
1. Air Quality 16 ( 25.4%)
2. Hazardous Waste Management 48 ( 76.2%)
3. Individual Water Supply Safety 59 ( 93.7%)
4. Noise Pollution 12 ( 19.0%)
5. Occupational Health and Safety 23 ( 36.5%)
6. Public Water Supply Safety 55 ( 87.3%)
7. Radiation Control 30 ( 47.6%)
8. Sewage Disposal Systems 60 ( 95.2%)
9. Solid Waste Management 40 ( 63.5%)
10. Vector and Animal Control 59 ( 93.7%)
11. Water Pollution 44 ( 69.8%)
E. Personal Health Services
1. AIDS Testing and Counseling 63 (100.0%)
2. Alcohol Abuse 7 ( 11.1%)
3. Child Health 63 (100.0%)
4. Chronic Diseases 59 ( 93.7%)
5. Dental Health 32 ( 50.8%)
6. Drug Abuse 11 ( 17.5%)
7. Emergency Medical Service 6 ( 9.5%)
8. Family Planning 63 (100.0%)
9. Handicapped Children 15 ( 23.8%)
10. Home Health Care 26 ( 41.3%)
11. Hospitals 2 ( 3.2%)
12. Immunizations 63 (100.0%)
13. Laboratory Services 45 ( 71.4%)
14. Long-term Care Facilities 7 ( 11.1%)
15. Mental Health 2 ( 3.2%)
16. Obstetrical Care 37 ( 58.7%)
17. Prenatal Care 61 ( 96.8%)
18. Primary Care 62 ( 98.4%)
19. Sexually Transmitted Diseases 63 (100.0%)
20. Tuberculosis 62 ( 98.4%)
21. WIC 62 ( 98.4%)
C. Local Health Officer
M.D. or D.O. Requirement, Secretary Appointment
County public health units are headed by a Director or
Administrator. The Director is a doctor of medicine or
osteopathy who is trained in public health administration and
appointed by the Secretary of HRS after consultation with the
State Health Officer, the District Administrator, and after
concurrence of the Board of County Commissioners. The
Administrator is trained in public health administration, but is
not a physician. Administrators are appointed in the same
fashion as directors. Directors and Administrators are HRS
employees.
D. Local Board of Health
Florida does not have local boards of health.
E. Staff
The county public health unit employees are HRS employees. They
are supervised, with the exceptions of the unit directors and
administrators, by the supervisory staff in the unit. Unit
directors and administrators are supervised by the district
administrators and deputy administrators. The number of
employees for public health units ranges from 4 to 680.
F. Budget
Total FY 1988 LPHA expenditures were $216,402,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $19,105,000
State Funds $146,531,000
Local Funds $29,358,000
Fees and Reimbursements $21,407,000
Other Sources 0
Source Unknown 0
The SHA reported that these figures include the total amount of
additional monies expended by all local health departments.
2Florida Department of Health and Rehabilitative Services, 1990
Secretary
Deputy Secretary for Administrative Services
Deputy Secretary for Programs
Deputy Secretary for Health
Assistant Deputy
Program and Financial Assessment
Director of Quality Assurance and Public Health Nursing
Assistant Health Officer for Disease Control and AIDS
Prevention
Assistant Health Officer for Family Health Services
Assistant Health Officer for Technical Health Services
Assistant Health Officer for Environmental Health
Deputy Secretary for Operations
District Administrator
Deputy District Administrator for Health
HRS County Public Health Units
Deputy Secretary for Management Systems
2Types of Local Health Departments by Jurisdiction
Florida, 1990
Jurisdiction Co
Alachua X
Baker X
Bay X
Bradford X
Brevard X
Broward X
Calhoun X
Charlotte X
Citrus X
Clay X
Collier X
Columbia X
Dade X
De Soto X
Dixie X
Duval X
Escambia X
Flagler X
Franklin X
Gadsden X
Gilchrist X
Glades X
Gulf X
Hamilton X
Hardee X
Hendry X
Hernando X
Highlands X
Hillsborough X
Holmes X
Indian River X
Jackson X
Jefferson X
Lafayette X
Lake X
Lee X
Leon X
Levy X
Liberty X
Madison X
Manatee X
Marion X
Martin X
Monroe X
Nassau X
OKaloosa X
Okeechobee X
Orange X
Osceola X
Palm Beach X
Pasco X
Pinellas X
Polk X
Putnam X
Santa Rosa X
Sarasota X
Seminole X
St. Johns X
St. Lucie X
Sumter X
Suwannee X
Taylor X
Union X
Volusia X
Wakulla X
Walton X
Washington X
Co = County HD
1GEORGIA
2Georgia Divison of Public Health, 1990
3I. General State Information
A. Selected Socio-Demographic Indicators
State United States
Population (1988) 6,342,000 245,803,000
Population Density (1988) * 107.7 69.4
(per/sq.mi.)
Number of Counties 159 3,139
Median Age (1987) * 30.6 31.7
Percent Below Poverty Level (1985) * 16.6 14.0
(persons)
Percent of Population Rural (1980) * 37.6 26.0
Percent of Population White (1980) * 72.8 83.1
Percent of Population Non-white (1980) * 27.2 16.9
Median Years of Education (1980) 12.2 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
Georgia counties operate under powers granted to them by the
Georgia Constitution and Statutes.
Commission Form - (159) - The county government is based on the
Commission Form and is usually made up of three- to nine-member
boards. However, 22 counties have only one commissioner.
Sixty-one counties appoint an administrative manager who is
responsible for the daily administration of the county
government.
Home Rule - (39) - The power of county governments in Georgia is
limited to that conferred on them by law or implied in the
granting of other authority. In 1965 the state constitution was
amended under home rule legislation giving counties legislative
authority to pass ordinances, regulations, and resolutions on
subjects that were not otherwise restricted by the state
constitution or other laws.
City-County Consolidation - (1) - Although the state constitution
permits cities and counties to consolidate their
* These date were provided by the SHA.
Data for this state were updated October 1990. governments, only
Columbus-Muscogee have chosen to do so. This consolidated
government functions with an elected mayor and 10
councilmen.
County governments do not have charters in Georgia. Instead,
legislative acts function in the same way and establish boards of
commissioners, their terms of office, salaries, powers, and
duties.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The SHA in Georgia is called the Division of Public Health. It
is a component of a superagency that is called the Georgia
Department of Human Resources (GDHR). The mission of the GDHR is
to assist Georgians in achieving their highest levels of health,
development, independence, and self sufficiency.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
B. Head of State Health Agency
M.D. Required, Not Cabinet-level Appointment
The head of the SHA is the Director of the Division of Public
Health. This position is appointed by the Commissioner of the
Department of Human Resources. There is a legal requirement that
the Director be a physician. The Director has responsibility for
the management and administration of the Division of Health.
C. State Board of Health/Council
Policy-making
Georgia has a Board of Human Resources rather than a State Board
of Health or Health Council. It is composed of 15 members, but
not more than two, from each congressional district in the
state. The members are appointed by the Governor and confirmed
by the Senate for staggered 5-year terms. Seven members of the
board must be professionally engaged in rendering health
services, and at least five of those seven must be licensed to
practice medicine in Georgia. The Board establishes the general
policy to be followed by the agency. It also appoints the
commissioner for the department, subject to approval of the
Governor. The Commissioner of the GDHR is required by law to be
the chief administrative officer of the Board and subject to the
policy established by the Board.
D. Regional/District Health Offices
State law permits the establishment of administrative multicounty
districts with the consent of the county governments and boards
of health of the counties involved. Nineteen administrative
areas (known as districts) currently exist in Georgia. The
districts range in size from 1 to 16 counties. Each district has
a health director who is appointed by the Commissioner and
approved by the boards of health of the concerned counties. The
District Health Director serves all of the counties in common and
has all of the powers and duties as the director of a single
county board of health.
The district offices are staffed with the following employees:
District Health Director
District Administrator
District Community Epidemiologist
District Chief of Nursing
District Program Manager
District Environmental Chief
District Program Heads
District Typists and Clerks
District offices are in the "lead" county of the district, which
is usually the largest county in population. The district office
is usually housed separately from a county health department.
Staff from the district office are involved in the direct
provision of services, but the services are usually provided at a
county health department rather than the district office.
E. State-local Liaison
Shared Organizational Control, Informal Liaison Function
The state does not have a single individual or office that has
responsibility for the interface between the SHA and local health
agencies. The Director of the Division of Public Health,
however, has four individuals who function as regional
coordinators, relating to counties and regions within their
geographic areas of responsibility.
The interaction between state and local public health agencies in
Georgia may be characterized as shared organizational control.
Under this arrangement, local health departments are under the
authority of the board of health and certain indirect authority
from the state which is provided contractually.
F. Budget
Total FY 1988 Georgia SHA expenditures were $198,845,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $81,008,000
State Funds $116,710,000
Local Funds 0
Fees and Reimbursements $788,000
Other $339,000
3III. Local Public Health Agencies (LPHAs)
A. General
Each of the 159 counties in Georgia has a county health
department which functions as the LPHA.
B. Services Provided
The following information on services provided by local health
departments in Georgia is derived from a survey conducted by
NACHO during 1989. One Hundred and fourteen of the 159 local
health departments responded to the survey. Services provided by
70 percent of the local health departments in the state
responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 55 ( 48.2%)
2. Morbidity Data 86 ( 75.4%)
3. Reportable Diseases 107 ( 93.9%)
4. Vital Records and Statistics 56 ( 49.1%)
B. Epidemiology/Surveillance
1. Chronic Diseases 57 ( 50.0%)
2. Communicable Diseases 106 ( 93.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 55 ( 48.2%)
B. Health Planning 71 ( 62.3%)
C. Priority Setting 59 ( 51.8%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 72 ( 63.2%)
2. Health Facility Safety/Quality 64 ( 56.1%)
3. Rec. Facility Safety/Quality 61 ( 53.5%)
4. Other Facility Safety/Quality 13 ( 11.4%)
B. Licensing
1. Health Facilities 39 ( 34.2%)
2. Other Facilities 90 ( 78.9%)
C. Health Education 89 ( 78.1%)
D. Environmental
1. Air Quality 23 ( 20.2%)
2. Hazardous Waste Management 26 ( 22.8%)
3. Individual Water Supply Safety 97 ( 85.1%)
4. Noise Pollution 10 ( 8.8%)
5. Occupational Health and Safety 39 ( 34.2%)
6. Public Water Supply Safety 52 ( 45.6%)
7. Radiation Control 14 ( 12.3%)
8. Sewage Disposal Systems 89 ( 78.1%)
9. Solid Waste Management 31 ( 27.2%)
10. Vector and Animal Control 64 ( 56.1%)
11. Water Pollution 37 ( 32.5%)
E. Personal Health Services
1. AIDS Testing and Counseling 112 ( 98.2%)
2. Alcohol Abuse 51 ( 44.7%)
3. Child Health 112 ( 98.2%)
4. Chronic Diseases 88 ( 77.2%)
5. Dental Health 70 ( 61.4%)
6. Drug Abuse 50 ( 43.9%)
7. Emergency Medical Service 28 ( 24.6%)
8. Family Planning 114 (100.0%)
9. Handicapped Children 74 ( 64.9%)
10. Home Health Care 31 ( 27.2%)
11. Hospitals 7 ( 6.1%)
12. Immunizations 114 (100.0%)
13. Laboratory Services 82 ( 71.9%)
14. Long-term Care Facilities 8 ( 7.0%)
15. Mental Health 56 ( 49.1%)
16. Obstetrical Care 34 ( 29.8%)
17. Prenatal Care 110 ( 96.5%)
18. Primary Care 16 ( 14.0%)
19. Sexually Transmitted Diseases 113 ( 99.1%)
20. Tuberculosis 111 ( 97.4%)
21. WIC 113 ( 99.1%)
C. Local Health Officer (District Health Director)
M.D. Requirement, Commissioner of Department of Human Resources
Appointment
The District Health Director usually serves as the county health
officer for each of the counties in the district. He/she is
appointed by the Commissioner of the Department of Human
Resources with the consent of the county boards of health in the
district. In fact, the boards of health in each county
subsequently appoint the district health director to the position
of county medical director. The district health officer is
required to provide those services mandated by the SHA, but
he/she has the authority to provide other services. The limiting
factor is the availability of local funds to support additional
services.
The Director is subject to the policies and directives of the
county board of health and the policies and directives of the
Division of Public Health. The Director is required to devote
his/her entire time to service and to the health districts and to
be vigilant in procuring compliance with its rules and
regulations and with Georgia health laws and rules and
regulations that have application within the county and
district. The Director is also directed to make reports to the
county board of health and to the Division of Public Health as
required.
D. Local Board of Health
Policy-making
State law provides for the creation of county boards of health,
their membership, powers and responsibilities. Each board of
health is specified by law to be composed of the following seven
members:
1. The Chief Executive Officer of the governing authority
of the county.
2. The county superintendent of schools.
3. A practicing physician (a nurse or dentist if no
physician is available).
4. A consumer to represent mental health, mental
retardation, and substance abuse services.
5. A consumer or nurse who is interested in promoting
public health.
6. A consumer who represents the county's needy,
underprivileged, or elderly.
7. The Chief Executive Officer of the governing authority
of the largest municipality in the county.
In counties with a population between 250,000 and 400,000, the
board may appoint the superintendent of the county's largest
municipal school system as an ex officio member.
The county boards of health are empowered by state statutes to
perform the following functions:
1. Establish and adopt bylaws for its own governance.
2. Exercise responsibility and authority in all matters
within the county pertaining to health unless the
responsibility is designated to another agency.
3. Take such steps as may be necessary to prevent and
suppress disease and conditions deleterious to health
and determine compliance with health laws and rules,
regulations, and standards.
4. Adopt and enforce rules and regulations appropriate to
its functions and powers.
5. Receive and administer all grants, gifts, moneys, and
donations for purposes of health.
6. Make contracts and establish fees for the provision of
mental health and other public health services by
county boards of health.
7. Contract with the Department of Human Resources or
other agencies for assistance in the performance of its
functions and the exercise of its powers and for
supplying services which are within its purview to
perform.
Counties with more than 550,000 population may create boards of
health by ordinance. The board of health in these counties is
very similar in structure (seven members) and functions by
operating under state law.
The board of health is directed to appoint a director who is a
licensed physician to serve as its chief executive officer. The
director, with approval of the board, may designate aides and
assistants.
E. Staff
The county health department staffs are employees of the county
board of health, but under the State Merit and Retirement
Systems. Additionally, they are not considered to be county
employees, but rather board of health employees. The funds for
staff salaries may come from all sources available such as fees,
grants-in-aid, county money, and state money. Employees are not
categorized according to the source of funds for their salaries
and are generally unaware of the source. The number of employees
for local health departments ranges from 2 to 698.
F. Budget
Total FY 1988 Georgia LPHA expenditures were $91,371,000. Total
FY 1988 United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $5,307,000
State Funds $44,987,000
Local Funds $25,110,000
Fees and Reimbursements $11,175,000
Other Sources $4,794,000
Source Unknown 0
2Georgia Division of Public Health, 1990
Director
Office of Epidemiology
Employees' Health Service
Administrative Services Section
Planning and Evaluation
Library
Fiscal Management
Personnel
Vital Records and Health Statistics
Research and Special Studies
Emergency Health Section
Field Services
Research and Evaluation
Training
Administrative Services
Environmental Health Section
Environmental Services
Special Services
Occupational Health
Family Health Services Section
Immunization Program
Women's Health
Office of Dental Health
Office of Medicine
Office of Nursing
Office of Nutrition
Children's Medical Services
Office of Pharmacy
Children and Adolescent Health
WIC
Community Health Section
Field Laboratory Services
Administrative Support Services
Micro-Immunology Services
Chemistry Services
Sexually Transmitted Disease
Adult Health
Genetic Screening
Tuberculosis Control
Primary Health Care Section
Appalachia
Resource Development
Coastal Plains
District/Unit Health Directors
County Health Departments
County Boards of Health
2Types of Local Health Departments by Jurisdiction
Georgia, 1990
Jurisdiction Co
Appling X
Atkinson X
Bacon X
Baker X
Baldwin X
Banks X
Barrow X
Bartow X
Beckley X
Ben Hill X
Berrien X
Bibb X
Brantley X
Brooks X
Bryan X
Bulloch X
Burke X
Butts X
Calhoun X
Camden X
Carroll X
Catoosa X
Chandler X
Charlton X
Chatham X
Chattahoochee X
Chattoga X
Cherokee X
Clarke X
Clay X
Clayton X
Clinch X
Cobb X
Coffee X
Columbia X
Cook X
Coweta X
Crawford X
Crisp X
Dade X
Dawson X
De Kalb X
Decatur X
Dodge X
Dooly X
Dougherty X
Douglas X
Early X
Echols X
Effingham X
Elbert X
Emanuel X
Evans X
Fannin X
Fayette X
Floyd X
Forsyth X
Franklin X
Fulton X
Gilmer X
Glascock X
Glynn X
Gordon X
Grady X
Greene X
Gwinnett X
Habersham X
Hall X
Hancock X
Haralson X
Harris X
Hart X
Heard X
Henry X
Irwin X
Jackson X
Jasper X
Jeff Davis X
Jefferson X
Jenkins X
Johnson X
Jones X
Lamar X
Lanier X
Laurens X
Lee X
Liberty X
Lincoln X
Long X
Lowndes X
Lumpkin X
Macon X
Madison X
Marion X
McDuffie X
McIntosh X
Meriwether X
Miller X
Mitchell X
Monroe X
Montgomery X
Morgan X
Murray X
Muscogee X
Newton X
Oconee X
Oglethorpe X
Paulding X
Peach X
Pickens X
Pierce X
Pike X
Polk X
Pulaski X
Putnam X
Quitman X
Rabin X
Randolph X
Richmond X
Rockdale X
Schley X
Screven X
Seminole X
Spalding X
Stephens X
Stewart X
Sumter X
Talbot X
Taliaferro X
Tattanall X
Taylor X
Telfair X
Terrel X
Thomas X
Tift X
Toombs X
Towns X
Treutlen X
Troup X
Turner X
Twiggs X
Union X
Upson X
Walker X
Walton X
Ware X
Warren X
Washington X
Wayne X
Webster X
Wheeler X
White X
Whitefield X
Wilcox X
Wilkerson X
Wilkes X
Worth X
Colquitt X
Houston X
Co = County HD
1HAWAII
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,098,000 245,803,000
Population Density (1988) 170.9 69.4
(per/sq.mi.)
Number of Counties 4 3,139
Median Age (1987) 30.9 31.7
Percent Below Poverty Level (1985) 10.7 14.0
(persons)
Percent of Population Rural (1980) 13.0 26.0
Percent of Population White (1980) 33.0 83.1
Percent of Population Non-white (1980) 67.0 16.9
Median Years of Education (1980) 12.7 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for county governments in Hawaii are
established by the state constitution.
Charter Form - (4) - All of the counties have this form of
government. The governing body for the counties is the council,
the members of which are elected at-large, except for Honolulu
city-county which elects them from districts. Three counties are
served by nine-member councils, and one is served by a
seven-member council. While the legislative function of county
government is served by the council, the executive function is
served by a mayor.
City-County Consolidation - (1) - The state constitution permits
the consolidation of city and county governments. At the present
time, only Honolulu city-county has merged.
Home rule authority is also provided for in the constitution.
The constitution states that each county shall have power to
develop and adopt a charter for its own self-government within
limits established by law.
One county, Kalawao, is administratively associated with the
County of Maui and does not have full county status.
Data for this state were updated December 1990
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Hawaii Department of Health (HDH), the SHA, is a
free-standing, independent agency. The mission of the Department
is to provide leadership to monitor, protect, and enhance the
health of all people in Hawaii.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Mental Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency (attached to
the HDH for administrative purposes)
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Director is the head of the HDH. The Director, under the
general direction of the Governor and with the advice of the
Board of Health, plans, directs, and administers statewide
activities designed to protect, preserve and improve the physical
and mental well-being of the people of the state of Hawaii. The
Governor appoints the Director and the Senate confirms the
appointment.
C. State Board of Health/Council
Advisory
The State Board of Health is composed of 11 members appointed by
the Governor with confirmation by the Senate. Terms of office
are 4 years and not to exceed two terms. One member is appointed
from each of the counties, including Kalawao, and six members are
appointed at-large. The Director of the Department of Human
Services serves as an ex officio member.
The Board functions to provide advice to the Director on matters
within the jurisdiction of the Department to hold hearings for
the Department at the request of the Director and to undertake
special projects at the request of the Director.
D. Regional/District Health Offices
The central health office is located on the island of Oahu and
district health offices are on Kauai, Maui and Hawaii. The
district offices administer and coordinate the delivery of public
health services. Services for some programs are delivered
directly through the district offices, but services for other
programs are provided by private providers through contracts.
E. State-local Liaison
Centralized Organizational Control, Informal Liaison Function
Since the service-providing units, the district health offices,
are part of the HDH, there is no need for a formal liaison
between the state and local units. Communications between the
different levels take place through the normal chain of command.
The interaction between state and local public health agencies in
Hawaii may be characterized as centralized organizational
control. Under this arrangement local health departments
function directly under the state's authority and are operated
the HDH or State Board of Health.
F. Budget
Total FY 1988 Hawaii SHA expenditures were $218,116,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $19,099,000
State Funds $110,419,000
Local Funds 0
Fees and Reimbursements $88,033,000
Other $567,000
3III. Local Public Health Agencies (LPHAs)
A. General
The Honolulu City Health Department is the only local health
department in Hawaii. Three district health offices are located
on the islands of Kauai, Maui, and Hawaii. The central office on
Oahu functions as a district office. The district offices
provide public health services to local areas and perform the
same basic function as local health departments in other states.
However, Hawaii does not consider these district units to be
local health departments.
B. Services Provided
The following are services provided by the district health
offices in Hawaii. Information on all three district health
departments was provided by the HDH. Honolulu City Health
Department provides physical examinations for city employees and
runs the ambulance service on Oahu under contract with the
state. Services provided by the Honolulu City Health Department
are not included in the following list:
Services Provided by LPHAs Number of LPHAs
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment -
2. Morbidity Data -
3. Reportable Diseases -
4. Vital Records and Statistics 3
B. Epidemiology/Surveillance
1. Chronic Diseases -
2. Communicable Diseases 3
II. Policy Development
A. Health Code Dev. and Enforcement -
B. Health Planning -
C. Priority Setting -
III. Assurance Activities
A. Inspection
1. Food and Milk Control 3
2. Health Facility Safety/Quality 3
3. Rec. Facility Safety/Quality 3
4. Other Facility Safety/Quality 3
B. Licensing
1. Health Facilities -
2. Other Facilities 3
C. Health Education 3
D. Environmental
1. Air Quality 3
2. Hazardous Waste Management 3
3. Individual Water Supply Safety 3
4. Noise Pollution -
5. Occupational Health and Safety -
6. Public Water Supply Safety 3
7. Radiation Control -
8. Sewage Disposal Systems 3
9. Solid Waste Management 3
10. Vector and Animal Control 3
11. Water Pollution 3
E. Personal Health Services
1. AIDS Testing and Counseling 3
2. Alcohol Abuse 3
3. Child Health 3
4. Chronic Diseases -
5. Dental Health 3
6. Drug Abuse 3
7. Emergency Medical Service -
8. Family Planning 3
9. Handicapped Children 3
10. Home Health Care 1
11. Hospitals -
12. Immunizations 3
13. Laboratory Services 3
14. Long-term Care Facilities -
15. Mental Health 3
16. Obstetrical Care -
17. Prenatal Care 3
18. Primary Care 3
19. Sexually Transmitted Diseases 3
20. Tuberculosis 3
21. WIC 3
C. Local Health Officer
M.D. Requirement, State Health Director Appointment
The District Health Services Administrator is equivalent to the
local health officer and is appointed by the State Director of
Health. This position requires an M.D. degree. The District
Health Services Administrator is responsible for managing the
district health office and its programs.
D. Local Board of Health
There are no local boards of health in Hawaii.
E. Staff
The staffs of the district health offices are employees of the
HDH and part of the State Civil Service System.
F. Budget
Total FY 1988 LPHA expenditures were $7,028,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts 0
State Funds $6,582,000
Local Funds $445,000
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
The SHA reported that these figures include the total amount of
additional local health department monies spent by the Honolulu
City Health Department.
2Hawaii Department of Health, 1990
Director of Health
Administrative Services Office
Personnel Office
Health Information Systems Office
Office of Affirmative Action
District Health Office Hawaii
District Health Office Maui
District Health Office Kauai
Personal Health Services Administration
Family Health Services Administration
Developmental Disabilities Division
Community Health Nursing Division
Office of Elder Health
Environmental Health Administration
Environmental Health Services Division
Environmental Management Division
Hazardous Evaluation and Emergency Response Office
Environmental Planning Office
Environmental Resources Office
Community Hospital Administration
Community Hospital Division
Health Promotion and Disease Prevention Administration
Health Prevention and Education Division
Communicable Disease Division
Dental Health Division
Office of Refugee Immigrant Health
Behavioral Health Services Administration
Adult Mental Health Division
Alcohol and Drug Abuse Division
Children and Adolescent Mental Health Division
Health Resources Administration
State Laboratory Division
Health Quality Assurance Division
Office of Health Status Monitoring
Office of Hawaiian Health
Office of Planning, Policy and Program Development
2Types of Local Health Departments by Jurisdiction
Hawaii, 1990
Jurisdiction C N/Co
Hawaii X
Honolulu X
Honolulu X
Kalawao X
Kauai X
Maui X
C = City HD
N/Co = No county HD
1IDAHO
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,003,000 245,803,000
Population Density (1988) 12.2 69.4
(per/sq.mi.)
Number of Counties 44 3,139
Median Age (1987) 29.8 31.7
Percent Below Poverty Level (1985) 16.0 14.0
(persons)
Percent of Population Rural (1980) 46.0 26.0
Percent of Population White (1980) 95.5 83.1
Percent of Population Non-white (1980) 4.5 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
County governments in Idaho are empowered by the state
constitution which provides the legal framework for the county
government, establishes the authority of county officials and
their terms of office, lists the function that counties perform,
creates limits on county indebtedness, and contains detailed
provisions on county boundaries.
Commission Form - (44) - Three-member county commissions are the
governing bodies of the counties. The boards of commissioners
exercise both legislative and executive powers. They are elected
at large but must meet district residency requirements.
Counties in Idaho function as units of the state government by
administering elections, enforcing state laws, and performing
other functions required by the state. They also function as
units of local government in meeting needs of citizens by
providing standard services at the local level.
Data for this state were updated October 1990.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The SHA in Idaho is the Department of Health and Welfare, with
primary health-related responsibility delegated to the Division
of Health. The information provided is restricted to the
Division of Health. The mission of the Division of Health is to
effectively and efficiently mobilize and manage appropriate
resources for the protection and improvement of the health of the
citizens of Idaho.
The following are some areas of responsibility for the Department
of Health and Welfare:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
The following are some areas of responsibility for the Division
of Health:
Preventive Medicine
Maternal and Child Health
Emergency Medical Services
Health Policy
Vital Statistics
State Laboratories
Epidemiology Services
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet Level Appointment
The Administrator for the Division of Health is the head of the
SHA. The Administrator is appointed by the Director of the
Department of Health and Welfare with concurrence of the State
Board of Health and Welfare. The Administrator reports to the
Director.
It is the responsibility of this person to administer the
numerous programs of the Division of Health in a manner that most
efficiently protects the citizens of the state from communicable
disease, substance abuse, improperly administered health
facilities, accidents, and aggravated conditions due to lack of
early diagnosis.
C. State Board of Health/Council
Policy-making
Idaho has a Board of Health and Welfare which consists of seven
members who are appointed by the Governor with the charge to
formulate rules and regulations for the Department of Health and
Welfare and to advise its directors. The members are chosen with
regard for their knowledge and interest in environmental
protection and health.
D. Regional/District Health Offices
The state is subdivided into seven administrative regions. The
regions have offices which function as extensions of the central
office. They provide direct services to their jurisdictions in
the areas of mental health, food stamps, and Medicaid.
E. State-Local Liaison
Decentralized Organizational Control, Informal Liaison Function
The district health departments are autonomously governed by
local boards of health. The relationship between the Division of
Health and the district health departments is basically a
contractual arrangement wherein the Bureaus of Preventive
Medicine and Maternal and Child Health contract with the
districts to provide program services.
The interaction between state and local public health agencies in
Idaho may be characterized as decentralized organizational
control. Under this arrangement local governments directly
operate health departments with a local board of health.
F. Budget
Total FY 1988 Idaho SHA expenditures were $21,005,000. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $14,195,000
State Funds $6,809,000
Local Funds 0
Fees and Reimbursements 0
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
During the 1970's, Idaho passed legislation to provide for fairly
uniform public health services for every county in the state
through seven multicounty health departments which are called
district health departments. Each district is autonomously
governed by a local board of health. These agencies are
answerable to the public through the county commissioners and
district boards of health. The districts receive state money in
the form of contracts for services.
B. Services Provided
The following information on services provided by local health
departments in Idaho is derived from a survey conducted by NACHO
during 1989. All seven of the local health departments in Idaho
responded to the survey. Services provided by at least 70
percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 3 ( 42.9%)
2. Morbidity Data 4 ( 57.1%)
3. Reportable Diseases 7 (100.0%)
4. Vital Records and Statistics 6 ( 85.7%)
B. Epidemiology/Surveillance
1. Chronic Diseases 6 ( 85.7%)
2. Communicable Diseases 7 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 5 ( 71.4%)
B. Health Planning 6 ( 85.7%)
C. Priority Setting 6 ( 85.7%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 7 (100.0%)
2. Health Facility Safety/Quality -
3. Rec. Facility Safety/Quality 6 ( 85.7%)
4. Other Facility Safety/Quality 3 ( 42.9%)
B. Licensing
1. Health Facilities -
2. Other Facilities 6 ( 85.7%)
C. Health Education
D. Environmental
1. Air Quality 2 ( 28.6%)
2. Hazardous Waste Management 5 ( 71.4%)
3. Individual Water Supply Safety 7 (100.0%)
4. Noise Pollution 1 ( 14.3%)
5. Occupational Health and Safety -
6. Public Water Supply Safety 5 ( 71.4%)
7. Radiation Control 2 ( 28.6%)
8. Sewage Disposal Systems 6 ( 85.7%)
9. Solid Waste Management 7 (100.0%)
10. Vector and Animal Control 7 (100.0%)
11. Water Pollution 6 ( 85.7%)
E. Personal Health Services
1. AIDS Testing and Counseling 7 (100.0%)
2. Alcohol Abuse 1 ( 14.3%)
3. Child Health 7 (100.0%)
4. Chronic Diseases 6 ( 85.7%)
5. Dental Health 7 (100.0%)
6. Drug Abuse -
7. Emergency Medical Service -
8. Family Planning 7 (100.0%)
9. Handicapped Children 7 (100.0%)
10. Home Health Care 3 ( 42.9%)
11. Hospitals -
12. Immunizations 7 (100.0%)
13. Laboratory Services 4 ( 57.1%)
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care 2 ( 28.6%)
17. Prenatal Care 7 (100.0%)
18. Primary Care 1 ( 14.3%)
19. Sexually Transmitted Diseases 7 (100.0%)
20. Tuberculosis 7 (100.0%)
21. WIC 7 (100.0%)
C. Local Health Officer
No M.D. Requirement, Local Board of Health Appointment
The District Health Director is appointed by the District Board
of Health. Although there is no M.D. requirement, each district
must have a doctor of medicine licensed in Idaho as a staff
member or as a regular consultant. The Director is responsible
for administration of the health department.
D. Local Board of Health
Policy-making
District boards of health are appointed by the boards of county
commissioners within each district. The duties and
responsibilities of the boards include both advisory and policy
making.
E. Staff
District health department staffs are employed and supervised by
the jurisdiction which they serve. The number of employees for
district health departments in Idaho ranges from 45 to 104.
F. Budget
Total FY 1988 LPHA Expenditures were $3,174,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $3,174,000
State Funds 0
Local Funds 0
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
2Idaho Department Of Health and Welfare, 1990
Division of Health
Office of Epidemiological Services
Office of Policy and Resource Development
Emergency Medical Service Bureau
Southwest/South Central Region
East Region
North Region/Central Region
EMGE Project
Training
Bureau of Laboratories
Virology/Serology
Chemistry
Genetics
Lab Improvement
Microbiology
Inorganic
Organic
Center for Health Statistics
Vital Records
Health Statistics
Maternal and Child Health Bureau
Children's Special Health Program
Improved Pregnancy
Family Planning
WIC
Dental Health
Nutrition
Preventive Medicine Bureau
AIDS/STD
Environmental Health
Immunization
Food Protection
Film Library
Health Promotion/Disease Prevention
2Types of Local Health Departments by Jurisdiction
Idaho, 1990
Jurisdiction M/Co
Ada X
Adams X
Bannock X
Bear Lake X
Benewah X
Bingham X
Blaine X
Boise X
Bonner X
Bonneville X
Boundary X
Butte X
Camas X
Canyon X
Caribou X
Cassia X
Clark X
Clearwater X
Custer X
Elmore X
Franklin X
Fremont X
Gem X
Gooding X
Idaho X
Jefferson X
Jerome X
Kootenai X
Latah X
Lemhi X
Lewis X
Lincoln X
Madison X
Minidoka X
Nez Perce X
Oneida X
Owyhee X
Payette X
Power X
Soshone X
Teton X
Twin Falls X
Valley X
Washington X
M/Co = Multicounty
HD
1ILLINOIS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 11,615,000 243,915,000
Population Density (1988) 208.7 69.4
(per/sq.mi.)
Number of Counties 102 3,139
Median Age (1987) * 32.0 31.7
Percent Below Poverty Level (1985) 15.6 14.0
(persons)
Percent of Population Rural (1980) * 16.7 26.0
Percent of Population White (1980) * 83.6 83.1
Percent of Population Non-white (1980) * 16.4 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The state constitution and statutes establish the structure and
authority for county governments in Illinois.
County Board Form - (85) - This form has 5 to 29 board members
elected from districts.
Commission Form - (17) - In this form are three commissioners
elected from the county at large.
Elected Executive Form - (1) - Under the Illinois Constitution,
counties may adopt home rule authority. The home rule authority
comes through the adoption of an Elected County Executive Form of
government. Home rule counties are entitled to exercise any
power or perform any function related to government affairs.
However, the General Assembly may deny or limit any power granted
to local governments. Cook county is the only county that has
adopted home rule.
Non-home rule counties have only the general powers granted to
them by law. They elect an executive officer from the board or
commission.
* These data were provided by the SHA.
The following are four variations from which counties can choose
in regard to an executive officer:
Elected Executive Plan -(1) - Although this plan is part of the
home rule packet, counties can adopt the elected executive
portion of the plan and reject the home rule elements. This
option establishes a separate legislative and executive branch.
At the present time, only Will county has adopted this plan.
Appointed County Administrator Plan - (12) - Under this plan the
appointed administrator has responsibility for administration and
coordination.
County Board President Plan - (2) - DuPage and St. Clair utilize
this plan and grant the president general administrative
responsibility for the affairs of the county.
County Manager Plan - (0) - This option has not been used at the
present time, but it gives administrative authority to a
professional administrator appointed and supervised by the
board.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The SHA in Illinois, the Department of Public Health (IDPH), is a
free-standing, independent agency. The mission of the Department
is to fulfill society's interest in assuring conditions in which
people can be healthy. The Department has authority to
promulgate rules and regulations setting minimum program and
performance standards for local health departments, while
prescribing minimum qualifications for professional, technical
and administrative staff of local health departments. Other
responsibilities include the approval of counties seeking to form
multicounty health departments and the determination of
classifications for local health departments. The IDPH contains
five administrative units, with staff located in two
co-centralized offices in Springfield and Chicago, eight regional
offices and three public health laboratories.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Health Policy and Planning
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Director of the IDPH, appointed by the Governor, must be
either a person licensed to practice medicine and surgery in this
state, having had at least 5 years' practical experience in the
practice of medicine and surgery, have administrative knowledge
of and experience in public health or a person with the general
knowledge of and administrative experience in public health.
C. State Board of Health/Council
Advisory
The State Board of Public Health Advisors is an advisory
committee composed of nine members, one of whom is a senior
citizen, appointed by the Governor. The Governor will appoint
four members who will be physicians (licensed to practice
medicine in all branches); one member who is a local public
health administrator; one member who is a dentist licensed to
practice dentistry and who has been active in public health; one
member who is a registered professional nurse (licensed) and who
has been active in public health; one member who is a member of
the statewide Health Coordinating Council, who represents a
professional group; and one member who is a public health
sanitarian or sanitary engineer.
D. Regional/District Health Offices
The IDPH operates eight regional offices located in Chicago,
Rockford, Peoria, Springfield, Edwardsville, Marion, Champaign,
and West Chicago. Each of the regional offices operates under
the direction of a Regional Health Officer (RHO) and is
responsible for a specified geographic area of the state. The
general duties of the Regional Health Officer are as follows:
Under the direction of the IDPH Associate Director, Office
of Program Administrative Support, to coordinate, monitor
and evaluate the effectiveness of programs.
To be the focal point for regional activities by requiring
all Governor's office, legislative, press, consumer or
interest group inquiries be handled through the RHO.
To be responsible for conflict resolution within the
regional office; however, if a resolution cannot be
accomplished, the RHO shall initiate and participate in
discussion with the central office to ensure resolution.
To coordinate regional activities as they affect local
health agencies.
To develop grants and contracts for services in consultation
with the regional program supervisor or division chiefs.
The following are some of the principal positions that are
included in the 30- to 35-member staffs of regional offices:
Regional Health Officer
Communicable Disease Coordinator
Immunization Coordinator
MCH Nurse Coordinator
Long-term Care Nurse
Regional Engineer
Swimming Pool Inspector
Plumbing Inspector
Food Inspector
Environmental Health Inspector
Architect
Clerical Staff
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The local liaison unit within IDPH is the Division of Local
Health Administration (DLHA). Organizationally it is one
division within the Office of Program and Administrative
Support. The overall mission of DLHA is to maintain and improve
communication with local health departments (LHDs). The division
serves as the state health department contact point for LHDs;
promotes the development of LHDs; promulgates program standards
and minimum qualifications for LHDs; provides oversight to the
evaluation of LHD basic public health services; distributes
formula grant funds to LHDs; provides consultation and technical
assistance to LHDs; offers training to LHD personnel; assists
LHDs with personnel recruitment; processes evaluation of LHD
personnel; updates and distributes LHD directories; provides
information to LHDs regarding legislation, rules or policies that
may affect them; provides orientation to newly appointed LHD
administrators; consults or meets with LHD administrators, boards
of health and other local officials on local health issues;
participates in planning retreats for boards of health;
participates on various committees comprised of Department
personnel and LHD administrators on issues of common interest;
staffs Project Health; maintains electronic communication with
LHDs in emergency and non-emergency situations; provides
environmental health liaison and training for LHDs; and provides
nursing liaison and training for LHDs.
The interaction between state and local public health agencies in
Illinois may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement,
local health services may be provided by the SHA in some
jurisdictions and by local governmental units, boards of health,
or health departments in others.
F. Budget
Total FY 1988 SHA expenditures were $189,333,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $101,659,000
State Funds $86,119,000
Local Funds 0
Fees and Reimbursements $1,510,000
Other $44,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 81 local health departments covering 85 counties and 94
percent of the Illinois population. Five city, 3 township (known
as districts in Illinois), 6 multicounty units (serving 17
counties), 1 city-county, and 66 county health departments make
up the 81 local health departments. In Illinois, local
governments are the primary source of support for local public
health services; whether these services exist or not is decided
by the people in local political units. Counties may establish a
health department by resolution of the county board or by
referendum vote.
Resolution health departments can be established by a majority of
the county board. Upon passage of the resolution, the chairman
of the county board appoints a board of health. The primary
funding source for resolution health departments comes from the
general fund of the county government. Referendum health
departments have a tax base established in the referendum to
provide local support. The structure and function of the two
types of health departments is the same, only the source of local
funds is different. The IDPH provides Basic Health Service Grant
funds through a formula distribution to both resolution and
referendum health departments. No matching local funds are
required for receiving these funds. During the health
department's first 3 years of development, a Development Grant in
the range of $17,500-$27,500 (depending on population size) is
available each year. After the third year of operation,
resolution and referendum health departments are expected to have
implemented the 10 required programs.
Due to autonomy of local health departments in Illinois, the IDPH
cannot mandate a specific role for them. Through the
Department's standard setting and funding roles, however,
attempts have been made to encourage the following activities for
local health departments:
1. Provide a local operation sufficient to meet local
public health needs.
2. Develop and maintain local fiscal support.
3. Maintain and continue to upgrade all required programs.
4. Develop and maintain all recommended and optional
programs which are appropriate to the needs and
priorities of the area served.
5. Provide consultation to the state agency through
service on various Departmental task forces designed to
review standards and other mutual problems.
6. Endeavor to enhance local programs through contracts or
merger with adjacent departments.
The IDPH divides local health departments into four primary
types:
1. Developmental: A local health department which has
been in operation less than 3 full years and has not
been approved for the five core programs.
2. Unaccredited: A local health department which has been
in operation more than 3 full years and has not been
approved for all five core programs.
3. Accredited: A local health department which is
approved for the five core programs but currently is
not approved for at least one of the five non-core
programs.
4. Certified: A local health department which is
currently approved for all 10 of the required programs.
B. Services Provided
The following information on services provided by local health
departments in Illinois is derived from a survey conducted by
NACHO during 1989. Sixty-eight of the 81 local health
departments in Illinois responded to the survey. Services
provided by at least 70 percent of health departments in the
state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 32 ( 47.1%)
2. Morbidity Data 44 ( 64.7%)
3. Reportable Diseases 66 ( 97.1%)
4. Vital Records and Statistics 40 ( 58.8%)
B. Epidemiology/Surveillance
1. Chronic Diseases 58 ( 85.3%)
2. Communicable Diseases 68 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 54 ( 79.4%)
B. Health Planning 52 ( 76.5%)
C. Priority Setting 49 ( 72.1%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 62 ( 91.2%)
2. Health Facility Safety/Quality 18 ( 26.5%)
3. Rec. Facility Safety/Quality 11 ( 16.2%)
4. Other Facility Safety/Quality 11 ( 16.2%)
B. Licensing
1. Health Facilities 6 ( 8.8%)
2. Other Facilities 55 ( 80.9%)
C. Health Education 59 ( 86.8%)
D. Environmental
1. Air Quality 4 ( 5.9%)
2. Hazardous Waste Management 21 ( 30.9%)
3. Individual Water Supply Safety 60 ( 88.2%)
4. Noise Pollution 6 ( 8.8%)
5. Occupational Health and Safety 5 ( 7.4%)
6. Public Water Supply Safety 21 ( 30.9%)
7. Radiation Control 6 ( 8.8%)
8. Sewage Disposal Systems 63 ( 92.6%)
9. Solid Waste Management 58 ( 85.3%)
10. Vector and Animal Control 42 ( 61.8%)
11. Water Pollution 37 ( 54.4%)
E. Personal Health Services
1. AIDS Testing and Counseling 50 ( 73.5%)
2. Alcohol Abuse 16 ( 23.5%)
3. Child Health 65 ( 95.6%)
4. Chronic Diseases 67 ( 98.5%)
5. Dental Health 22 ( 32.4%)
6. Drug Abuse 14 ( 20.6%)
7. Emergency Medical Service 5 ( 7.4%)
8. Family Planning 48 ( 70.6%)
9. Handicapped Children 12 ( 17.6%)
10. Home Health Care 40 ( 58.8%)
11. Hospitals 1 ( 1.5%)
12. Immunizations 67 ( 98.5%)
13. Laboratory Services 25 ( 36.8%)
14. Long-term Care Facilities 5 ( 7.4%)
15. Mental Health 15 ( 22.1%)
16. Obstetrical Care 6 ( 8.8%)
17. Prenatal Care 54 ( 79.4%)
18. Primary Care 14 ( 20.6%)
19. Sexually Transmitted Diseases 65 ( 95.6%)
20. Tuberculosis 58 ( 85.3%)
21. WIC 65 ( 95.6%)
C. Local Health Officer
M.D. Requirement for Medical Health Officer, Local Board of
Health Appointment
Two job titles in Illinois are equivalent to the title of local
health officer: Public Health Administrator and Medical Health
Officer. The primary duties for the Public Health Administrator
are as follows: planning, organizing, and directing the work of
all staff while establishing operational methods and procedures;
assisting in policy development while recommending the
establishment and revision of rules and regulations; preparing
statistical, financial and special reports while holding periodic
conferences with subordinates; directing staff services and
developing data, budget estimates, and requests; directing the
department personnel program; supervising purchasing and
storekeeping activities; performing public standards development,
research and planning programs; writing, assigning, and reviewing
correspondence; interpreting statistics, regulations and rules
while adapting methods and procedures to change legal and policy
conditions.
Requirements for the Public Health Administrator are a master's
degree in public health or public administration and 2 years of
full-time administrative experience in public health; or
graduation from a 4-year college with a broad educational
background and 4 years of full-time experience, of which at least
2 years must be in public health.
Medical Health Officer has identical distinguishing work features
to the Public Health Administrator; however, the minimum
requirements for each job title differ. This position
requires completion of courses in an approved medical school or
completion of courses approved by the Education Council for
Foreign Medical Graduates supplemented by 1 year of internship or
its equivalent; a license to practice medicine in Illinois; a
master's degree in public health or equivalent experience in a
health field; a certification in public health by the American
Board of Preventive Medicine or board certification in a related
specialty is desirable; and a year of full-time experience in
public health administration.
D. Local Board of Health
Policy-making
County boards of health consist of eight members appointed by the
president or chairman of the county board. Membership, as
defined under Illinois Statutes, requires "at least two members
of each county board of health shall be physicians licensed in
Illinois to practice medicine in all of its branches, at least
one member shall be a dentist licensed in Illinois and one member
shall be chosen from the county board of supervisors or
commissioners as the case may be."
Public health districts and municipalities may also establish a
board of health. In counties not under township organization,
the county commissioners are the board of health for each
district in the county. Districts in counties under township
organization that consist of a single town have the supervisor,
assessor and town clerk as members of the board. When a district
consists of two or more adjacent towns, the supervisors of the
towns in conjunction with the chairman of the county board make
up the board of health. In municipalities with Commission Form
of government, the Mayor, with the approval of the corporate
authorities, appoints the board of five directors, two of whom
must be physicians.
E. Staff
Local health department staffs are employed and supervised by the
local jurisdiction. The number of employees for a local health
department ranges from 2 to 2,100.
F. Budget
Total FY 1988 LPHA expenditures were $197,791,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $33,786,000
State Funds $45,547,000
Local Funds $66,263,000
Fees and Reimbursements $17,401,000
Other Sources $12,563,000
Source Unknown $22,232,000
2Illinois Department of Public Health, 1990
Director
Board of Public Health Advisors
Medical Determinations Board
Assistant Director
Center for Rural Health
Office of Health Policy and Planning
Division of Facilities Development
Division of Health Statistics and Policy Development
Division of Legal Services
Division of Governmental Affairs
Division of Audits
Division of Communications
Equal Employment Opportunity Officer
Public Health Deputy Director
Office of Program and Administrative Support
Employee Services and Benefits Unit/Word Processing
Center
Training Center
Regional Operations
Division of Local Health Administration
Division of Personnel and Labor Relations
Division of General Services
Division of Financial Services
Division of Vital Records
Division of Data Processing
Office of Health Services
Assistant Associate Director
Center for Health Promotion
Division of Family Health
Division of Chronic Diseases
Division of Dental Health
Division of Alcohol and Substance Abuse Testing
Division of Health Assessment and Screening
Office of Health Care Regulation
Division of Administrative and Technical Support
Bureau of Long-Term Care
Division of LTC Quality Assurance
Division of LTC Field Operations
Division of LTC Information and Research
Division of Health Care Facilities and Programs
Division of Emergency Medical Services and Highway
Safety
Office of Health Protection
Assistant Associate Director
Emergency Officer
Division of Infectious Diseases
Division of Food, Drugs and Dairies
Division of Environmental Health
Division of Epidemiologic Studies
Division of Laboratories
2Types of Local Health Departments by Jurisdiction
Illinois, 1990
Jurisdiction Co C C/Co M/Co N/Co T/T
Adams X
Alexander X
Bond X
Boone X
Brown X
Bureau X
Calhoun X
Carroll X
Cass X
Champaign X
Champaign-Urbana X
Chicago X
Christian X
Clark X
Clay X
Clinton X
Coles X
Cook X
Crawford X
Cumberland X
De Kalb X
Dewitt X
Douglas X
Du Page X
East Side District X
Edgar X
Edwards X
Effingham X
Evanston X
Fayette X
Ford X
Franklin X
Fulton X
Gallatin X
Greene X
Grundy X
Hamilton X
Hancock X
Hardin
Henderson X X
Henry X
Iroquois X
Jackson X
Jasper X
Jefferson X
Jersey X
Jo Daviess X
Johnson X
Kane X
Kankakee X
Kendall X
Knox X
La Salle X
Lake X
Lawrence X
Lee X
Livingston X
Logan X
Macon X
Macoupin X
Madison X
Marion X
Marshall X
Mason X
Massac X
McDonough X
McHenery X
McLean X
Menard X
Mercer X
Monroe X
Montgomery X
Morgan X
Oak Park X
Ogle X
Peoria City/Co X
Perry X
Piatt X
Pike X
Pope X
Pulaski X
Putnam X
Randolph X
Richland X
Rock Island X
Saline X
Sangamon X
Schuyler X
Scott X
Shelby X
Skokie X
Springfield X
St. Clair X
Stark X
Stephenson X
Stickney Township X
Tazwell X
Union X
Vermillion X
Wabash X
Warren X
Washington X
Wayne X
White X
Whiteside X
Will X
Williamson X
Winnebago X
Woodford X
Co = County HD
C = City HD
C/Co = City/County
HD
M/Co = Multicounty
HD
N/Co = No County HD
T/T = Town/Township
HD
1INDIANA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 5,556,000 245,803,000
Population Density (1988) 154.6 69.4
(per/sq.mi.)
Number of Counties 92 3,139
Median Age (1987) 31.3 31.7
Percent Below Poverty Level (1985) 12.0 14.0
(persons)
Percent of Population Rural (1980) 36.0 26.0
Percent of Population White (1980) 91.2 83.1
Percent of Population Non-white (1980) 8.8 16.9
Median Years of Education (1980) 12.4 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and function of counties in Indiana are established
by the state constitution and Title 36 of the Indiana Code.
Commission Form - (92) - The Commission Form of government is
used by the counties in Indiana. Most county governments in
Indiana have two governing bodies, a board of commissioners and a
county council. The boards of commissioners are made up of three
members elected at large with residency requirements in existing
districts. They serve as the executive and legislative bodies of
county governments. The county councils serve as the fiscal
bodies of the governments and are usually made up of seven
members. Four council members are elected from single-member
districts and three members are elected at large. Additionally,
two counties have appointed administrators to handle the
administrative duties of the county.
Counties in Indiana have home rule authority as granted in Title
36 of the Indiana Code. The section of code relating to home
rule specifies that counties have the powers granted by law and
other powers necessary or desirable to conduct county affairs.
Data for this state were updated February 1991. In 1969, the Indiana
General Assembly passed a law facilitating the consolidation of
Marion County and Indianapolis. This unified government consists
of a 29-member city-county council and a mayor. Twenty-five members
of the council are elected from single-member districts and four are
elected at large.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Indiana State Board of Health (ISBH), the SHA, is a
free-standing, independent agency.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
Special State Institutions such as School for Blind
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The State Health Commissioner serves as the Chief Executive
Officer of the Department and as Secretary for the Executive
Board of the State Board of Health. The Commissioner is
appointed by and serves at the pleasure of the Governor. As
Chief Executive Officer, the Commissioner is responsible for
overall management of the SHA and its programs.
C. State Board of Health/Council
Policy-making
The Executive Board of the State Board of Health is composed of
11 members appointed by the Governor. The members of the Board
elect a Chairman from among its membership. The Executive Board
is responsible for making policy for the State Board of Health
and approving appointments made by the Commissioner.
D. Regional/District Health Offices
The ISBH has not divided the state into regions or districts.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The primary mission of the staff members of the State Board of
Health is to function as consultants to local health department
staff within the state. In addition staff members of the
Division of Local Support are assigned on a geographical basis to
work directly with local health department staff and to provide
both technical and management consultative services.
Interaction between state and local public health agencies in
Indiana may be characterized as decentralized organizational
control. Under this arrangement local governments directly
operate health departments with or without a board of health.
F. Budget
Total FY 1988 Indiana SHA expenditures were $106,237,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $48,357,000
State Funds $57,881,000
Local Funds 0
Fees and Reimbursements 0
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Indiana has 96 local health departments, composed of 1
multicounty, 5 city, and 90 county health departments. According
to state law, the ISBH is the "superior agency" to each of the
local health departments. In this capacity the ISBH is charged
with the responsibility of approving the appointment of local
health officers and overseeing the programs and activities of the
local health departments.
B. Services Provided
The following information on services provided by local health
departments in Indiana is derived from a survey conducted by
NACHO during 1989. Ninety-four of the 95 local health
departments in Indiana responded to the survey. Services
provided by at least 70 percent of health departments in the
state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 13 ( 13.8%)
2. Morbidity Data 38 ( 40.4%)
3. Reportable Diseases 71 ( 75.5%)
4. Vital Records and Statistics 89 ( 94.7%)
B. Epidemiology/Surveillance
1. Chronic Diseases 38 ( 40.4%)
2. Communicable Diseases 85 ( 90.4%)
II. Policy Development
A. Health Code Dev. and Enforcement 51 ( 54.3%)
B. Health Planning 49 ( 52.1%)
C. Priority Setting 21 ( 22.3%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 67 ( 71.3%)
2. Health Facility Safety/Quality 21 ( 22.3%)
3. Rec. Facility Safety/Quality 30 ( 31.9%)
4. Other Facility Safety/Quality 8 ( 8.5%)
B. Licensing
1. Health Facilities 6 ( 6.4%)
2. Other Facilities 63 ( 67.0%)
C. Health Education 56 ( 59.6%)
D. Environmental
1. Air Quality 41 ( 43.6%)
2. Hazardous Waste Management 50 ( 53.2%)
3. Individual Water Supply Safety 76 ( 80.9%)
4. Noise Pollution 9 ( 9.6%)
5. Occupational Health and Safety 12 ( 12.8%)
6. Public Water Supply Safety 51 ( 54.3%)
7. Radiation Control 17 ( 18.1%)
8. Sewage Disposal Systems 87 ( 92.6%)
9. Solid Waste Management 61 ( 64.9%)
10. Vector and Animal Control 76 ( 80.9%)
11. Water Pollution 65 ( 69.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 22 ( 23.4%)
2. Alcohol Abuse 3 ( 3.2%)
3. Child Health 61 ( 64.9%)
4. Chronic Diseases 50 ( 53.2%)
5. Dental Health 9 ( 9.6%)
6. Drug Abuse 6 ( 6.4%)
7. Emergency Medical Service 4 ( 4.3%)
8. Family Planning 16 ( 17.0%)
9. Handicapped Children 53 ( 56.4%)
10. Home Health Care 45 ( 47.9%)
11. Hospitals 2 ( 2.1%)
12. Immunizations 89 ( 94.7%)
13. Laboratory Services 17 ( 18.1%)
14. Long-term Care Facilities 1 ( 1.1%)
15. Mental Health 4 ( 4.3%)
16. Obstetrical Care 11 ( 11.7%)
17. Prenatal Care 29 ( 30.9%)
18. Primary Care 5 ( 5.3%)
19. Sexually Transmitted Diseases 26 ( 27.7%)
20. Tuberculosis 75 ( 79.8%)
21. WIC 30 ( 31.9%)
C. Local Health Officer
M.D. or D.O. Requirement, Local Board of Health Appointment
The role of the local health officer is to serve as chief
executive officer for the local health department and carry out
the policies and programs as determined by the local board.
Local health officers are appointed to 4-year terms by members of
the local board of health.
D. Local Board of Health
Policy-making
The board of a county health department is composed of seven
members--no more than four of whom may be from the same political
party. The members of the board are appointed by their
respective city or county executives for a 4-year term. The
authority for this organization and function lies in state
statutes. The local board is responsible for the appointment of
a health officer. The local health officer and the local board
of health work with the county commissioners in establishing
annual budgets which are submitted to the county councils for
approval. Those health departments which are based within the
city structure follow a similar process with the city officials.
The board of health for multicounty health departments is
composed of four members from each county represented in the
department.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdiction. The number of staff for a
local health department ranges from 1 to 550.
F. Budget
Total FY 1988 LPHA expenditures were $41,920,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $5,416,000
State Funds $2,805,0000
Local Funds $28,281,000
Fees and Reimbursements $5,058,000
Other Sources $360,000
Source Unknown 0
The SHA reported that there were additional fees and
reimbursements not retained by the local health departments, but
which reverted to the general revenues of the local or state
government.
2Indiana State Board of Health, 1990
State Health Commissioner
Office of External Affairs
Office of Legal Affairs
Executive Assistant
Executive Assistant
Executive Assistant
Office of Assistant Commissioner for Health Support Services
Bureau of Laboratories
Environmental Laboratories Division
Disease Control Laboratories Division
Laboratory Support Division
Consumer Health Lab Division
Bureau of Administrative Services
Management Information Services Division
Human Resources Division
Finance Division
Bureau of Institutional Services
Internal Support Services Division
Indiana Veterans' Home
Indiana School for the Blind
Indiana School for the Deaf
Soldiers' and Sailors' Children's Home
Silvercrest Children's Development Center
Office of Assistant Commissioner for Health Maintenance
Bureau of Disease Intervention
Acute Disease Division
Chronic Disease Division
Acquired Disease Division
Bureau of Family Health Services
Nutrition Division
MCH Division
Child Specialty Services Division
Bureau of Local Health Services
Dental Health
Local Support Services Division
Industrial Hygiene and Radiologic Health Division
Sanitary Engineering Division
Office of Assistant Commissioner for Health Marketing
Bureau of Quality Assurance
Health Facilities Division
Acute Care Services Division
Child Care Facilities Division
Bureau of Policy Development
Public Health Research Division
Public Health Statistics Division
Division of Health Planning
Bureau of Health Promotion
Health Education Division
Graphic Arts Division
Bureau of Consumer Protection
Wholesale Consumer Affairs Division
Retail Consumer Affairs Division
Food Animal Affairs Division
2Types of Local Health Departments by Jurisdiction
Indiana, 1990
Jurisdiction Co C M/Co
Adams X
Allen X
Bartholomew X
Benton X
Blackford X
Boone X
Brown X
Carroll X
Cass X
Clark X
Clay X
Clinton X
Crawford X
Daviess X
De Kalb X
Dearborn X
Decatur X
Delaware X
Dubois X
East Chicago X
Elkhart X
Fayette X
Floyd X
Fountain X
Franklin X
Fulton X
Gary X
Gibson X
Grant X
Greene X
Hamilton X
Hammond X
Hancock X
Harrison X
Hendricks X
Henry X
Howard X
Huntington X
Jackson X
Jasper X
Jay X
Jefferson X
Jennings X
Johnson X
Knox X
Kosciusko X
La Porte X
Lafayette X
Lagrange X
Lake X
Lawrence X
Madison X
Marion X
Marshall X
Martin X
Miami X
Monroe X
Montgomery X
Morgan X
Newton X
Noble X
Ohio X
Orange X
Owen X
Parke X
Perry X
Pike X
Porter X
Posey X
Pulaski X
Putnam X
Randolph X
Ripley X
Rush X
Scott X
Shelby X
Spencer X
St. Joseph X
Starke X
Steuben X
Sullivan X
Switzerland X
Tippecanoe X
Tipton X
Union X
Vanderburgh X
Vermillion X
Vigo X
Wabash X
Warren X
Warrick X
Washington X
Wayne X
Wells X
West Lafayette X
White X
Whitley X
Co = County HD C = City HD M/Co = Multicounty HD
1IOWA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 2,834,000 245,803,000
Population Density (1988) 50.6 69.4
(per/sq.mi.)
Number of Counties 99 3,139
Median Age (1987) 32.0 31.7
Percent Below Poverty Level (1985) 8.0 14.0
(persons)
Percent of Population Rural (1980) 41.0 26.0
Percent of Population White (1980) 97.4 83.1
Percent of Population Non-white (1980) 2.6 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority of county governments in Iowa are
established by the state constitution and statutes.
Commission Form - (99) - All 99 counties in Iowa operate under a
County Commission Form of government. The board is made up of
three or five members called county supervisors. They are
elected from single-member districts and have residency
requirements. Two counties, Scott and Polk, have appointed
administrators.
Iowa counties have had constitutional home rule since 1979.
Under home rule, counties have been able to pass legislation
without permission from the state. The constitution, under home
rule provisions, permits the consolidation of counties or
city-counties. These jurisdictions are granted authority to
establish their governments and perform governmental functions
but not to levy tax unless specifically authorized by the General
Assembly.
A new county government law became effective in 1988. It
provides five new, optional governmental structures and a
Data for this state were updated October 1990.
mechanism for establishing a charter commission. The five
options are as follows:
1. Board-elected Executive - a strong elected executive
with veto power over the board.
2. Board-manager - an elected board with an appointed
manager.
3. Charter - Specific charter proposed by a charter
commission county may have an elected or appointed
administrative officer.
4. City-county Consolidation - a city-county consolidation
is conferred with all of the powers granted to cities
or counties.
5. County-county Consolidation - permits the consolidation
of contiguous counties upon approval of the voters in
the affected areas.
Counties have not yet adopted any of these new options.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The SHA is a free-standing, independent agency named the Iowa
Department of Public Health (IDPH). The IDPH exists to promote,
protect, and ensure the health and well-being of Iowans, and to
provide for access, quality and affordability of services. The
Department promotes health and prevents disease by the following:
Conducting research, planning and evaluating as a basis for
initiating and revising programs and policies.
Assuring compliance with public health laws through
regulation and enforcement.
Administering state and Federal statutory requirements and
programs through direct and contracted services.
Promoting and supporting health and well-being through
education and consultation.
The Department is responsible for substance abuse prevention,
health planning, vital records, health professional licensure,
communicable disease control, radiation control, emergency
medical services, maternal and child health, nutrition, dental
health, birth defects/genetics counseling, health promotion,
public health nursing, homemaker-home health aide, and a few
environmental programs.
The following are some broad areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
(through contract with the University of Iowa)
State Health Planning and Development Agency
State Health Professions Licensing Agency
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Director of Health is the chief administrative officer of the
Department. The Director is a cabinet-level officer appointed by
the Governor and confirmed by the Senate. The Director is
responsible for directing and administering the programs and
services of the Department. The duties of the Director include:
recommendations to the state board of health; the adoption of
rules for the implementation of statutes; service as Secretary of
the State Board of Health; the establishment of the
administrative organization; and other actions to administer and
direct the Department's programs.
C. State Board of Health/Council
Policy-making
The Board of Health is made up of nine members. Five members are
to be learned in the health professions and four are to represent
the general public. The members are appointed by the Governor
for 3-year terms. They approve all Department rules before they
become effective, establish policies for the performance of the
Department, and advise the Department, the Governor, and the
Legislature on public health matters.
D. Regional/District Health Offices
The Department does not have regional/district offices. Specific
programs have field staffs with assigned territories, but these
staffs are housed in the central office, in a local health
department, or some other individual arrangement.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The state-local liaison function is currently being performed by
a nurse consultant in the Division of Family and Community
Health.
The interaction between state and local public health agencies in
Iowa may be characterized as decentralized organizational
control. Under this arrangement local governments directly
operate health departments.
F. Budget
Total FY 1988 Iowa SHA expenditures were $58,273,000. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $30,538,000
State Funds $27,510,000
Local Funds 0
Fees and Reimbursements $73,000
Other $152,000
3III. Local Public Health Agencies (LPHAs)
A. General
Iowa has 99 local health departments. These consist of 93 county
units, 5 city units and 1 city-county unit (the city-county unit
is designated as a district by Iowa). Iowa uses the term "boards
of health" rather than health departments. Boards of health that
employ at least one full-time employee are referred to as a
health department in this document. Nine boards employ only a
nurse and 16 boards employ only an environmentalist. All other
boards have more than one employee.
The SHA provides the funds to the local areas to support public
health nursing services and homemaker-home health aide services.
These funds may go through the local board of health, board of
supervisors, or other governmental or non-profit organization.
B. Services Provided
The following information on services provided by local health
departments in Iowa is derived from a survey conducted by NACHO
during 1989. Since only 9 of the 99 Iowa counties participated
in this survey, the results may not be representative of the
total state. Services provided by 70 percent of health
departments in the state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 1 ( 11.1%)
2. Morbidity Data 5 ( 55.6%)
3. Reportable Diseases 6 ( 66.7%)
4. Vital Records and Statistics 2 ( 22.2%)
B. Epidemiology/Surveillance
1. Chronic Diseases 3 ( 33.3%)
2. Communicable Diseases 8 ( 88.9%)
II. Policy Development
A. Health Code Dev. and Enforcement 4 ( 44.4%)
B. Health Planning 7 ( 77.8%)
C. Priority Setting 6 ( 66.7%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 7 ( 77.8%)
2. Health Facility Safety/Quality 2 ( 22.2%)
3. Rec. Facility Safety/Quality 1 ( 11.1%)
4. Other Facility Safety/Quality 2 ( 22.2%)
B. Licensing
1. Health Facilities -
2. Other Facilities 8 ( 88.9%)
C. Health Education 6 ( 66.7%)
D. Environmental
1. Air Quality 7 ( 77.8%)
2. Hazardous Waste Management 5 ( 55.6%)
3. Individual Water Supply Safety 6 ( 66.7%)
4. Noise Pollution 5 ( 55.6%)
5. Occupational Health and Safety 1 ( 11.1%)
6. Public Water Supply Safety 3 ( 33.3%)
7. Radiation Control 1 ( 11.1%)
8. Sewage Disposal Systems 7 ( 77.8%)
9. Solid Waste Management 4 ( 44.4%)
10. Vector and Animal Control 8 ( 88.9%)
11. Water Pollution 8 ( 88.9%)
E. Personal Health Services
1. AIDS Testing and Counseling 9 (100.0%)
2. Alcohol Abuse -
3. Child Health 4 ( 44.4%)
4. Chronic Diseases 4 ( 44.4%)
5. Dental Health 1 ( 11.1%)
6. Drug Abuse -
7. Emergency Medical Service 2 ( 22.2%)
8. Family Planning 2 ( 22.2%)
9. Handicapped Children 1 ( 11.1%)
10. Home Health Care 6 ( 66.7%)
11. Hospitals -
12. Immunizations 8 ( 88.9%)
13. Laboratory Services 3 ( 33.3%)
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care 2 ( 22.2%)
18. Primary Care -
19. Sexually Transmitted Diseases 8 ( 88.9%)
20. Tuberculosis 7 ( 77.8%)
21. WIC 3 ( 33.3%)
C. Local Health Officer
No M.D. Requirement, Board of Health Appointment
The primary authority in local public health resides with the
local boards of health. The boards delegate responsibility to
their employees. This can include the formal naming of a health
officer for certain functions but this is not routinely done. If
named, the health officer would only have authority through the
local board of health.
D. Local Board of Health
Policy-making
Each county must have a board of health unless they are part of a
district health department. Cities with populations over 25,000
may have a board of health and 5 cities have chosen to do so.
Local boards of health may apply to create district boards of
health. The boards are consist of five volunteer members (one of
which must be a physician) appointed by the board of supervisors
or city council. These boards are planning and policy-making
boards, and their rules must be approved by the board of
supervisors before they take effect. Funds for the local boards
of health must be appropriated by the board of supervisors.
E. Staff
The staffs are employees of the local boards of health. The
number of employees for a local health department ranges from 5
to 84.
F. Budget
Total FY 1988 LPHA expenditures were $23,494,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contract $990,000
State Funds $4,266,000
Local Funds $7,080,000
Fees and Reimbursements $760,000
Other Sources $1,254,000
Source Unknown $682,000
The SHA reported that there were additional fees and
reimbursements not retained by the LPHA, but which reverted to
the general revenues of the local or state government. The SHA
also reported that these figures include the total amount of
additional local health department monies expended by all local
health departments.
2Iowa Department of Public Health, 1990
Governor
State Board of Health
Substance Abuse Commission
Health Facilities Council
Professional Licensing Boards
Director of Public Health
Health Data Commission
Health Advisory Committee and Councils
Division of Substance Abuse
Bureau of Prevention and Training
Bureau of Licensure
Division of Central Administration
Bureau of Accounting/Finance
Bureau of Information Management
Bureau of Communications
Bureau of Vital Records
Bureau of Professional Licensure
Division of Disease Prevention
Bureau of Radiological Health
Bureau of Health Engineering/Consumer Safety
Bureau of Veterinarian P.H. Environmental Epidemiology
Bureau of Compliance/Health Care Services
Bureau of Disease Assessment
Bureau of Epidemiology
Office of Health Planning
Planning
Office of Rural Health
Health Data Commission
Primary Care
Certificate of Need
Division of Family and Community Health
Bureau of Maternal and Child Health
Bureau of Nutrition
Bureau of Dental Health
Bureau of Birth Defects/Genetics Complex
Bureau of Public Health Nursing
Bureau of Homemaker/Home Health Aide
Bureau of Support Services
Well Elderly Clinics
2Types of Local Health Departments by Jurisdiction
Iowa, 1990
Jurisdiction Co C C/Co N/Co
Adair X
Adams X
Allamakee X
Ames X
Appanoose X
Audubon X
Benton X
Blackhawk X
Boone X
Bremer X
Buchanan X
Buena Vista X
Butler X
Calhoun X
Carroll X
Cass X
Cedar X
Cerro Gordo X
Cherokee X
Chicksaw X
Clarke X
Clay X
Clayton X
Clinton X
Council Bluffs X
Crawford X
Dallas X
Davis X
Decatur X
Delaware X
Des Moines X
Des Moines X
Dickenson X
Dubuque X
Dubuque X
Emmet X
Fayette X
Floyd X
Franklin X
Fremont X
Greene X
Grundy X
Gutherie X
Hamilton X
Hancock X
Hardin X
Harrison X
Henry X
Howard X
Humboldt X
Ida X
Iowa X
Jackson X
Jasper X
Jefferson X
Johnson X
Jones X
Keokuk X
Kossuth X
Lee X
Linn X
Louisa X
Lucas X
Lyon X
Madison X
Mahaska X
Marion X
Marshall X
Mills X
Mitchell X
Monona X
Monroe X
Montgomery X
Muscatine X
O'Brien X
Osceola X
Ottumwa X
Page X
Palo Alto X
Plymouth X
Pocohontas X
Polk X
Pottawattamie X
Poweshiek X
Ringgold X
Sac X
Scott X
Shelby X
Sioux X
Siouxland Dist X
Story X
Tama X
Taylor X
Union X
Van Buren X
Wapello X
Warren X
Washington X
Wayne X
Webster X
Winnebago X
Winneshiek X
Worth X
Wright X
Co = County HD
C = City HD
C/Co = City/County HD
N/Co = No County HD
1KANSAS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 2,496,000 245,803,000
Population Density (1988) 30.5 69.4
(per/sq.mi.)
Number of Counties 105 3,139
Median Age (1987) 31.7 31.7
Percent Below Poverty Level (1985) 13.8 14.0
(persons)
Percent of Population Rural (1980) 33.0 26.0
Percent of Population White (1980) 91.7 83.1
Percent of Population Non-white (1980) 8.3 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
County governments in Kansas are established and empowered by the
state constitution.
Commission Form - (105) - All counties in the state use this form
of government. The commissions are made up of three- or
five-member boards that are elected from single-member
districts. Seven counties utilize an appointed administrator for
their administrative functions.
Authority for home rule was established in 1974. This
legislation gives counties authority to conduct business and
perform legislative and administrative functions that are
considered appropriate and not otherwise prohibited by statutes.
The data for this state were updated September 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Kansas Department of Health and Environment (KDHE) is the
official SHA. It is a free-standing, independent agency. The
mission of the KDHE is to protect and maintain the health of
Kansans and the quality of the environment through information,
education, prevention, and regulation.
The Division of Health, one of the major units within KDHE, is
responsible for protecting and promoting the health of Kansans
through a variety of public health service delivery and
regulatory programs. The Division's role is to assure services
through funding assistance to local agencies; establishing policy
and procedures; technical assistance; and program consultation,
planning, implementation, and continuation.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Secretary of KDHE, entrusted with broad powers to ensure
public health and a safe environment, directs the management of
the Department in the provision of services to the citizens of
Kansas. The Secretary, a member of the Governor's Cabinet, sets
agency policy and assigns staff to carry out regulatory
enforcement and public health tasks. The Secretary is not
required to be a physician.
The Director of Health, the State Health Officer, is appointed by
the Secretary KDHE. The Director is the state's chief public
health medical official and is responsible for the management of
the Division of Health. The Director is required to be a
physician. Specifically, the Director of Health is charged with
the responsibility of maintaining surveillance of indicators of
disease and disability, and overseeing and assisting in the
provision of public health services to the citizens of Kansas.
C. State Board of Health/Council
Advisory
The Advisory Commission on Health and Environment is a 13-member
body which advises the Secretary, KDHE, on public health and
environmental issues. Members serve as a sounding board for
departmental initiatives. The Governor appoints individuals to
represent a cross-section of the health and environmental
interests.
D. Regional/District Health Offices
Six district offices are located in cities throughout the state,
but the state has not been divided into geographic regions. The
district offices serve as an extension of the central office
programs in Topeka, providing consultation and technical
assistance to local health departments, enabling the agency to
maintain closer ties to citizens and local health departments in
more remote geographic areas, and permitting the agency to
respond more quickly and appropriately to problems or requests.
Program field staffs are assigned to each district office.
Management responsibilities, including provision of support
services for field staffs, are carried out in each district
office by a District Office Manager and administrative support
staff. District Office Managers are supervised by staff from the
Office of the Secretary in Topeka.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The Office of Local Health serves as the liaison with local
health departments. Community consultants, which are a part of
the central office but physically are located in KDHE district
offices, serve as the Division of Health's field staff and
liaison to local health departments. The consultants deliver
state-level administrative leadership, consultation, and support
services to local health units, and assist program consultants in
monitoring quality and standards-of-care given by local agencies.
The office administers the Aid-to-Counties Program; this provides
local health departments and other eligible community agencies
with state and Federal funding of public health services at the
local level. The state aid is provided through a formula which
requires an equal match of local tax funds. The office also
maintains a Continuing Education for Nursing Providership
Agreement with the Kansas State Board of Nursing.
The Office of Rural Health serves as a focal point in the effort
to maintain rural health care services. It exists to facilitate
and coordinate locally generated ideas to improve the
availability of a variety of rural health services. The office
draws on the resources, program activities, and staffing of the
Division to ensure that Department activities are responsive to
rural health needs.
The interaction between state and local health agencies in Kansas
may be characterized as mixed centralized and decentralized
organizational control. Under this arrangement, local health
services in the state may be provided by the SHA in some
jurisdictions and by local governmental units, boards of health,
or health departments in other jurisdictions.
F. Budget
Total FY 1988 SHA expenditures were $46,945,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $28,923,000
State Funds $17,148,000
Local Funds 0
Fees and Reimbursements $546,000
Other $328,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 97 local health departments in Kansas. Local health
departments exist in 104 of 105 counties in Kansas. Three
multicounty agencies provide service to 10 counties, 12 counties
are served by city/county health departments, and the other 82
counties are served by county health departments. Two of the
counties, Stevens and Nemaha, provide health services through
contract with a county hospital and a private provider,
respectively. Within the 82 counties there are several informal
"program sharing" arrangements whereby one county health
department may contract with KDHE to provide service for a number
of surrounding, usually contiguous, counties.
B. Services Provided
The following information on services provided by local health
departments in Kansas is derived from a survey conducted by NACHO
during 1989. Eighty-one of 97 local health departments in Kansas
responded to the survey. Services provided by at least 70
percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 21 ( 25.9%)
2. Morbidity Data 12 ( 14.8%)
3. Reportable Diseases 62 ( 76.5%)
4. Vital Records and Statistics 14 ( 17.3%)
B. Epidemiology/Surveillance
1. Chronic Diseases 36 ( 44.4%)
2. Communicable Diseases 68 ( 84.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 24 ( 29.6%)
B. Health Planning 32 ( 39.5%)
C. Priority Setting 17 ( 21.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 8 ( 9.9%)
2. Health Facility Safety/Quality 21 ( 25.9%)
3. Rec. Facility Safety/Quality 10 ( 12.3%)
4. Other Facility Safety/Quality 8 ( 9.9%)
B. Licensing
1. Health Facilities 30 ( 37.0%)
2. Other Facilities 22 ( 27.2%)
C. Health Education 61 ( 75.3%)
D. Environmental
1. Air Quality 8 ( 9.9%)
2. Hazardous Waste Management 14 ( 17.3%)
3. Individual Water Supply Safety 36 ( 44.4%)
4. Noise Pollution 1 ( 1.2%)
5. Occupational Health and Safety 5 ( 6.2%)
6. Public Water Supply Safety 20 ( 24.7%)
7. Radiation Control 5 ( 6.2%)
8. Sewage Disposal Systems 29 ( 35.8%)
9. Solid Waste Management 16 ( 19.8%)
10. Vector and Animal Control 22 ( 27.2%)
11. Water Pollution 24 ( 29.6%)
E. Personal Health Services
1. AIDS Testing and Counseling 40 ( 49.4%)
2. Alcohol Abuse 7 ( 8.6%)
3. Child Health 73 ( 90.1%)
4. Chronic Diseases 51 ( 63.0%)
5. Dental Health 13 ( 16.0%)
6. Drug Abuse 8 ( 9.9%)
7. Emergency Medical Service 2 ( 2.5%)
8. Family Planning 58 ( 71.6%)
9. Handicapped Children 33 ( 40.7%)
10. Home Health Care 47 ( 58.0%)
11. Hospitals 1 ( 1.2%)
12. Immunizations 79 ( 97.5%)
13. Laboratory Services 32 ( 39.5%)
14. Long-term Care Facilities 13 ( 16.0%)
15. Mental Health 4 ( 4.9%)
16. Obstetrical Care 7 ( 8.6%)
17. Prenatal Care 37 ( 45.7%)
18. Primary Care 12 ( 14.8%)
19. Sexually Transmitted Diseases 41 ( 50.6%)
20. Tuberculosis 53 ( 65.4%)
21. WIC 67 ( 82.7%)
C. Local Health Officer
M.D. Requirement in Jurisdictions over 100,000 Population, County
Board of Health Appointment
The local health officer is appointed by the county board of
health. In counties or multicounty units with less than 100,000
population the board may appoint a qualified local health
administrator (generally a nurse) as the local health officer, if
a person licensed to practice medicine, surgery, or dentistry is
designated as medical consultant to the administrator. Counties
with more than 100,000 population must appoint a health officer
who has been licensed to practice medicine and surgery, with
preference being given to persons who have training in public
health.
The local health officer in each county is responsible for
keeping accurate records of all the transactions of the
department, and for receiving and distributing all forms from the
Secretary of KDHE. In addition, the health officer is
responsible for having an annual sanitary inspection made of each
school building and grounds within the county, and investigating,
reporting, and taking measures to prevent the spread of
infectious, contagious, or communicable disease. The health
officer is also responsible for performing such other duties as
may be required by the county, joint board of health, or the
Secretary.
D. Local Board of Health
Policy-making
Boards of county commissioners act as county boards of health for
their respective counties. The board of county commissioners in
any county having a population of less than 15,000 may contract
with the governing body of any hospital located in the county for
the provision of services to the county board of health.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdiction. The number of employees
for a local health department ranges from 1 to 183. In 15 health
departments there is only 1 nurse on staff. There are 76 health
departments that do not employ a sanitarian.
F. Budget
Total FY 1988 LPHA expenditures were $23,821,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $6,010,000
State Funds $2,190,000
Local Funds 0
Fees and Reimbursements $186,000
Other Sources 0
Source Unknown $15,435,000
2Kansas Department of Health and Environment, 1990
Governor
Department of Health and Environment
Advisory Commission on Health and Environment
Task Forces, Boards
Assistant Secretary and General Counsel
Executive Manager
Legal Services
General Services
Personnel Services
Health and Environmental Laboratory
Analytical Chemistry
Microbiology Laboratories
Laboratory Information and Reporting Office
Laboratory Improvement Program Office
Division of Environment
Bureau of Environmental Remediation
Bureau of Air and Waste Management
Bureau of Water
Bureau of Environmental Quality
Surface Mining Section
Division of Health
Assistant Director for Medical Services
Office of Local and Rural Health Systems
Bureau of Environmental Health Services
Bureau of Disease Control
Bureau of Adult and Child Care
Bureau of Family Health
Office of Chronic Disease and Health Promotion
Division of Information Systems
Office of Communication Services
Office of Vital Statistics
Office of Public Information Services
Office of Health and Environmental Education
District Offices (answer to all of the above).
2Types of Local Health Departments by Jurisdiction
Kansas, 1990
Jurisdiction Co C/Co M/Co N/Co
Allen X
Anderson X
Atchinson X
Barber X
Barton X
Bourbon X
Brown X
Butler X
Chase X
Chatauqua X
Cherokee X
Cheyenne X
City-Cowley Co X
Clark X
Clay X
Cloud X
Coffee X
Commanche X
Crawford X
Dickinson X
Doniphan X
Edwards X
Elk X
Ellis X
Ellsworth X
Emporia-Lyon Co X
Finney X
Ford X
Franklin X
Gove X
Graham X
Grant X
Gray X
Greeley X
Greenwood X
Hamilton X
Harper X
Harvey X
Haskell X
Hodgeman X
Hutchinson-Reno Co X
Jackson X
Jefferson X
Jewell X
Johnson X
Junction C.-Geary X
Kansas C-Wyandotte X
Kearny X
Kingmen X
Kiowa X
Labette X
Lane X
Lawrence-Douglas Co X
Levenworth X
Liberal-Seward Co X
Lincoln X
Linn X
Logan X
Manhattan-Riley Co X
Marion X
Marshall X
McPherson X
Meade X
Miami X
Mitchell X
Montgomery X
Morris X
Morton X
Nemaha X
Neosho X
Ness X
Norton X
Oberlin-Decatur Co X
Osage X
Osborne X
Ottowa X
Pawnee X
Phillips X
Pottawatomie X
Pratt X
Rawlings X
Republic X
Rice X
Rooks X
Rush X
Russell X
Salina-Saline Co X
Scott X
Sheridan X
Sherman X
Smith X
Stafford X
Stanton X
Stevens X
Sumner X
Thomas X
Topeka-Shawnee Co X
Trego X
Wabaunsee X
Wallace X
Washington X
Wichita X
Wichita-Sedwick Co X
Wilson X
Woodson X
Co = County HD
C/Co = City/County HD
M/Co = Multicounty HD
N/Co = No County HD
1KENTUCKY
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 3,726,000 245,803,000
Population Density (1988) 93.9 69.4
(per/sq.mi.)
Number of Counties 120 3,139
Median Age (1987) 31.1 31.7
Percent Below Poverty Level (1985) 19.4 14.0
(persons)
Percent of Population Rural (1980) 49.0 26.0
Percent of Population White (1980) 92.3 83.1
Percent of Population Non-white (1980) 7.7 16.9
Median Years of Education (1980) 12.1 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
Kentucky counties receive their authority to exist and function
from the state constitution and statutes. County governments are
based on the Fiscal Court System. Under this system the counties
are given the choice of Magistrate or Commission status.
Magistrate Variety - (106) - This form consists of a County
Judge/Executive and three to eight justices of the peace who are
elected from separate districts. The County Judge serves as the
executive officer for the county and presiding officer of the
Fiscal Court. The justices of the peace have duties and
authority that relate only to the Fiscal Court.
Commission Form - (13) - The Commission Form of government under
the Fiscal Court System consists of county judge/executive and
three commissioners elected at large. The authority of the
commissioners is related to the fiscal court.
Urban-County Form - (1) - The state constitution does not provide
for charter, consolidated city-county or other structural forms
of government. In 1970, however, the General Assembly passed a
Data for this state were updated October 1990. law authorizing an
Urban-County government form. The merger provided for in this law
produces an entity that is neither a city nor a county but has the
authority and characteristics of a city or county. Lexington-Fayette
chose this form of government. Additionally, Louisville-Jefferson
developed a limited consolidation under which there is an agreement on
sharing taxes, annexation, and specific services.
Home Rule Authority - The Fiscal Court depends on authority
delegated to it by the General Assembly under Kentucky Revised
Statutes. The home rule provision that was amended in 1978,
however, granted the counties more authority so they could
operate more efficiently while still operating under some
constraints. Under these acts counties may pass ordinances,
issue regulations, levy taxes, issue bonds, and appropriate
funds.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Department of Health Services is the SHA for Kentucky. It is
a component of a superagency called the Cabinet for Human
Resources. The mission of the SHA is to protect and promote the
health of the citizens of Kentucky.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Health Planning and Development Agency
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The Department for Health Services is headed by a Commissioner.
The Commissioner is appointed by the Secretary of the Cabinet for
Human Resources with the approval of the Governor. The
Commissioner must be a licensed physician with training and
experience in the administration and management of public
health. The Commissioner is responsible for advising the head of
major organizational units on policies and programs relating to
all matters of public health and on any actions necessary to
safeguard the health of the citizens of Kentucky. The
Commissioner serves as the chief medical officer of Kentucky.
The Commissioner exercises authority over the Department for
Health Services under the direction of the Secretary of the
Cabinet for Human Resources and is responsible only for what is
delegated by the Secretary.
C. State Board of Health/Council
Advisory
The Council for Health Services is a citizen advisory body which
provides advice to the Citizens' Commission for Human Resources
(a citizen advisory body to the Cabinet for Human Resources), the
Secretary for Human Resources, the Commissioner for Health
Services, and other officials of the commonwealth on policy
matters concerning the delivery of health services. The Council
for Health Services is composed of no more than 19 citizen
members appointed by the Governor. Members are chosen to broadly
represent public interest groups concerned with health services,
recipients of health services provided by the state, minority
groups, and the general public. The Governor appoints the
Chairman of the Council who also serves as a voting member of the
Citizens' Commission for Human Resources. The Secretary for
Human Resources and the Commissioner for Health Services are
non-voting ex officio members of the Council and the Commissioner
is staff director and secretary to the Council. The Council
meets quarterly or on the call of the Secretary of Human
Resources or the Commissioner for Health Services.
D. Regional/District Health Offices
The Department of Health Services has not divided the state into
administrative regions or districts. There are district health
departments, but these are counties that have combined their
health departments to make one service unit. The only membership
restriction is that counties within a district health department
must be within the same governmental Area Development District
(ADD).
E. State-local Liaison
Shared Organizational Control, Informal Liaison Function
The Department for Health Services, Cabinet for Human Resources,
does not employ state-local liaisons as such. Rather, the
Department's program, professional, and support staffs provide
direct technical assistance to local health departments via
telephone consultations, written communications, and on-site
consultations. The Department does employ regional nurse
consultants in the Home Health Program and program/field
representatives in the sexually transmitted diseases (STD)
immunization, women, infants, and children (WIC) and
environmental health programs. The function of these staffs is
to relay the program-specific priorities of Federal and state
agencies and to provide readily available, on-site assistance and
supervision to local health department staff. In turn, the
"regional" field staff can relate local concerns and the local
perspective to state program staff.
The interaction between state and local public health agencies in
Kentucky may be characterized as shared organizational control.
Under this arrangement local health departments are under the
authority of the SHA, as well as the local government and board
of health.
F. Budget
Total FY 1988 Kentucky SHA expenditures were $110,232,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $63,620,000
State Funds $44,404,000
Local Funds 0
Fees and Reimbursements $2,135,000
Other $73,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 52 local health departments in Kentucky. Seventeen of
these are district (multicounty health departments), 33 are
single-county health departments, and 2 are city-county health
departments. The districts contain five health departments that
were city-county units before their merger into the districts.
The two city-county health departments consist of Jefferson
County which has a city of the 1st class (Louisville) and Fayette
County\Lexington City which has an Urban County Form of
government. The Cabinet for Human Resources determines the areas
in which district (multicounty) health departments may be
established. The fiscal court for each of the counties must
approve the formation of the district by a simple majority vote.
Each county included in the district will be responsible for
providing its share of the expense of creating, establishing,
operating, and maintaining the department.
B. Services Provided
The following information on services provided by local health
departments in Kentucky is derived from a survey conducted by
NACHO during 1989. Forty-four of the 52 local health departments
in Kentucky responded to the survey. Services provided by at
least 70 percent of health departments in the state responding to
the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 15 ( 34.1%)
2. Morbidity Data 30 ( 68.2%)
3. Reportable Diseases 43 ( 97.7%)
4. Vital Records and Statistics 43 ( 97.7%)
B. Epidemiology/Surveillance
1. Chronic Diseases 34 ( 77.3%)
2. Communicable Diseases 42 ( 95.5%)
II. Policy Development
A. Health Code Dev. and Enforcement 23 ( 52.3%)
B. Health Planning 31 ( 70.5%)
C. Priority Setting 28 ( 63.6%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 40 ( 90.9%)
2. Health Facility Safety/Quality 26 ( 59.1%)
3. Rec. Facility Safety/Quality 34 ( 77.3%)
4. Other Facility Safety/Quality 16 ( 36.4%)
B. Licensing
1. Health Facilities 6 ( 13.6%)
2. Other Facilities 37 ( 84.1%)
C. Health Education 35 ( 79.5%)
D. Environmental
1. Air Quality 4 ( 9.1%)
2. Hazardous Waste Management 11 ( 25.0%)
3. Individual Water Supply Safety 38 ( 86.4%)
4. Noise Pollution 2 ( 4.5%)
5. Occupational Health and Safety 4 ( 9.1%)
6. Public Water Supply Safety 29 ( 65.9%)
7. Radiation Control 15 ( 34.1%)
8. Sewage Disposal Systems 40 ( 90.9%)
9. Solid Waste Management 17 ( 38.6%)
10. Vector and Animal Control 35 ( 79.5%)
11. Water Pollution 22 ( 40.0%)
E. Personal Health Services
1. AIDS Testing and Counseling 36 ( 81.8%)
2. Alcohol Abuse 3 ( 6.8%)
3. Child Health 44 (100.0%)
4. Chronic Diseases 37 ( 84.1%)
5. Dental Health 25 ( 56.8%)
6. Drug Abuse 6 ( 13.6%)
7. Emergency Medical Service 1 ( 2.3%)
8. Family Planning 44 (100.0%)
9. Handicapped Children 19 ( 43.2%)
10. Home Health Care 19 ( 43.2%)
11. Hospitals -
12. Immunizations 44 (100.0%)
13. Laboratory Services 32 ( 72.7%)
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care 21 ( 47.7%)
17. Prenatal Care 43 ( 97.7%)
18. Primary Care 5 ( 11.4%)
19. Sexually Transmitted Diseases 44 (100.0%)
20. Tuberculosis 44 (100.0%)
21. WIC 44 (100.0%)
C. Local Health Officer
M.D. Requirement, Local Board of Health Appointment
County and district boards of health have authority to appoint a
health officer. The appointments are subject to the approval of
the Cabinet for Human Resources. The health officer is subject
to Merit System provisions and holds office at the pleasure of
both the board of health and the Cabinet for Human Resources.
The health officer of a county or district health department is
directed to devote his entire time to the duties of his office
and not be engaged in the private practice of medicine, serve as
the secretary to the county board of health and keep minutes of
the proceedings, and be the chief administrative officer of the
county health department. A local health officer may serve as
health officer for more than one county if the local boards of
health and the Cabinet for Human Resources approve.
D. Local Board of Health
Policy-making
County boards of health consist of nine members, except for the
five city-county boards of health which consist of seven
members. On the county boards of health, seven members are
appointed by the Cabinet for Human Resources; one member is
appointed by the Fiscal Court; and the County Judge/Executive is
a member by virtue of his office. On the city-county boards of
health, the seven-member board is composed of the mayor or city
manager; the County Judge/Executive; and five appointed members
which include one dentist, one nurse, and three physicians. In
the event that qualified persons are not available to fill
specific positions on the board, the Secretary of the Cabinet for
Human Resources may appoint a resident lay person knowledgeable
in consumer affairs to fill each vacancy.
District boards of health, except for districts which serve a
county containing a city of the first class or an urban-county
government, are composed of the one county judge/executive or his
designee from each county in the district and one additional
member per county per 15,000 population. The fiscal court of
each county submits names to the Secretary of the Cabinet for
Human Resources, who makes the appointments. Nominations to the
Secretary are to include two nominations from each of the
following groups: fiscal court of each county; county board of
health for each county; county medical society; county dental
society; district nursing association; and veterinarians from the
county, when available. The district boards are composed of the
following: at least 25 percent doctors of medicine or osteopathy
licensed in Kentucky; at least one licensed, registered nurse;
one dentist; and one veterinarian, when available. The remaining
members of the board will be concerned community leaders residing
within the county they are to represent. The term of office for
district boards of health is 2 years, with the terms staggered so
that half of the members are appointed each year.
Responsibilities for county, city-county, and district boards of
health include the following: appoint a health officer and
establish his salary; hold regular meetings at least once every 3
months; adopt rules and regulations necessary to protect the
health of the people; act in a general advisory capacity to the
health officer on all matters relating to the local department of
health; hear and decide appeals from rulings, decisions, and
actions of the local health department or health officer; perform
all other functions necessary to carry out the provisions of law
and the rules and regulations that have been adopted.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdiction. The number of employees
for a local health department ranges from 5 to 289.
F. Budget
Total FY 1988 LPHA expenditures were $78,678,000. Total FY 1988
LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $15,759,000
State Funds $18,215,000
Local Funds $20,983,000
Fees and Reimbursements $23,721,000
Other Sources 0
Source Unknown 0
2Kentucky Department for Health Services, 1990
Commissioner
Division of Administration and Financial Management
Budget and Fiscal Planning Branch
Administrative Branch
Local Fiscal Systems Branch
Division of Vital Records and Health Development
Health Data Branch
Vital Statistics Branch
Community Health Development Branch
Division of Disability Determination
Claims Adjudication Branch (A)
Claims Adjudication Branch (B)
Operations Support Branch
Medical Services Branch
Hearings Branch
Administrative Support Branch
Lexington Branch
Louisville Branch
Division of Epidemiology
Health Promotion Branch
Communicable Disease Branch
Surveillance and Investigation Branch
Chronic Disease Branch
Division of Community Safety
Product Safety Branch
Radiation Control Branch
Drug Control Branch
EMS Branch
Milk Control Branch
Division of Laboratory Services
Chemistry Branch
Microbiology Branch
Technical and Administrative Services Branch
Division of Local Health
Environmental Sanitation Branch
Food Branch
Information and Support Branch
Local Health Personnel Merit System Branch
Local Program Support Branch
Division of Maternal and Child Health
Nutrition Services Branch
Central Support Branch
Maternal and Family Planning Services Branch
2Types of Local Health Departments by Jurisdiction
Kentucky, 1990
Jurisdiction Co C/Co M/Co
Adair X
Allen X
Anderson X
Ballard X
Barren X
Bath X
Bell X
Boone X
Bourbon X
Boyd X
Boyle X
Bracken X
Breathitt X
Breckinridge X
Bullitt X
Butler X
Caldwell X
Calloway X
Campbell X
Carroll X
Carslile X
Carter X
Casey X
Christian X
Clark X
Clay X
Clinton X
Crittenden X
Cumberland X
Daviess X
Edmondson X
Elliott X
Estill X
Fleming X
Floyd X
Franklin X
Fulton X
Gallatin X
Garrard X
Grant X
Graves X
Grayson X
Green X
Greenup X
Hancock X
Hardin X
Harlan X
Harrison X
Hart X
Henderson X
Henry X
Hickman X
Hopkins X
Jackson X
Jessamine X
Johnson X
Kenton X
Knott X
Larue X
Laurel X
Lawrence X
Lee X
Leslie X
Letcher X
Lewis X
Lexington-Fayette X
Lincoln X
Livingston X
Logan X
Louisville-Jefferso X
Lyon X
Madison X
Magoffin X
Marion X
Marshall X
Martin X
Mason X
McCracken X
McCreary X
McLean X
Meade X
Menifee X
Mercer X
Metcalfe X
Monroe X
Montgomery X
Morgan X
Muhlenberg X
Nelson X
Nicholas X
Ohio X
Oldham X
Owen X
Owsley X
Pendleton X
Perry X
Pike X
Powell X
Pulaski X
Robertson X
Rockcastle X
Rowan X
Russell X
Scott X
Shelby X
Simpson X
Spencer X
Taylor X
Todd X
Trigg X
Trimble X
Union X
Warren X
Washington X
Wayne X
Webster X
Whitley X
Wolfe X
Woodford X
Co = County HD
C = City HD
C/Co = City/County HD
M/Co = Multicounty HD
1LOUISIANA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 4,408,000 245,803,000
Population Density (1988) 99.0 69.4
(per/sq.mi.)
Number of Counties 64 3,139
Median Age (1987) 29.1 31.7
Percent Below Poverty Level (1985) 18.1 14.0
(persons)
Percent of Population Rural (1980) 31.0 26.0
Percent of Population White (1980) 69.2 83.1
Percent of Population Non-white (1980) 30.8 16.9
Median Years of Education (1980) 12.2 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The state constitution and statutes provide the structure and
authority for county equivalents, called parishes, to operate in
Louisiana. Parishes may choose any of three variations in
structure for their governments: Commission, Police Jury System,
or Parish Home Rule Charter.
Police Jury System - (50) - In this system the governing body,
the Police Jury, has both legislative and administrative
authority. The Jury is made up of 5 to 15 members who are
elected from single-member districts. The exact number of
members is determined by historical and population factors. The
administrative structure varies widely in parishes with Police
Jury. They have the authority to appoint a manager or
administrator position. Sixteen parishes have appointed an
administrator.
Parish Home Rule Charter - (14) - Home rule parishes may use a
President-Council plan involving the election of a full-time
chief executive, elected at large. Thirteen of the 14 home rule
parishes elect an executive. The other parish uses a
Council-Administrator who is appointed by the board and is
Data for this state were updated November 1990.
responsible for administrative functions. Consolidation of
parish and city governments is authorized under home rule
charters and has been implemented in three metropolitan areas:
the City of Baton Rouge and East Baton Rouge Parish, the City of
New Orleans and Orleans Parish, and the City of Houma and
Terrebonne Parish.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The SHA is the Office of Public Health (OPH). It is a component
of a superagency called the Department of Health and Hospitals.
The mission of the SHA is to protect and enhance the health of
the people of Louisiana and to help create the conditions in
which all can enjoy the best of health.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
State Maternal and Child Health Agency
State Title 10/Family Planning Agency
State Safe-drinking Water Program Agency
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The OPH is administered by an Assistant Secretary appointed by
the Secretary of the Department of Health and Hospitals (DHH) in
accordance with the provisions of law.
It is not a requirement for the Director of the OPH to be a
physician. When he/she is not a physician, the designation of
State Health Officer falls upon a person meeting the requirements
stated below:
"The State Health Officer shall be a licensed and practicing
physician in the state of Louisiana and continue to be so
qualified during his term of office. He shall be a
full-time employee of the DHH. The Secretary of DHH may
designate any department employee, including himself, as
State Health Officer."
The State Health Officer is responsible at all times for taking
all of the necessary steps to execute the sanitary laws of the
state and to carry out the rules, ordinances, and regulations
that are contained in the state sanitary code. He/she may issue
warrants only to arrest or prevent epidemics or abate any
imminent menace to the public health. All other actions are
governed by the administrative enforcement procedures contained
in the State Sanitary Code.
C. State Board of Health/Council
Currently the state of Louisiana does not have a State Board or
Council of Health.
D. Regional/District Health Offices
The OPH has divided the state into nine administrative regions
(see attached map). The health regions function as
administrative units in the field. They coordinate health
activities, administrative, programmatic, and professional
supervision, and are a direct link for parish health units and
the central office.
All but two of the parish health units act under the supervision
and direction of the regional offices of the OPH of the
Department of Health and Hospitals. Five of the largest parishes
in the OPH system have physician health directors. The other 57
have a chief nurse, chief sanitarian, and chief clerk who answers
to their counterparts at the regional office. None of them have
administrative authority over the entire parish health unit, and
there is no administrator or administrative assistant.
Two of the 64 parishes, Orleans and Plaquemines, have local
health departments that answer to the parish, not to OPH.
Despite this difference in management structure, these two local
health departments maintain excellent working relationships with
the Office of Public Health.
The regional offices are staffed with 15 to 50 employees. Each
region has a Regional Administrator, Assistant Administrator,
Regional Public Health Nurse, Regional Sanitarian, clerical
support staff and program consultants. Programs administered by
regional offices include maternal and child health, family
planning, nutrition, genetic diseases, social services,
handicapped children, adult health, disease control, laboratory
services and regulatory services such as water and sewage,
sanitary services, and oyster water monitoring.
E. State-local Liaison
Centralized Organizational Control, Informal Liaison Function
The liaison between state and local public health units is
accomplished through the normal chain of command.
The interaction between state and 62 of the 64 local public
health agencies in Louisiana may be characterized as centralized
organizational control. The other two are decentralized. Under
this arrangement local health services in the state are provided
by the SHA in most jurisdictions and by local government in two
jurisdictions.
F. Budget
Total FY 1988 Louisiana SHA expenditures were $116,726,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $71,560,000
State Funds $28,051,000
Local Funds $6,845,000
Fees and Reimbursements $10,243,000
Other 24,000
3III. Local Public Health Agencies (LPHAs)
A. General
There is a health unit in each of the 64 parishes. Sixty-two of
these are parish health units, which are units of the OPH. The
other two are independent, local health departments located in
Orleans and Plaquemines Parishes. The Orleans Parish unit is a
city-parish (county) unit and Plaquemines is a parish (county)
unit. The state does not consider the parish health units they
administer to be local health departments. However, they are
included in our count of local health departments because they
meet our definition of a local health department.
B. Services Provided
The following information on services provided by local health
departments in Louisiana is derived from a survey conducted by
NACHO during 1989. Twenty-five of the 64 local health
departments in Louisiana responded to the survey. Services
provided by 70 percent of health departments in the state
responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 7 ( 28.0%)
2. Morbidity Data 18 ( 72.0%)
3. Reportable Diseases 25 (100.0%)
4. Vital Records and Statistics 25 (100.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases * -
2. Communicable Diseases 25 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 13 ( 52.0%)
B. Health Planning 15 ( 60.0%)
C. Priority Setting 12 ( 48.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 20 ( 80.0%)
2. Health Facility Safety/Quality 18 ( 72.0%)
3. Rec. Facility Safety/Quality 13 ( 52.0%)
4. Other Facility Safety/Quality 13 ( 52.0%)
B. Licensing
1. Health Facilities * -
2. Other Facilities 17 ( 68.0%)
C. Health Education 17 ( 68.0%)
D. Environmental
1. Air Quality 2 ( 8.0%)
2. Hazardous Waste Management 7 ( 28.0%)
3. Individual Water Supply Safety 24 ( 96.0%)
4. Noise Pollution 3 ( 12.0%)
5. Occupational Health and Safety * -
6. Public Water Supply Safety 24 ( 96.0%)
7. Radiation Control * -
8. Sewage Disposal Systems 25 (100.0%)
9. Solid Waste Management 16 ( 64.0%)
10. Vector and Animal Control 19 ( 76.0%)
11. Water Pollution 17 ( 68.0%)
E. Personal Health Services
1. AIDS Testing and Counseling 19 ( 76.0%)
2. Alcohol Abuse * -
3. Child Health 25 (100.0%)
4. Chronic Diseases * -
5. Dental Health 10 ( 40.0%)
6. Drug Abuse * -
7. Emergency Medical Service * -
8. Family Planning 25 (100.0%)
9. Handicapped Children 21 ( 84.0%)
10. Home Health Care * -
11. Hospitals -
12. Immunizations 25 (100.0%)
13. Laboratory Services 20 ( 80.0%)
14. Long-term Care Facilities -
15. Mental Health * -
16. Obstetrical Care 10 ( 40.0%)
17. Prenatal Care 23 ( 92.0%)
18. Primary Care 4 ( 16.0%)
19. Sexually Transmitted Diseases 24 ( 96.0%)
20. Tuberculosis 25 (100.0%)
21. WIC 25 (100.0%)
* The SHA provided additional information indicating that these
particular activities are not performed by any local health
departments in Louisiana.
C. Local Health Officer
No M.D. Requirement, State Health Officer Appointment
Local health departments may have local health officers. These
health officers are appointed by the State Health Officer after
consultation with the parish governing authority and with the
approval of the Secretary of the Department of Health and
Hospitals. The parish health officer is a full-time licensed
physician, if possible, and if a physician is not available, the
parish health officer is a full-time employee experienced in the
administration and enforcement of public health programs. The
health officer must live in the parish in which appointed unless
service to more than one parish is provided. These officers are
responsible for administering the local health department,
including all of its programs and functions.
D. Local Board of Health
With the exception of Orleans Parish there are no local boards of
health in Louisiana. Informal advisory committees are present in
42 of the 62 parishes run by OPH.
E. Staff
The staffs of local health departments except Orleans and
Plaquemines Parishes are state employees. Orleans Parish staff
are local employees and part of the City of New Orleans Merit
System. Plaquemines Parish staff are employees of that parish
merit system. Administrative supervision of parish health units
is performed by regional staff. The number of employees for a
local health department ranges from 2 to 300.
F. Budget
Total FY 1988 LPHA expenditures were $685,000 **. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $548,000
State Funds $103,000
Local Funds $32,000
Fees and Reimbursements 2,000
Other Sources 0
Source Unknown 0
** These data include only money provided to the City of New
Orleans and Plaquemines Parish in the form of contracts for
services.
The SHA reported that there were additional fees and
reimbursements not retained by the local health departments, but
which reverted to the general revenues of the local or state
government.
2Louisiana Department of Health and Hospitals, 1990
Secretary
Undersecretary
Deputy Secretary
Assistant Secretary Office of Public Health
Deputy Assistant Secretary - Programs
Division of Family Health Services
Maternal and Child Health Section
Family Planning Section
Nutrition Section
Genetic Diseases Section
Social Services Section
Handicapped Children's Services Section
Division of Disease Control
Tuberculosis Control Section
Sexually Transmitted Diseases Section
Health Promotion Section
Epidemiology Section
Immunization Section
Division of Environmental Health Services
Engineering Services Section
Sanitarian Services Section
Division of Laboratories
Amite Milk Lab Section
Lake Charles Regional Lab Section
Alexandria Regional Lab Section
Shreveport Regional Lab Section
Monroe Regional Lab Section
Lafayette Regional Lab Section
Central Lab Section
Chemistry Section
Microbiology Section
Virology-Immunology Section
Biochemistry Section
Quality Assurance Section
Radiation Section
Deputy Assistant Secretary - Administration
Division of Local Health Services
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region X
Division of Records and Statistics
Public Health Statistics Section
Vital Records Section
Tumor Registry Section
LA Cancer and Lung Trust Fund Board Section
Division of Administrative Services
Pharmacy Section
Policy, Planning and Evaluation Section
Human Resources Section
Data Processing Section
Operations and Support Section
Administrative Services Section
2Types of Local Health Departments by Jurisdiction
Louisiana, 1990
Jurisdiction Co C/Co
Acadia X
Allen X
Ascension X
Assumption X
Avoyelles X
Beauregard X
Bienville X
Bossier X
Caddo X
Calcasieu X
Caldwell X
Cameron X
Catahoula X
Claiborne X
Concordia X
De Soto X
E. Baton Rouge X
East Carroll X
East Feliciana X
Evangeline X
Franklin X
Grant X
Iberia X
Iberville X
Jackson X
Jefferson X
Jefferson Davis X
La Salle X
Lafayette X
Lafourche X
Lincoln X
Livingston X
Madison X
Morehouse X
Natchitoches X
New Orleans X
Ouachita X
Plaquemines X
Pointe Coupee X
Rapides X
Red River X
Richland X
Sabine X
St. Bernard X
St. Charles X
St. Helena X
St. James X
St. John Baptis X
St. Landry X
St. Martin X
St. Mary X
St. Tammany X
Tangipahoa X
Tensas X
Terrebonne X
Union X
Vermilion X
Vernon X
W. Baton Rouge X
Washington X
Webster X
West Carroll X
West Feliciana X
Winn X
Co = County HD
C/Co = City/County HD
1MAINE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,206,000 245,803,000
Population Density (1988) 38.9 69.4
(per/sq.mi.)
Number of Counties 16 3,139
Median Age (1987) 32.4 31.7
Percent Below Poverty Level (1985) 11.9 14.0
(persons)
Percent of Population Rural (1980) 53.0 26.0
Percent of Population White (1980) 98.7 83.1
Percent of Population Non-white (1980) 1.3 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The structure of authority of county governments in Maine is
determined by statutes enacted by the legislature.
Commission Form - (16) - This form of government is used by all
counties in Maine. The commissions are composed of three-member
boards elected from single-member districts. Counties can
appoint an administrator to perform administrative functions in
the county. Two counties currently have appointed
administrators.
There are no provisions for home rule authority. The commission,
however, may determine if a charter should be adopted or
amended. Voters can also petition for the establishment of a
charter by submitting petitions with signatures that represent
10 percent of the vote in the last gubernatorial election. At
the present, no counties operate under a charter.
Data for this state were updated April 1991.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Bureau of Health, the SHA, is a component of a superagency
called the Department of Human Services. The mission of the
Bureau of Health is to preserve, protect, and promote the health
and well-being of the population through the organization and
delivery of services designed to reduce the risk of disease by:
(1) modifying physiological and behavioral characteristics of
population groups; (2) controlling environmental hazards to human
health; and (3) promoting health/wellness through education,
counseling and access to health services.
The following are some broad areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
These are some additional areas of responsibility for the SHA:
Wastewater and Plumbing
Radiological Health
Drinking Water Regulations
Maternal and Child Health
Immunizations
Epidemiology
Disease Control
AIDS
Sexually Transmitted Diseases
Tuberculosis
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The head of the SHA is the Director of the Bureau of Health. The
Commissioner of the Department of Human Services appoints the
Director. The Director of the Bureau functions as the state's
Health Officer. In addition to overseeing the Bureau's programs,
the Director is instrumental in furthering cooperative
relationships with the medical and public health communities in
the state and in the Nation. The director represents the Bureau
of Health's interests through active participation in the work of
numerous state boards, committees, and organizations, and at the
national level, represents Maine through membership in the
Association of State and Territorial Health Officers.
C. State Board of Health/Counil
Maine does not have a State Board of Health or State Council of
Health.
D. Regional/District Health Offices
The SHA has not divided the state into administrative regions or
districts.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
Responsibility for liaison between the SHA and local public
health/community health agencies has not been assigned to any
particular office or individual. Liaison activities are handled
informally by individual agencies, programs and offices.
The interaction between state and local public health agencies in
Maine may be characterized as mixed centralized and decentralized
organizational control. Under this arrangement local health
services may be provided by the SHA in some jurisdictions and by
local governmental units, boards of health, or health departments
in other jurisdictions.
F. Budget
Total FY 1988 Maine SHA expenditures were $25,736,000. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $15,002,000
State Funds $8,869,000
Local Funds 0
Fees and Reimbursements $1,865,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
The eight local health departments in Maine consist of three city
health departments (located in the cities of Bangor, Lewiston,
and Portland) and five Department of Human Service regions (one
county and four multicounty units). The city health departments
are autonomous units, and the public health nursing services are
elements of the SHA that provide public health services to local
areas.
B. Services Provided
The following information on services provided by local health
departments in Maine is derived from a survey conducted by NACHO
during 1989. Five of the eight local health departments in Maine
responded to the survey.
Services Provided by LPHAs Number of LPHAs
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment -
2. Morbidity Data -
3. Reportable Diseases 3
4. Vital Records and Statistics 1
B. Epidemiology/Surveillance
1. Chronic Diseases -
2. Communicable Diseases 3
II. Policy Development
A. Health Code Dev. and Enforcement 1
B. Health Planning 1
C. Priority Setting 1
III. Assurance Activities
A. Inspection
1. Food and Milk Control 1
2. Health Facility Safety/Quality 2
3. Rec. Facility Safety/Quality 1
4. Other Facility Safety/Quality 1
B. Licensing
1. Health Facilities 2
2. Other Facilities 2
C. Health Education 2
D. Environmental
1. Air Quality 1
2. Hazardous Waste Management 1
3. Individual Water Supply Safety 1
4. Noise Pollution 1
5. Occupational Health and Safety 1
6. Public Water Supply Safety 1
7. Radiation Control 1
8. Sewage Disposal Systems 2
9. Solid Waste Management 1
10. Vector and Animal Control 1
11. Water Pollution 1
E. Personal Health Services
1. AIDS Testing and Counseling 1
2. Alcohol Abuse -
3. Child Health 2
4. Chronic Diseases -
5. Dental Health 1
6. Drug Abuse -
7. Emergency Medical Service 1
8. Family Planning 1
9. Handicapped Children -
10. Home Health Care 1
11. Hospitals -
12. Immunizations 3
13. Laboratory Services 1
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care 1
17. Prenatal Care 2
18. Primary Care 1
19. Sexually Transmitted Diseases 1
20. Tuberculosis 2
21. WIC -
C. Local Health Officer
No M.D. Requirement, Local Governing Body Appointment
Each municipality in Maine is required to appoint a health
officer. Maine has approximately 325 local health officers. A
listing is maintained by the Bureau of Health. Over one-third of
them have a medical/health/public health background (doctors,
nurses, physician assistants, and emergency medical
technicians). These people are considered a valuable resource
for the state and, to date, have not been used to their full
potential. There is presently no structural statewide
organization for health officers.
D. Local Board of Health
Information on local boards of health is not available.
E. Staff
Autonomous local health departments employ and supervise their
staffs. The staffs of Public Health Nursing Services are
employed and supervised by the SHA. The number of employees for
a local service unit ranges from 1 to 30.
F. Budget
Total FY 1988 LPHA expenditures are not available.
2Maine Department of Human Services, 1990
Department of Human Services
Advisory Comm. on Radioactive Waste
Human Services Council
Maine AFDC Coordinating Committee
Certificate of Need Advisory Committee
Office of Attorney General
Office of Public and Legislative Affairs
Environmental Health Advisory Committee
Alcohol and Drug Abuse Plan Committee
Advisory Committee on Radiation
Bureau of Health
Division of Health Engineering
Radiological Emergency Prep. Committee
Scientific Advisory Panel
Division of Disease Control
Maine-Dental Health Council
Emergency Medical Services Board
Division of Health Promotion and Education
Bureau of Medical Services
Comm. to Advise D.H.S. on AIDS
Division of Maternal and Child Health
Public Health Laboratory
Office of Dental Health
Division of Public Health Nursing
Office of Emergency Medical Services
Maine Medical Lab Commission
Advisory Board for Water Treatment Plant Operations
Bureau of Medical Services
Office of Vital Statistics
Office of Mgmt. and Budget
Division of Regional Administration
Office of Programs
Bureau of Income Maintenance
Bureau of Maine's Elderly
Bureau of Social Services
Bureau of Rehabilitation
Division of Deafness
Division of Eye Care
Office of Alcohol & Drug Abuse Prevention
2Types of Local Health Departments by Jurisdiction
Maine, 1990
Jurisdiction Co C M/Co
Androscoggin X
Aroostook X
Bangor X
Cumberland X
Franklin X
Hancock X
Kennebec X
Knox X
Lewiston X
Lincoln X
Oxford X
Penobscot X
Piscataquis X
Portland X
Sagadahoc X
Somerset X
Waldo X
Washington X
York X
Co = County HD
C = City HD
M/Co = Multicounty HD
1MARYLAND
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 4,622,000 245,803,000
Population Density (1988) 469.9 69.4
(per/sq.mi.)
Number of Counties 24 3,139
Median Age (1987) * 32.5 31.7
Percent Below Poverty Level (1985) 8.7 14.0
(persons)
Percent of Population Rural (1980) 20.0 26.0
Percent of Population White (1980) 74.9 83.1
Percent of Population Non-white (1980) 25.1 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure of county government in Maryland is established by
the state constitution and is either Commission, Code Home Rule,
or Charter Home Rule. The governing bodies are elected from
single-member districts, at large, or by a combination of the
methods.
Commission Form - (11) - These counties have not adopted a level
of home rule. They have a board of commissioners made up of five
members with administrative and legislative responsibility.
Seven of the commission counties have appointed administrators.
Maryland has provided counties with home rule authority under two
structures: code home rule and charter home rule. Under both of
these options the state has delegated some legislative authority
for local matters to the counties. The primary difference in the
two structures is the method by which they are adopted and
changed. All home rule counties can use either commission,
elected executive-council, or council-manager as the structure of
their governmental body.
*These data were provided by the SHA.
Data for this state were updated November 1990.
Code Home Rule - (4) - In these counties the governmental board
makes structural changes in the county government by enacting
laws. These counties operate with a board of county
commissioners, and each has an appointed county administrator.
Charter Home Rule - (8) - In these counties the governmental body
is required to submit any proposed amendments of the charter to
the voters for approval. Six of these counties have a county
council with an elected executive, and two counties use the
Council-manager Form.
Independent City - (1) - Baltimore City is an independent city
which operates as a county with an elected executive/mayor.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Maryland Department of Health and Mental Hygiene (MDHMH), the
SHA, is a free-standing, independent agency. The mission of
public health services in Maryland is to prevent and reduce the
consequences of illness and disability on individuals and society
and to assure a dynamic system of prevention, intervention, and
rehabilitation services.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Mental Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
State Professions Licensing Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Secretary of MDHMH is the head of the SHA. This official is
appointed by the Governor with advice and consent of the Senate.
The Secretary is responsible directly to the Governor and serves
at the pleasure of the Governor. The Secretary has
responsibility for advising the Governor on all matters assigned
to the Department and is responsible for carrying out the
Governor's policies on these matters. Full responsibility for
operation of the Department, including the establishment of
guidelines and procedures to promote the orderly and efficient
administration of the Department, rests with the Secretary.
C. State Board of Health/Council
Advisory
Maryland has a board entitled the Board of Review of the
Department. This board is composed of seven members appointed by
the Governor with advice and consent of the Senate. At least
four of the members must come from the general public and the
other three must have knowledge and experience in at least one of
the fields under the jurisdiction of the Department. The term of
office for members is 3 years. The terms of members are
staggered so that no more than three members' terms will expire
on any given year.
The Board is responsible for making recommendations to the
Secretary on the operation and administration of the Department
as the Board considers necessary or desirable. If an advisory
board for the department is not created, the Board will advise
the Secretary on any departmental matter that the Secretary
submits to the Board. Unless otherwise provided for in policy or
law, the Board will hear and determine appeals from decisions
involving the Secretary or any unit of the Department.
D. Regional/District Health Offices
The state is not generally divided into administrative districts
or regions. The local service units are organized along county
lines, and the services are provided at the county level. Some
individual programs such as Mental Hygiene and WIC, however, have
established administrative regions.
E. State-Local Liaison
Shared Organizational Control, Formal Liaison Function
The Office of Local and Family Health Administration is
responsible for the liaison function between local health
agencies and the MDHMH. In this role the office serves as a
primary focus of communications between the state and local
health agencies. Some functions of this office include the
management of monthly local health officers' roundtable meetings,
assisting local areas in recruiting health officers, and
participation in meetings of the Association of Local Health
Officers when invited and upon request.
The interaction between state and local public health agencies in
Maryland may be characterized as shared organizational control.
Under this arrangement local health departments are under the
authority of the SHA, as well as the local government and board
of health.
F. Budget
Total FY 1988 Maryland SHA expenditures were $732,553,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $63,006,000
State Funds $590,872,000
Local Funds $32,079
Fees and Reimbursements 0
Other $46,597,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 24 local health jurisdictions in Maryland.
Twenty-three of these are county health departments, and one is a
city health department (Baltimore City).
The state supports local health services through a mechanism
called Case Formula. This formula provides money to local health
departments on an approximate 50/50 percent matching basis. The
exact percentage of the match is based on the population and the
equalized property tax in each county.
B. Services Provided
The following information on services provided by local health
departments in Maryland is derived from a survey conducted by
NACHO during 1989. All 24 of the local health departments in
Maryland responded to the survey. Services provided by at least
70 percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
1. Behavioral Risk Assessment 16 ( 66.7%)
2. Morbidity Data 20 ( 83.3%)
3. Reportable Diseases 23 ( 95.8%)
4. Vital Records and Statistics 22 ( 91.7%)
B. Epidemiology/Surveillance
1. Chronic Diseases 12 ( 50.0%)
2. Communicable Diseases 24 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 18 ( 75.0%)
B. Health Planning 21 ( 87.5%)
C. Priority Setting 18 ( 75.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 21 ( 87.5%)
2. Health Facility Safety/Quality 15 ( 62.5%)
3. Rec. Facility Safety/Quality 18 ( 75.0%)
4. Other Facility Safety/Quality 12 ( 50.0%)
B. Licensing
1. Health Facilities 9 ( 37.5%)
2. Other Facilities 23 ( 95.8%)
C. Health Education 23 ( 95.8%)
D. Environmental
1. Air Quality 19 ( 79.2%)
2. Hazardous Waste Management 16 ( 66.7%)
3. Individual Water Supply Safety 22 ( 91.7%)
4. Noise Pollution 15 ( 62.5%)
5. Occupational Health and Safety 5 ( 20.8%)
6. Public Water Supply Safety 19 ( 79.2%)
7. Radiation Control 8 ( 33.3%)
8. Sewage Disposal Systems 22 ( 91.7%)
9. Solid Waste Management 14 ( 58.3%)
10. Vector and Animal Control 20 ( 83.3%)
11. Water Pollution 18 ( 75.0%)
E. Personal Health Services
1. AIDS Testing and Counseling 24 (100.0%)
2. Alcohol Abuse 22 ( 91.7%)
3. Child Health 24 (100.0%)
4. Chronic Diseases 22 ( 91.7%)
5. Dental Health 16 ( 66.7%)
6. Drug Abuse 23 ( 95.8%)
7. Emergency Medical Service 5 ( 20.8%)
8. Family Planning 24 (100.0%)
9. Handicapped Children 21 ( 87.5%)
10. Home Health Care 19 ( 79.2%)
11. Hospitals -
12. Immunizations 24 (100.0%)
13. Laboratory Services 13 ( 54.2%)
14. Long-term Care Facilities 3 ( 12.5%)
15. Mental Health 23 ( 95.8%)
16. Obstetrical Care 12 ( 50.0%)
17. Prenatal Care 22 ( 91.7%)
18. Primary Care 6 ( 25.0%)
19. Sexually Transmitted Diseases 24 (100.0%)
20. Tuberculosis 24 (100.0%)
21. WIC 22 ( 91.7%)
C. Local Health Officer
No M.D. Requirement, Secretary Appointment
County health officers are nominated by the county governing body
and are appointed by the Secretary of MDHMH. The local health
officer is the chief executive officer of the local health
department. Health officers are required to have a master's
degree in public health and at least 2 years' work in the field
of public health, or at least 5 years' work in the field of
public health.
The following are powers and duties of county health officers:
1. The health officer for a county is the
Executive Officer and Secretary of the county
board of health.
2. The health officer for a county has
responsibility for appointing the staff of
the county health department.
3. A health officer may obtain samples of food
and drugs for analysis.
4. A county health officer, under the direction
of the Secretary, will enforce the state
health laws and the policies, rules, and
regulations that the Secretary adopts.
5. The health officer will have an office at an
accessible place in the county.
6. Except for particular situations specified by
law, the county health officer will, under
the direction of the county board of health,
enforce the rules and regulations that the
county board adopts.
7. The county health officer will enforce in
each municipality or special taxing district
in the county the rules and regulations that
the county board of health adopts, unless the
municipality or district has a charter
provision or ordinance that specifies
otherwise.
8. A health officer will perform any
investigation or other duties or function
directed by the Secretary or the county board
of health and submit appropriate reports to
them.
D. Local Board of Health
Policy-making
In general, the county governing body functions as the board of
health for the county. In a code county or charter county the
governing body has the option of appointing a board of health or
serving that function themselves.
Responsibilities of the local boards of health are to meet each
May and October, to coordinate its activities with the
Department, to report to the Department on the sanitary
conditions of the county whenever the Board considers it
important and necessary, and to adopt and enforce rules and
regulations on any nuisance or cause of disease in the county.
E. Staff
In three jurisdictions the local staff is employed by the
county. In 21 jurisdictions the staff is employed by the state.
However, in all jurisdictions, except Baltimore City, the health
officer is a state employee. The number of employees for an
individual local health department ranges from 49 to 706.
F. Budget
Total FY 1988 LPHA expenditures were $99,542,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $2,424,000
State Funds $41,575,000
Local Funds $32,079,000
Fees and Reimbursements 0
Other Sources $23,463,000
Source Unknown 0
2Maryland Department of Health and Mental Hygiene, 1990
Governor
Secretary
Deputy Secretary for Operations
Deputy Secretary for Public Health Services
Office of Health Program Support/Special Projects
Local Health Administration
AIDS Administration
Alcohol and Drug Abuse Administration
Community Health Surveillance and Laboratory
Administration
Developmental Disabilities Administration
Family Health Administration
Mental Hygiene Administration
Deputy Secretary for Health Care Policy, Finance and Regulation
2Types of Local Health Departments by Jurisdiction
Maryland, 1990
Jurisdiction Co C
Allegany X
Anne Arundel X
Baltimore X
Baltimore City X
Calvert X
Caroline X
Carroll X
Cecil X
Charles X
Dorchester X
Frederick X
Garrett X
Harford X
Howard X
Kent X
Montgomery X
Prince Georges X
Queen Annes X
Somerset X
St. Marys X
Talbot X
Washington X
Wicomico X
Worchester X
Co = County HD
1MASSACHUSETTS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 5,890,000 245,803,000
Population Density (1988) 752.8 69.4
(per/sq.mi.)
Number of Counties 14 3,139
Median Age (1987) 33.0 31.7
Percent Below Poverty Level (1985) 9.3 14.0
(persons)
Percent of Population Rural (1980) 16.0 26.0
Percent of Population White (1980) 93.5 83.1
Percent of Population Non-White (1980) 6.5 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for counties in Massachusetts are
provided by the state constitution and statutes.
Commission Form - (10) - Ten of the 14 counties in Massachusetts
have 3-member county commissions, treasurers, and county advisory
boards made up of locally elected officials. The primary
function of counties under this framework is the administration
of jails, houses of correction, court houses, and registries of
deeds.
Home Rule Charter - (2) - In 1985 Massachusetts enacted
provisions of home rule authority which provided the counties
with greater legislative authority. Home Rule Charters were
adopted in Hampshire and Barnstable counties. Hampshire County
adopted a charter plan which has a government body with 26
commissioners elected to 2-year terms from 26 towns in the county
and an appointed administrator. The vote of each commissioner is
weighted according to the population of the town from which
he/she is elected. Barnstable County has a 3-member executive
body elected at large, a 15-member legislative assembly elected
by district, and an appointed administrator. The vote of the
assembly members is weighted according to the population of their
respective districts.
Data for this state were updated February 1991. City/County Consolidation -
(2) - These consolidations are Boston and Suffolk County and Nantucket
and Nantucket County. Both governments operate with an elected executive.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Massachusetts Department of Public Health (MDPH), the SHA, is
a component of a superagency known as the Executive Office of
Human Services. MDPH is one of 11 departments within the
Secretariat of Human Services. The MDPH includes the following
bureaus: Communicable Disease Control; Laboratory and
Environmental Sciences, Environmental Monitoring and Regulation;
Parent; Child and Adolescent Health; Health Statistics Research
and Evaluation; Community Health Programs; Health Care Systems;
Public Health Hospitals; and Substance Abuse.
Initiatives of MDPH include the following: strengthen efforts to
fight AIDS and substance abuse; promote better adolescent health;
reduce infant deaths; decrease environmental health hazards;
reduce health risks for the poor; improve health care for the
elderly; assure high quality, accessible health care for all
citizens; and maximize the use of MDPH resources.
The following are some broad areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Commissioner is head of the Department of Public Health.
This officer is appointed by the Governor and responsible to the
Secretary of Human Services. The Commissioner sits on the Public
Health Council, the final decision-making body for the state
public health policies.
C. State Board of Health/Council
Policy-making
Massachusetts has a State Public Health Council which consists of
eight members and the Commissioner who serves as chairman. Three
of the appointed members must be providers of health services, of
whom two must be physicians. The five remaining members must not
be providers of health care. Three of these must be selected
from a list of candidates submitted by the Secretary of Elder
Affairs. The term of office is 6 years. Members are appointed
by the Governor with advice and consent of the Senate.
The Council is responsible for approving public health policy for
the operation of the health department and its programs.
D. Regional/District Health Offices
MDPH has two regional units which serve local health departments
and boards--one in western Massachusetts and the other in the
Boston central office. They provide consultation and technical
assistance, planning and coordination, inspection and code
enforcement, and continuing education and training. Overall,
staff in the two regional offices represent the following MDPH
programs: community sanitation, childhood lead poisoning
prevention, radon control, AIDS, communicable diseases, prenatal
outreach, high-risk infant and early childhood intervention,
school nursing and case management for children with special
health care needs.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
MDPH has not designated one office or individual the
responsibility for liaison between the SHA and local health
agencies. Specific programs communicate directly with the local
boards of health. Staff units in the two regional offices, which
are extensions of the central office, function as liaisons for
information and referral.
The interaction between state and local public health agencies in
Massachusetts may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement
local health services may be provided by the SHA in some
jurisdictions and by local governmental units, boards of health,
or health departments in other jurisdictions.
F. Budget
Total FY 1988 Massachusetts SHA expenditures were $281,759,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $61,555,000
State Funds $220,204,000
Local Funds 0
Fees and Reimbursements 0
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Massachusetts has 351 cities and towns, each with their own local
board of health. Although the commonwealth has no direct
authority over these health units, it does have authority by
regulation and mandate to determine their functions and
activities. The local units range from offices staffed only with
volunteer, part-time board members or part-time staff, to
full-fledged health departments. While information on the
specifics of local staffing is limited, estimates are that
Massachusetts has approximately 183 local units which have
at least one full-time employee and thereby meet our definition
of a local health department. Seven of these represent multitown
jurisdictions (intermunicipal health districts) which enable
member towns to share staff and other resources. Massachusetts
has one county health department (Barnstable).
B. Services Provided
The following information on services provided by local health
departments in Massachusetts is derived from a survey conducted
by NACHO during 1989. Two hundred and thirty-nine of the 359
local boards of health in Massachusetts responded to the survey.
Services provided by at least 70 percent of the boards of health
in the state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 17 ( 7.1%)
2. Morbidity Data 70 ( 29.3%)
3. Reportable Diseases 172 ( 72.0%)
4. Vital Records and Statistics 82 ( 34.3%)
B. Epidemiology/Surveillance
1. Chronic Diseases 48 ( 20.1%)
2. Communicable Diseases 174 ( 72.8%)
II. Policy Development
A. Health Code Dev. and Enforcement 198 ( 82.8%)
B. Health Planning 87 ( 36.4%)
C. Priority Setting 70 ( 29.3%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 201 ( 84.1%)
2. Health Facility Safety/Quality 125 ( 52.3%)
3. Rec. Facility Safety/Quality 154 ( 64.4%)
4. Other Facility Safety/Quality 83 ( 34.7%)
B. Licensing
1. Health Facilities 89 ( 37.2%)
2. Other Facilities 215 ( 90.0%)
C. Health Education 103 ( 43.1%)
D. Environmental
1. Air Quality 100 ( 41.8%)
2. Hazardous Waste Management 155 ( 64.9%)
3. Individual Water Supply Safety 150 ( 62.8%)
4. Noise Pollution 87 ( 36.4%)
5. Occupational Health and Safety 57 ( 23.8%)
6. Public Water Supply Safety 117 ( 49.0%)
7. Radiation Control 40 ( 16.7%)
8. Sewage Disposal Systems 204 ( 85.4%)
9. Solid Waste Management 166 ( 69.5)
10. Vector and Animal Control 133 ( 55.6%)
11. Water Pollution 163 ( 68.2%)
E. Personal Health Services
1. AIDS Testing and Counseling 18 ( 7.5%)
2. Alcohol Abuse 16 ( 6.7%)
3. Child Health 76 ( 31.8%)
4. Chronic Diseases 50 ( 20.9%)
5. Dental Health 34 ( 14.2%)
6. Drug Abuse 24 ( 10.0%)
7. Emergency Medical Service 17 ( 7.1%)
8. Family Planning 11 ( 4.6%)
9. Handicapped Children 13 ( 5.4%)
10. Home Health Care 73 ( 30.5%)
11. Hospitals 6 ( 2.5%)
12. Immunizations 139 ( 58.2%)
13. Laboratory Services 25 ( 10.5%)
14. Long-term Care Facilities 10 ( 4.2%)
15. Mental Health 27 ( 11.3%)
16. Obstetrical Care 6 ( 2.5%)
17. Prenatal Care 23 ( 9.6%)
18. Primary Care 11 ( 4.6%)
19. Sexually Transmitted Diseases 29 ( 12.1%)
20. Tuberculosis 96 ( 40.2%)
21. WIC 12 ( 5.0%)
C. Local Health Officer
No M.D. Requirement, Local Government Body Appointment
Approximately 75 percent of Massachusetts towns and cities hire
health agents; in 45 percent, the agents are full-time, in 30
percent part-time. The local health officer may or may not
supervise staff. Except for the larger communities, local health
officers are hired by local boards of health, or the mayor (with
council approval), depending on the form of local government.
The local board of health usually develops a contract with its
health officer. Local personnel policies and employee benefits
generally apply. He/she is involved in direct health protection
activities, which include inspections for permits and licenses,
responding to emergencies and complaints and reviewing plans for
facilities siting. Areas of responsibility include food service,
retail food, swimming pools, and beaches, private wells, septic
systems, recreational camps for children, solid waste transfer,
and housing and nuisance complaints. He/she also maintains
public records, keeps local board of health members informed and
organizes their regular meetings, hearings, and public education
campaigns. There is no involvement of county government, except
in Barnstable County, where county-level staff coordinate
activities with additional staff hired by the local health
boards. MDPH regional office staffs in western Massachusetts, as
well as Boston, provide consultation and training for local
health officers and board members on code enforcement and other
health-related programs such as cancer reduction and AIDS
education. Outside western Massachusetts, these functions are
performed solely by MDPH staff in Boston. The State Department
of Environmental Protection carries out similar functions for
program areas under its jurisdiction, including subsurface sewage
and solid waste disposal.
D. Local Board of Health
Policy-making
The local board of health was established by state legislation.
If a town does not choose to elect or have its Board of Selectmen
appoint a board of health, the Board of Selectmen act as the
Board of Health. Terms of office are generally staggered--1, 2
and 3 years. Most boards have three members; some have five.
Local health boards may appoint agents to act in their behalf to
handle code enforcement matters; however, final responsibility
rests with the board, which must conduct all its business at
regular or special public meetings, posted in advance.
Functions include: enforcement of the state sanitary and
environmental codes mentioned above, and handling of public
emergencies, nuisance problems and facilities siting. The local
board of health has extensive authority to enact local
regulations, to act in emergencies or to abate public health
nuisances, and to review and make decisions regarding definitive
housing subdivisions plans. Most are involved in vector control
programs, many conduct lead paint inspections and approximately
one-third manage solid waste disposal facilities and programs.
E. Staff
Local staffs are all employed by the local boards of health or
health departments. Some 3-year state seed grants have been
available for newly created, multitown health districts to
encourage smaller towns to obtain shared professional expertise.
The District boards, which employ the staff, contain equal
representation from their constituent towns, which still maintain
their individual health boards. No county or state unit employs
local public health staff.
F. Budget
Total FY 1988 LPHA expenditures were $2,396,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $1,529,000
State Funds $868,000
Local Funds 0
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
2Massachusetts Department of Public Health, 1990
Commissioner's Office
Planning and Policy
Government Relations
General Counsel
Management and Resources
Administration
Finance
AIDS Office
Communicable Disease Center
Laboratory and Environmental Sciences
Environmental Monitoring and Regulation
Parent, Child and Adolescent Health
Health Statistics, Research and Evaluation
Community Health Programs
Health Care Systems
Public Health Hospitals
Substance Abuse
2Types of Local Health Departments by Jurisdiction
Massachusetts, 1990
Jurisdiction Co C N/Co T/T M/T
Abington X
Achusnet X
Acton X
Agawam X
Amesbury X
Amhurst X
Andover X
Arlington X
Athol X
Attleboro X
Auburn X
Avon X
Barnstable X
Barnstable X
Bedford X
Bellingham X
Belmont X
Berkshire X
Beverly X
Billerica X
Blackstone X
Boston X
Bourne X
Boxford-Topsfield X
Braintree X
Bridgewater X
Bristol X
Brocton X
Brookline X
Burlington X
Cambridge X
Canton X
Charlton X
Chelmsford X
Chelsea X
Chicopee X
Clinton X
Cohasset X
Concord X
Danvers X
Dartmouth X
Dedham X
Dighton X
Dracut X
Dudley X
Dukes X
E. Franklin Co. X
Easton X
Essex X
Essex X
Everett X
Fall River X
Falmouth X
Fitchburg X
Foothills X
Foxborough X
Framington X
Franklin X
Franklin X
Freetown X
Gardner X
Georgetown X
Glouchester X
Greenfield X
Hamilton X
Hampden X
Hampden X
Hampshire X
Hanover X
Harwich X
Haverhill X
Hingham X
Holbrook X
Holden X
Holliston X
Holyoke X
Hopkinton X
Hudson X
Hull X
Ipswich X
Kingston X
Lakeville X
Lawrence X
Leominster X
Lexington X
Longmeadow X
Lowell X
Ludlow X
Lynn X
Lynnfield X
Malden X
Manchester X
Mansfield X
Marblehead X
Marion X
Marlborough X
Marshfield X
Mashpee X
Mattapoisett X
Maynard X
Medford X
Medway X
Melrose X
Methuen X
Middleborough X
Middlesex X
Middleton X
Milford X
Milton X
Nahant X
Nantucket X
Nantucket X
Nashoba Association X
Natick X
New Bedford X
Newburyport X
Newton X
Norfolk X
North Adams X
North Andover X
North Attleboro X
North Reading X
Northampton X
Northborough X
Norwell X
Norwood X
Orange X
Orleans X
Oxford X
Paxton X
Peabody X
Pembroke X
Pepperell X
Pittsfield X
Plymouth X
Plymouth X
Provincetown X
Quabbin District X
Quincy X
Randolph X
Raynham X
Reading X
Rehoboth X
Revere X
Rockland X
Rockport X
Rowe X
Salem X
Saugus X
Scituate X
Seekonk X
Sharon X
Sheffield X
Sherborn X
Shrewsbury X
Somerset X
Somerville X
Southborough X
Southbridge X
Spencer X
Springfield X
Sterling X
Stoneham X
Stoughton X
Stow X
Sudbury X
Suffolk X
Swampscott X
Swansea X
Taunton X
Tewksbury X
Tri-town District X
Tyngsborough X
Wakefield X
Walpole X
Waltham X
Wareham X
Watertown X
Wayland X
Welfleet X
Wellesley-Needham X
West Newbury X
West Springfield X
Westborough X
Westfield X
Westport X
Westwood X
Weymouth X
Whitman X
Williamstown X
Wilmington X
Winchendon X
Winthrop X
Woburn X
Worcester X
Worchester
X
Co = County HD
C = City HD T/T = Town/Township HD
N/Co = No County HD M/T = Multitownship HD
1MICHIGAN
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 9,240,000 245,803,000
Population Density (1988) 162.2 69.4
(per/sq.mi.)
Number of Counties 83 3,139
Median Age (1987) 31.1 31.7
Percent Below Poverty Level (1985) 14.5 14.0
(persons)
Percent of Population Rural (1980) 29.0 26.0
Percent of Population White (1980) 85.0 83.1
Percent of Population Non-white (1980) 15.0 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority of county governments in Michigan are
determined by the state constitution, state statutes and court
cases. Three forms of government are available to Michigan
counties: Commission, Charter, and United Forms.
Commission Form - (80) - Commissions are used by 80 counties.
The boards of commissioners are made up of 5 to 35 members,
determined by population, and elected from single-member
districts. State law permits commission counties to hire other
employees that they consider necessary. Under this provision 31
counties have appointed an administrator and 18 have hired a
fiscal controller.
Charter Form - (1) - One county has adopted the Charter Form of
government. The Charter has home rule provisions which permit
the county to elect an executive officer. Under the Charter the
board of commissioners become primarily a legislative body with
administrative functions transferred to the executive.
United Form - (2) - The United Form is currently being used by
two counties: Oakland and Bay. This type of government provides
more local options than the Commission but fewer than the
Charter. While it allows counties to elect an executive officer
Data for this state were updated December 1990. or appoint a manager,
both counties have chosen elected executives. The executive is elected
to 4-year terms and is stronger than an appointed manager because of
veto power.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The State Health Agency is an independent, free-standing agency
known as the Michigan Department of Public Health (MDPH). The
mission of the Department is to continually and diligently
endeavor to prevent disease, prolong life, and promote the public
health through organized programs, including prevention and
control of environmental hazards; prevention and control of
diseases; prevention and control of health problems of
particularly vulnerable population groups; development of health
care facilities and agencies and health services delivery
systems; and regulation of health care facilities and agencies
and health services delivery systems to the extent provided by
law.
Major department functions are divided among the following four
bureaus and two centers: Center for Environmental Health
Sciences; Bureau of Environmental and Occupational Health; Bureau
of Community Health Services; Center for Health Promotion; Bureau
of Health Facilities; and Bureau of Laboratory and
Epidemiological Services.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The head of the SHA is the State Health Director, who is a
cabinet-level officer appointed by the Governor. Under state law
if the state health director is not a physician, the Director
must designate a physician as the chief medical executive of the
department. The Director, with the approval of the Governor, may
establish the internal organization of the department and is
responsible for all internal administrative procedures.
C. State Board of Health/Council
Advisory
Michigan has the Public Health Advisory Council that consists of
16 members who are appointed by the Governor. The Council is to
represent consumers and providers of health and to be
representative of the population as to sex, race, and ethnicity
and will include representatives of the local governing body.
The term of office is 4 years. As the name indicates, the duties
of this Council involve advising and consulting with the Director
on public health programs and policy.
D. Regional/District Health Offices
The Bureau of Community Services has divided the state into three
administrative regions: Northern region, Eastern region, and
Western region. Each of the regions has a regional office,
located in Lansing. Through the regional offices the bureau
provides advice, policy direction, and technical support to local
agencies charged with the delivery of health services. Also,
they develop comprehensive plans, execute performance contracts
with local agencies, and monitor and evaluate local agency
performance.
The typical regional office staff consists of 15 to 20 persons
led by an administrative head, the Regional Chief. Under the
Regional Chief are two sections, the Operations Section and the
Program Section, which are supervised by section chiefs. The
Operations Section is staffed by administrative types of
personnel. The Program Section is staffed primarily by
individuals who are program consultants.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The function of state-local liaison has evolved from a separate
office within the Department, with some oversight
responsibilities, to a single position reporting to the
Director. It is this individual's responsibility to see that the
Department's programs with local public health departments are
coordinated, to act as an ombudsman for local health department
concerns, and to represent the Director in dealing with local
issues.
The interaction between state and local public health agencies in
Michigan may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement
local health services may be provided by the SHA in some
jurisdictions and by local governmental units, boards of health,
or health departments in other jurisdictions.
F. Budget
Total FY 1988 Michigan SHA expenditures were $306,640,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $126,208,000
State Funds $142,265,000
Local Funds $414,000
Fees and Reimbursements $32,085,000
Other $4,896,000
3III. Local Public Health Agencies (LPHAs)
A. General
Michigan has 50 local health departments, consisting of 35 county
health departments, 14 multicounty health departments (known as
districts) and 1 city health department. These local departments
can be organized in any of the four following ways: single
county units; district health departments comprised of two or
more counties; city health departments in cities with 750,000 or
more population; or associated health departments in which two or
more local governing entities may contract for employment of
personnel or the consolidation of functions of their local health
departments. Eight of these units are currently associated
units.
Each county maintaining an approved county health department is
entitled to participate in cost sharing by the state. Other
state and Federal funds are also available to local health
departments through MDPH in the form of general and categorical
appropriations made by the State Legislature and Congress to meet
specific needs or health problems.
B. Services Provided
The following information on services provided by local health
departments in Michigan is derived from a survey conducted by
NACHO during 1989. Forty-seven of 50 local health departments in
Michigan responded to the survey. Services provided by 70
percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 24 ( 51.1%)
2. Morbidity Data 28 ( 59.6%)
3. Reportable Diseases 45 ( 95.7%)
4. Vital Records and Statistics 23 ( 48.9%)
B. Epidemiology/Surveillance
1. Chronic Diseases 28 ( 59.6%)
2. Communicable Diseases 46 ( 97.9%)
II. Policy Development
A. Health Code Dev. and Enforcement 43 ( 91.5%)
B. Health Planning 28 ( 59.6%)
C. Priority Setting 31 ( 66.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 31 ( 66.0%)
2. Health Facility Safety/Quality 20 ( 42.6%)
3. Rec. Facility Safety/Quality 37 ( 78.7%)
4. Other Facility Safety/Quality 9 ( 19.1%)
B. Licensing
1. Health Facilities 4 ( 8.5%)
2. Other Facilities 44 ( 93.6%)
C. Health Education 35 ( 74.5%)
D. Environmental
1. Air Quality 15 ( 31.9%)
2. Hazardous Waste Management 29 ( 61.7%)
3. Individual Water Supply Safety 45 ( 95.7%)
4. Noise Pollution 5 ( 10.6%)
5. Occupational Health and Safety 10 ( 21.3%)
6. Public Water Supply Safety 42 ( 89.4%)
7. Radiation Control 14 ( 29.8%)
8. Sewage Disposal Systems 43 ( 91.5%)
9. Solid Waste Management 32 ( 68.1%)
10. Vector and Animal Control 41 ( 87.2%)
11. Water Pollution 40 ( 85.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 45 ( 95.7%)
2. Alcohol Abuse 12 ( 25.5%)
3. Child Health 47 (100.0%)
4. Chronic Diseases 37 ( 78.7%)
5. Dental Health 13 ( 27.7%)
6. Drug Abuse 14 ( 29.8%)
7. Emergency Medical Service 11 ( 23.4%)
8. Family Planning 44 ( 93.6%)
9. Handicapped Children 42 ( 89.4%)
10. Home Health Care 24 ( 51.1%)
11. Hospitals -
12. Immunizations 47 (100.0%)
13. Laboratory Services 16 ( 34.0%)
14. Long-term Care Facilities 7 ( 14.9%)
15. Mental Health 2 ( 4.3%)
16. Obstetrical Care 14 ( 29.8%)
17. Prenatal Care 39 ( 83.0%)
18. Primary Care 7 ( 14.9%)
19. Sexually Transmitted Diseases 46 ( 97.9%)
20. Tuberculosis 47 (100.0%)
21. WIC 39 ( 83.0%)
C. Local Health Officer
No M.D. Requirement, Board of Health or Governing Body
Appointment
State law requires that each local public health department have
a full-time local health officer. This officer may be a medical
health officer or an administrative health officer. The medical
health officer must be a licensed physician while the
administrative health officer has no such requirement. If the
health officer is not a physician, a medical director must be
employed who is responsible to the health officer for medical
decisions. The health officer functions as the administrative
officer of the board of health and as the director of the
department. In single county health departments, the board of
health usually selects and refers the preferred candidate to the
local governing entity with the recommendation for appointment.
In districts the board of health selects and appoints the health
officer.
D. Local Board of Health
Policy-making
County governments are authorized by state law to appoint a board
of health. Cities with 750,000 or more population also have this
authority. State law provides for formation of district boards
of health when district health departments are created. The
district board of health is composed of two members from each
county board of commissioners, or two members appointed by the
mayor in the case of a city. A county or city may have more
representatives with consent of the local governing bodies.
The major responsibility of the local board of health is to learn
as much as possible about health problems of the community and to
participate actively in finding solutions for these problems.
Other duties of the local boards of health include the
following: approve the health department programs; interpret
health department programs; approve the budget; approve
expenditures; and adopt regulation for approval by the local
governing body.
E. Staff
All local public health departments have as a minimum the
following staff members: medical or administrative health
officer, medical director (if an administrative health officer is
employed), administrator, public health nurses, environmental
health staff, office manager, bookkeepers, clerks, health
educators, vision and hearing technicians, accountants,
laboratory technicians, dentists, physical therapists, and home
health aids. The number of staff for a local health department
ranges from 9 to 911. The staff are employed and supervised by
the jurisdiction that they serve.
F. Budget
Total FY 1988 LPHA expenditures were $287,078,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $41,347,000
State Funds $77,990,000
Local Funds $112,338,000
Fees and Reimbursements $47,388,000
Other Sources $8,014,000
Source Unknown 0
The SHA reported that these figures include the total amount of
additional monies expended by all local health departments.
2Michigan Department of Public Health, 1990
State Health Director
Public Health Advisory Council
Office of Substance Abuse Services
Chief Medical Executive
Food and Nutrition Commission
Deputy Directors
Affirmative Action
Office of Budget and Finance
Office of Personnel
Office of General Services
Office of Management Information Systems
Office of State Registrar and Center for Health Statistics
Office of the Director
Publications and Media Services
Legislative Liaisons
Federal Liaison
Center for Environmental Health Sciences
Bureau of Environmental and Occupational Health
Bureau of Community Services
50 Local Health Departments
Center for Health Promotion
Bureau of Health Facilities
Bureau of Laboratory and Epidemiological Services
2Types of Local Health Departments by Jurisdiction
Michigan, 1990
Jurisdiction Co M/Co
Alcona X
Alger X
Allegan X
Alpena X
Antrim X
Arenac X
Baraga X
Barry X
Bay X
Benzie X
Berrien X
Branch X
Calhoun X
Cass X
Charlevoix X
Cheboygan X
Chippewa X
Clare X
Clinton X
Crawford X
Delta X
Dickinson X
Eaton X
Emmet X
Genesee X
Gladwin X
Gogebic X
Grand Traverse X
Gratiot X
Hillsdale X
Houghton X
Huron X
Ingham X
Iona X
Iron X
Isabella X
Jackson X
Kalamazoo X
Kalkaska X
Kent X
Keweenaw X
Lake X
Lapeer X
Leeanau X
Lenawee X
Livingston X
Losco X
Luce X
Mackinac X
Macomb X
Manistee X
Marquette X
Mason X
Mecosta X
Midland X
Minominee X
Missaukee X
Monroe X
Montcalm X
Montmorency X
Muskegon X
Newaygo X
Oakland X
Oceana X
Ogemaw X
Ontonagon X
Osceola X
Oscoda X
Otsego X
Ottawa X
Presque Isle X
Roscommon X
Saginaw X
Sanilac X
Scoolcraft X
Shiawassee X
St. Clair X
St. Joseph X
Tuscola X
Van Buren X
Washtenaw X
Wayne X
Wexford X
Co = County HD
M/Co = Multicounty HD
1MINNESOTA
2Public Helath System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 4,307,000 245,803,000
Population Density (1988) 54.1 69.4
(per/sq.mi.)
Number of Counties 87 3,139
Median Age (1987) 31.5 31.7
Percent Below Poverty Level (1985) 12.6 14.0
(persons)
Percent of Population Rural (1980) 33.0 26.0
Percent of Population White (1980) 96.6 83.1
Percent of Population Non-white (1980) 3.4 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The state constitution and statutes provide authority and
structure for county governments in Minnesota.
Commission Form - (87) - Commission is the basic structure for
county governments. The boards are made up of three, five,
seven, or nine members who are elected from single-member
districts.
Minnesota counties may choose one or more options from the
following five choices:
1. Elected Executive Plan
2. County Manager Plan
3. At-large Chair Plan
4. County Administrator Plan
5. Auditor-Administrator Plan
APPOINTED ADMINISTRATORS - (30) - This is an appointed
position with full administrative powers.
Data for this state were updated November 1990.
AUDITOR-ADMINISTRATOR PLAN - (12) - This involves the
election of an auditor who serves primarily in a fiscal
capacity but also has some administrative responsibilities.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Minnesota Department of Health (MDH), the SHA, is a
free-standing, independent agency. The mission of MDH is to
protect, maintain, and improve the health of citizens of the
state through the development and maintenance of an organized
system of programs and services carried out by both state and
local government with the cooperation of non-governmental
entities.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Commissioner of Health is the Chief Executive Officer for the
SHA. The Commissioner is appointed by the Governor with the
consent of the Senate. There is no requirement for the
Commissioner to be a physician. Selection is to be based on
ability and experience in matters of public health.
Responsibilities of the position include the administration of
the SHA and its offices, establishing standards for community
health boards, and assisting in the development, administration,
and implementation of community health services.
C. State Board of Health/Council
Advisory
Minnesota does not have a State Board of Health or Health
Council. However, it does have an advisory committee called the
State Community Health Services Advisory Committee. The
Committee is composed of representatives from each of the 48
local community health boards. The State Committee is required
by law to meet at least four times a year and provide advice,
consultation, and recommendations to the Commissioner regarding
the development, maintenance, funding and evaluation of community
health services (CHS). The Department relies on the State CHS
Advisory Committee for assistance in making policy and technical
decisions related to the CHS subsidy program and to local public
health in general.
D. Regional/District Health Offices
MDH has seven district offices. The geographic area that these
district offices serve varies from program to program depending
on the service and the population served. In fact district maps
are different for almost every program. The district offices are
staffed with MDH employees. The following is a list of staff
that is housed in a district:
District Representative
District Clerk Typist
District Epidemiologist
Community Environmental Services Consultant
Environmental Field Services Sanitarian/Supervisor
Emergency Medical Services Consultant
Health Facility Evaluator Unit Supervisor
Health Facility Evaluator Administrative Specialist
Health Facility Evaluator Laboratory Specialist
Health Facility Evaluator Nurse Consultant
Health Facility Evaluator Sanitarian Specialist
Mothers and Children Program Consultant
Public Health Nurse Consultant
Quality Assurance and Review Registered Nurse Senior
Quality Assurance and Review Social Worker Senior
Services for Children with Handicaps Nurse Consultant
Services for Children with Handicaps Social Worker
Vision and Hearing Consultant
Women, Infants and Children Program Consultant
Water Supply and Engineering Engineer/Sanitarian/Supervisor
E. State-local Liaison
Shared Organizational Control, Formal Liaison Function
The Local Public Health Act of 1987 (MN stay. 145A) was enacted
to develop and maintain an integrated system of community health
services under local administration and within a system of state
guidelines and standards. The mission of Community Health
Services is to bring people to protect and promote the health of
the general population within a community health service area.
This is accomplished by the prevention of disease, injury,
disability, and preventable death through the promotion of
effective coordination and use of community resources, and by
extending health services into the community. The Community
Health Services Division of MDH serves as the entity with
responsibility for state-local liaison activities. In this role
the Division assists the State CHS Advisory Committee by
coordinating, facilitating, and providing staff support for the
committee. The District Representatives that are assigned to the
district offices work for the Division. They are responsible for
maintaining the regional offices and assisting the community
health boards with administrative questions. The Division also
assigns public health nursing consultants to the regional offices
to provide technical assistance to the 48 community health boards
on matters relating to programs. Other program specialists are
in the regional offices to provide assistance to the community
health boards.
The interaction between state and local public health agencies in
Minnesota may be characterized as shared organizational control.
Under this arrangement local health departments are under the
authority of the SHA as well as the local government and board of
health.
F. Budget
Total FY 1988 Minnesota SHA expenditures were $87,454,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $49,983,000
State Funds $35,675,000
Local Funds 0
Fees and Reimbursements $1,748,000
Other $48,000
3III. Local Public Health Agencies (LPHAs)
A. General
In Minnesota all 87 counties are served by 48 local health
entities. These entities consist of 20 county health
departments, 23 multicounty units and 5 city health departments.
The SHA provides funds to eligible local boards of health through
a formula established in 1987. This formula is a base allocation
of funds equal to or above the 1985 appropriation plus a per
capita allocation of that amount above the 1985 base. The local
match required is now a dollar of local effort for each dollar of
state subsidy.
B. Services Provided
The following information on services provided by local health
departments in Minnesota is derived from a survey conducted by
NACHO during 1989. Forty-six of the 48 local health departments
in Minnesota responded to the survey. Services provided by 70
percent of the local health departments in the state responding
to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 26 ( 56.5%)
2. Morbidity Data 18 ( 39.1%)
3. Reportable Diseases 32 ( 69.6%)
4. Vital Records and Statistics 13 ( 28.3%)
B. Epidemiology/Surveillance
1. Chronic Diseases 20 ( 43.5%)
2. Communicable Diseases 30 ( 65.2%)
II. Policy Development
A. Health Code Dev. and Enforcement 24 ( 52.2%)
B. Health Planning 39 ( 84.8%)
C. Priority Setting 40 ( 87.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 14 ( 30.4%)
2. Health Facility Safety/Quality 7 ( 15.2%)
3. Rec. Facility Safety/Quality 18 ( 39.1%)
4. Other Facility Safety/Quality 5 ( 10.9%)
B. Licensing
1. Health Facilities 3 ( 6.5%)
2. Other Facilities 20 ( 43.5%)
C. Health Education 35 ( 76.1%)
D. Environmental
1. Air Quality 12 ( 26.1%)
2. Hazardous Waste Management 12 ( 26.1%)
3. Individual Water Supply Safety 30 ( 65.2%)
4. Noise Pollution 9 ( 19.6%)
5. Occupational Health and Safety 5 ( 10.9%)
6. Public Water Supply Safety 16 ( 34.8%)
7. Radiation Control 3 ( 6.5%)
8. Sewage Disposal Systems 22 ( 47.8%)
9. Solid Waste Management 18 ( 39.1%)
10. Vector and Animal Control 25 ( 54.3%)
11. Water Pollution 23 ( 50.0%)
E. Personal Health Services
1. AIDS Testing and Counseling 16 ( 34.8%)
2. Alcohol Abuse 8 ( 17.4%)
3. Child Health 44 ( 95.7%)
4. Chronic Diseases 43 ( 93.5%)
5. Dental Health 10 ( 21.7%)
6. Drug Abuse 3 ( 6.5%)
7. Emergency Medical Service 26 ( 56.5%)
8. Family Planning 34 ( 73.9%)
9. Handicapped Children 37 ( 80.4%)
10. Home Health Care 43 ( 93.5%)
11. Hospitals -
12. Immunizations 44 ( 95.7%)
13. Laboratory Services 10 ( 21.7%)
14. Long-term Care Facilities 2 ( 4.3%)
15. Mental Health 13 ( 28.3%)
16. Obstetrical Care 4 ( 8.7%)
17. Prenatal Care 39 ( 84.8%)
18. Primary Care 15 ( 32.6%)
19. Sexually Transmitted Diseases 23 ( 50.0%)
20. Tuberculosis 29 ( 63.0%)
21. WIC 37 ( 80.4%)
C. Local Health Officer
No Local Health Officer
There are no local health officers in Minnesota. The local board
of health is required to appoint an "agent" to act on the board's
behalf, but this agent functions as an administrator rather than
a health officer.
D. Local Board of Health
Policy-making
The governing body of a city or county is responsible for
assuming the duties of a board of health or appointing and
empowering a community health board. One political jurisdiction
may request a neighboring jurisdiction to undertake the
responsibilities of a board of health. Two or more contiguous
counties or city and county combinations may establish a joint
board of health (joint powers board). The board consists of at
least five members appointed by the local governing body(ies).
They are required to meet at least twice a year.
A county or multicounty board of health has responsibility and
power of a board of health for the entire jurisdiction unless a
city board of health is present within the jurisdiction. The
board, under supervision of the Commission, enforces laws,
regulations and ordinances within its jurisdiction and areas of
responsibility.
A community health board has the powers and duties of a board of
health, as well as the general responsibility for development and
maintenance of an integrated system of community health services.
There are currently 48 community health boards in Minnesota.
These boards were initiated to develop and maintain an integrated
system of community health services under local administration
and within a system of state guidelines and standards. Boards of
health may qualify as community health boards if they meet
specific requirements established by law. The following are some
of the requirements: meets requirements specified in sections
145A.09 to 145A.13 of the Local Public Health Act and is eligible
for community health subsidy under section 145A.13; the board
must include within its jurisdiction a population of 30,000 or
more or be composed of three or more contiguous counties; and a
city which meets requirements of law and is eligible for a
community health subsidy. Within a year of the approval of a
community health plan by the commissioner, all other boards of
health within the jurisdiction are generally required to cease to
exist. Some exceptions include: a joint powers agreement; a
delegation agreement; or a jurisdiction which includes a city
with 300,000 or more population. Local community health boards
are required to meet at least three times a year to assist in the
process of community assessment, priority setting, program
planning and budgeting, and other functions related to community
health services activities. They are also required to submit
formal plans every 2 years, submit annual activity reports and to
meet other eligibility requirements established in statute and
rule.
E. Staff
Local health department staffs are employed and supervised by the
jurisdiction that they serve. The number of employees for a
local health department ranges from 1 to 200.
F. Budget
Total FY 1988 LPHA expenditures were $128,537,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $13,230,000
State Funds $16,500,000
Local Funds $40,944,000
Fees and Reimbursements $51,132,000
Other Sources 0
Source Unknown $6,731,000
The SHA reported that these figures include the total amount of
additional local health department monies expended by all local
health departments.
2Minnesota Department of Health, 1990
Governor
Commissioner of Health
Assistant to Commissioner
Health Law
Executive Budget Officer
Office of Health Facility Complaints
Bureau of Administration
Health Information and General Services
Deputy Commissioner
Office of Legal and Policy Affairs
Bureau of Health Delivery Systems
Community Health Services
Health Resources
Health Systems Development
Maternal and Child Health
Bureau of Health Protection
Disease Prevention and Control
Environmental Health
Health Promotion and Education
Public Health Laboratory
2Types of Local Health Departments by Jurisdiction
Minnesota, 1990
Jurisdiction Co C M/Co
Aitkin X
Anoka X
Becker X
Beltrami X
Benton X
Big Stone X
Bloomington X
Blue Earth X
Brown X
Carlton X
Carver X
Cass X
Chippewa X
Chisago X
Clay X
Clearwater X
Cook X
Cottonwood X
Crow Wing X
Dakota X
Dodge X
Douglas X
Edina X
Faribault X
Fillmore X
Freeborn X
Goodhue X
Grant X
Hennepin X
Houston X
Hubbard X
Isanti X
Itasca X
Jackson X
Kanabec X
Kandiyohi X
Kittson X
Koochiching X
Lac qui Parle X
Lake X
Le Sueur X
Lincoln X
Lyon X
Mahonomen X
Marshall X
Martin X
McLeod X
Meeker X
Mille Lacs X
Minneapolis X
Morrison X
Mower X
Murray X
Nicollet X
Nobles X
Norman X
Olmstead X
Otter Tail X
Pennington X
Pine X
Pipestone X
Polk X
Pope X
Ramsey X
Red Lake X
Redwood X
Renville X
Rice X
Richfield X
Rock X
Roseau X
Scott X
Sherburne X
Sibley X
St Louis X
St. Paul X
Stearns X
Steele X
Stevens X
Swift X
Todd X
Traverse X
Wabasha X
Wadena X
Waseca X
Washington X
Watonwan X
Wilkin X
Winona X
Co = County HD
C = City HD
M/Co = Multicounty HD
1MISSISSIPPI
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) * 2,748,786 245,803,000
Population Density (1988) * 57.5 69.4
(per/sq.mi.)
Number of Counties 82 3,139
Median Age (1987) 29.1 31.7
Percent Below Poverty Level (1985) 25.1 14.0
(persons)
Percent of Population Rural (1980) * 52.7 26.0
Percent of Population White (1980) 64.1 83.1
Percent of Population Non-white (1980) 35.9 16.9
Median years of Education (1980) 12.2 12.5
(25 Years of age and over)
B. County Government Structure
Home Rule Authority
Counties are empowered by the state constitution and the
Mississippi Code.
Commission Form - (82) - County governments utilize a five-member
Board of Supervisors, based on the Commission Form of
government. The supervisors, who are the governing body, are
elected from single-member districts. Within this form of
government are two different organizational structures, the Unit
System and the Beat System.
Unit System - (47) - The five supervisors elected from
single-member districts serve as the governing body. It
differs in that administrative functions are placed under
the authority of a county road manager who is appointed by
the board of supervisors. This system includes more
centralization in the area of policy, administrative, and
budgetary affairs. Fourteen of these counties also have
appointed county administrators.
Beat System - (35) - Supervisors in this system have general
authority over the whole county and limited responsibility
Data for this state were updated November 1990. for managing
roads and bridges in their individual districts. Two of these
counties have appointed county administrators.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Mississippi State Department of Health (MSDH) is a
free-standing, independent agency. The mission of the MSDH is to
achieve the best possible health status for the citizens of
Mississippi. This mission incorporates the following goals of
public health:
1. To prevent or control diseases in the most
cost-effective manner possible.
2. To provide protection for the public from threats to
health and safety from several sources:
unsanitary conditions related to
food, drinking water, and sewage,
unnecessary exposure to radiation,
and unsafe and unhealthy conditions
in health care facilities, child
care facilities and the workplace.
3. To promote public policy and individual lifestyles
which will improve the health status of all citizens.
4. To assure access to essential health services for the
state's most vulnerable populations: low income women,
infants and children, the elderly, and the disabled.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The State Health Officer is the Executive Officer for the SHA and
has all authority and responsibility incumbent on the position by
law. The State Health Officer is appointed by the State Board of
Health for a term of 6 years. The appointee must be a physician
with a graduate degree in public health or be a physician who, in
the opinion of the Board, is fitted and equipped to execute the
duties incumbent on the position by law. The State Health
Officer may not engage in the private practice of medicine.
This position has the authority of the board when it is not in
session and is subject to the rules and regulations established
by the State Board of Health.
C. State Board of Health/Council
Policy-making
The State Board of Health consists of 13 members appointed by the
Governor and confirmed by the Senate. Terms of office are 6
years and are staggered so that expirations are spread out. The
members must be engaged professionally in rendering health
services or be consumers of health services and have no financial
conflict of interest. The members must also be knowledgeable in
at least one of the matters of jurisdiction of the board.
The following are some areas of responsibility for the State
Board of Health:
1. To organize the SHA into bureaus and divisions that are
considered necessary and to assign appropriate
functions as required by law.
2. To provide general supervision of the health interest
of the people of the state and to exercise the right,
powers, and duties of those acts which it is authorized
by law to enforce.
3. To establish programs to promote the public health, to
be administered by the State Department of Health.
4. To make and publish all reasonable rules and
regulations necessary to enable it to discharge its
duties and powers and to carry out the purposes and
objectives of its creation.
D. Regional/District Health Offices
The SHA has subdivided the state into nine public health
districts. Each district has an office which has direct line
authority over the local health departments within its
jurisdiction. They also provide support and consultative services.
The offices are staffed by 15 to 25 employees. The staffs usually
include the following positions:
District Health Officer
District Administrator
District Supervisor Nurse
District Environmentalist
District Office System Supervisor
District Secretary
District Social Worker
District Nutritionist
District Programmatic Coordinators (WIC, STD, TB)
E. State-local Liaison
Centralized Organizational Control, Informal Liaison Function
The Office of Field Services serves as a liaison between agency
field staff and the central office and support staff and provides
technical assistance to field and program staff. Office staff is
comprised of a director, a field clerical advisor/consultant, a
field nursing advisor/consultant, and a field administrative
advisor/consultant. The field clerical advisor represents field
clerical staff, the field nursing advisor represents field
nursing staff, and the field administrative advisor represents
district administrators and coordinates monthly district staff
meetings and certain conferences between central office and
district staff. The function of the Office of Field Services
involves several activities:
1. Responding to requests for field visits to identify
problem areas and/or make recommendations for problem
solving.
2. Responding to requests by the program and support staff
as representatives of the field staff.
3. Providing consultation to district staff on matters
such as manpower, budgets, and management.
4. Identifying training needs of field staff and providing
technical assistance to the Office of Staff
Development.
5. Providing consultation to program staff regarding
development and field implementation of services.
6. Providing field staff with pertinent and timely
information that impacts operations, i.e., state
legislative activities, central office activities, and
policy development and implementation.
7. Conducting special assignments and projects at the
request of the State Health Officer, Chief of Special
Staff, District Health Officers, or District
Administrators.
The interaction between state and local public health agencies in
Mississippi may be characterized as centralized organizational
control. Under this arrangement local health departments
function directly under the state's authority.
F. Budget
Total FY 1988 SHA expenditures were $105,899,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $55,247,000
State Funds $19,533,000
Local Funds $8,717,000
Fees and Reimbursements $22,382,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Mississippi has 81 local health departments, consisting of 80
county health departments and 1 multicounty health department.
In some counties there are full-time branches of the main health
department. In addition to the county health departments and
full-time branches, the SHA operates a statewide home health
program through a series of 26 regional offices. The entire
health department system operates under the State Board of Health
and the MSDH through the nine district offices to local health
departments and full-time branches.
State funds are provided to local health departments through a
"Funds Allocation Formula." Through this mechanism the monies
are distributed on the basis of population, poverty level, and
the level of utilization of health department services.
B. Services Provided
The following information on services provided by local health
departments in Mississippi is derived from a survey conducted by
NACHO during 1989. Sixty-four of the 81 local health departments
in Mississippi responded to the survey. Services provided by at
least 70 percent of health departments in the state responding to
the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 24 ( 37.5%)
2. Morbidity Data 31 ( 48.4%)
3. Reportable Diseases 64 (100.0%)
4. Vital Records and Statistics 20 ( 31.3%)
B. Epidemiology/Surveillance
1. Chronic Diseases 62 ( 96.9%)
2. Communicable Diseases 64 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 9 ( 14.1%)
B. Health Planning 8 ( 12.5%)
C. Priority Setting 15 ( 23.4%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 62 ( 96.9%)
2. Health Facility Safety/Quality 40 ( 62.5%)
3. Rec. Facility Safety/Quality 34 ( 53.1%)
4. Other Facility Safety/Quality 30 ( 46.9%)
B. Licensing
1. Health Facilities 13 ( 20.3%)
2. Other Facilities 53 ( 82.8%)
C. Health Education 50 ( 78.1%)
D. Environmental
1. Air Quality 14 ( 21.9%)
2. Hazardous Waste Management 17 ( 26.6%)
3. Individual Water Supply Safety 58 ( 90.6%)
4. Noise Pollution 2 ( 3.1%)
5. Occupational Health and Safety 2 ( 3.1%)
6. Public Water Supply Safety 60 ( 93.8%)
7. Radiation Control 20 ( 31.3%)
8. Sewage Disposal Systems 61 ( 95.3%)
9. Solid Waste Management 29 ( 45.3%)
10. Vector and Animal Control 56 ( 87.5%)
11. Water Pollution 45 ( 70.3%)
E. Personal Health Services
1. AIDS Testing and Counseling 64 (100.0%)
2. Alcohol Abuse 3 ( 4.7%)
3. Child Health 64 (100.0%)
4. Chronic Diseases 64 (100.0%)
5. Dental Health 17 ( 26.6%)
6. Drug Abuse 3 ( 4.7%)
7. Emergency Medical Service 4 ( 6.3%)
8. Family Planning 62 ( 96.9%)
9. Handicapped Children 58 ( 90.6%)
10. Home Health Care 61 ( 95.3%)
11. Hospitals -
12. Immunizations 64 (100.0%)
13. Laboratory Services 58 ( 90.6%)
14. Long-term Care Facilities 1 ( 1.6%)
15. Mental Health 5 ( 7.8%)
16. Obstetrical Care 52 ( 81.3%)
17. Prenatal Care 63 ( 98.4%)
18. Primary Care 31 ( 48.4%)
19. Sexually Transmitted Diseases 64 (100.0%)
20. Tuberculosis 64 (100.0%)
21. WIC 64 (100.0%)
C. Local Health Officer
M.D. Requirement, State Board of Health Appointment
A competent physician may be appointed county health officer for
each county by the State Board of Health or its executive
officer. It is the duty of the county health officer to
administer programs and enforce the public health provisions of
the Mississippi Code and the rules and regulations of the State
Board of Health applicable to the county. The health officer
must report results of investigations to the board of supervisors
and the State Board of Health.
D. Local Board of Health
No Local Boards of Health
E. Staff
The staffs of local health departments are made up of Federal,
state, and locally funded positions, and contract employees.
Some salaries are funded from general fees which are third party
collections. The state and locally funded employees are all
considered to be state employees. The number of staff for a
local health department ranges from 4 to 58.
F. Budget
Total FY 1988 LPHA expenditures were $30,043,000 *. Total FY
1988 United States LPHA expenditures were $3,987,948,000.
Source of Funds
Federal Grants and Contracts $9,449,000
State Funds $5,388,000
Local Funds $8,717,000
Fees and Reimbursements $6,498,000
Other Sources 0
Source Unknown 0
* This figure does not include the following expenditures paid
from the State Central Office Budget for the benefit of local
Public Health Agency clients:
WIC Food (Mississippi has a warehouse distribution center
rather than a voucher system)
Drugs (oral contraceptives, hypertension, and
hemophilia medications)
Hospital Care (sterilizations and high-risk maternity
deliveries)
Children's Medical Program Expenditures
Laboratory Services
2Mississippi State Department of Health, 1990
State Health Officer
District Offices (9)
County Health Departments (82)
State Health Officer's Staff
Bureau of Health Services
Children's Medical Services Division
Reproduction Health Division
Perinatal Services Division
Children's Health Division
Women, Infant and Children Division
Chronic Illness Division
Home Health Division
Bureau of Preventive Health Services
Communicable Disease Control Division
Bureau of Environmental Health
Sanitation Division
Water Supply Division
Safety and Health Division
Radiological Health Division
Bureau of Administrative Services
Finance and Accounts Division
Personnel Division
Bureau of Information Resources
Public Health Statistics Division
Data Administration and Development Division
Data Processing Division
Bureau of Health Resources and Laboratories
Public Health Laboratory Division
Planning and Resource Development Division
Licensure and Certification Division
Child Care and Special Division Licensure
Emergency Medical Services
2Types of Local Health Departments by Jurisdiction
Mississippi, 1990
Jurisdiction Co M/Co
Adams X
Alcorn X
Amite X
Attala X
Benton X
Bolivar X
Calhoun X
Carroll X
Chickasaw X
Choctaw X
Clairborne X
Clarke X
Clay X
Coahoma X
Copiah X
Covington X
De Soto X
Forrest X
Franklin X
George X
Greene X
Grenada X
Hancock X
Harrison X
Hines X
Holmes X
Humphreys X
Issaquena X
Itawamba X
Jackson X
Jasper X
Jefferson X
Jefferson Davis X
Jones X
Kemper X
Lafayette X
Lamar X
Lauderdale X
Lawrence X
Leake X
Lee X
Leflore X
Lincoln X
Lowndes X
Madison X
Marion X
Marshall X
Monroe X
Montgomery X
Neshoba X
Newton X
Noxubee X
Oktibbeha X
Panola X
Pearl River X
Perry X
Pike X
Pontotoc X
Prentiss X
Quitman X
Rankin X
Scott X
Sharkey X
Simpson X
Smith X
Stone X
Sunflower X
Tallahatchie X
Tate X
Tippah X
Tishomingo X
Tunica X
Union X
Walthall X
Warren X
Washington X
Wayne X
Webster X
Wilkinson X
Winston X
Yazoo X
Yolobusha X
Co = County HD
M/Co = Multicounty HD
1MISSOURI
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 5,141,000 245,803,000
Population Density (1988) 74.6 69.4
(per/sq.mi.)
Number of Counties 115 3,139
Median Age (1987) 32.4 31.7
Percent Below Poverty Level (1985) 13.7 14.0
(persons)
Percent of Population Rural (1980) 32.0 26.0
Percent of Population White (1980) 88.4 83.1
Percent of Population Non-white (1980) 11.6 16.9
Median Years of Education (1980) 12.4 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for counties in Missouri are
established by the state constitution and statutes.
Commission Form - (90) - The common structure of government is
the commission consisting of three members with executive and
legislative responsibility. There is one presiding commissioner
who is elected at large for a 4-year term and two associate
commissioners elected from single-member districts for 2-year
terms. The constitution refers to the county government
structure as County Court. The name has been legally changed to
commission but the constitution has not been amended.
The constitution permits two alternate forms of county government
in Missouri: the Township Form and Home Rule Charter.
Township Form - (23) - Counties which operate under this form are
subdivided into 326 townships with each township electing four
officials.
Home Rule Charter - (2) - Counties with more than 85,000
population may frame a county home rule charter. These counties
establish within the charter the specifics of their county
Data for this state were updated November 1990. structure.
Jackson and St. Louis Counties have adopted home rule
charters. Jackson has a nine-member board of legislators and
St. Louis has a seven-member council. Both counties use an
elected county executive. The authorizing legislation for
charter government permits the consolidation of city and county
governments, although none has chosen this option at the present
time. This legislation also designates St. Louis as a city and a
county, thereby causing it to be considered an independent city.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Missouri Department of Health (MDH), the SHA, is a
free-standing, independent agency. It was created in 1985 when
the Division of Health, in the Department of Social Services, was
elevated to a separate cabinet-level Department of Health. The
mission of the Department of Health remains basically unchanged
from that of the first board of health 100 years ago. Personnel
of the Department of Health continue to be dedicated to the
prevention of disease and the promotion of health for the
citizens of the state.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Certificate of Need Program
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
State Health Laboratory
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Director of the MDH is appointed by the Governor, with advice
and consent of the Senate. As the chief executive officer, the
Director is responsible for the managing the Department and the
administering its programs and services. The Director of Health
is also the chief liaison officer of the Department of Health for
joint efforts with other governmental agencies and with private
organizations which conduct or sponsor programs that relate to
public health in Missouri. The Director's office also oversees
public information, information systems, minority health, and
personnel and training.
C. State Board of Health/Council
Advisory
The State Board of Health is made up of seven members appointed
by the Governor with the advice and consent of the Senate.
Statutes specify that three members must be physicians and
surgeons licensed by the state, one member must be a dentist
licensed by the state, and the other three members will be
representatives of those persons, professions, and businesses
which are regulated and supervised by the Department of Health
and the State Board of Health.
Duties and services of the Board of Health include the following:
Advising the director of the MDH regarding the priorities,
policies, and programs of the department;
Reviewing all rules promulgated by MDH;
Reviewing the budget of MDH; and
Advising on administration of the State Hospital Subsidy
Program, and administering the Medical and Osteopathic
Student Loan Program, the Family Practice Residency Program,
and the Student Nurse Loan Repayment Program.
D. Regional/District Health Offices
MDH has divided the state into six geographical areas called
districts. Within these districts are six district and eight
area (branch) offices which provide administrative and
supervisory guidance to county and city health departments.
Responsibilities of the district and area offices include the
following:
Assisting and guiding local health units in planning and
carrying out public health programs;
Providing technical assistance and consultation to county
and city health units;
Planning and conducting programs in areas without a local
health unit or in areas with a local unit which lacks the
personnel or expertise for a specific program; and
Assisting county and city health units with preparation of
budgets and other matters relating to the successful
operation of the unit.
The number of staff for the district offices ranges from 27 to
43. These staff generally include the following positions:
District Administrator
Community Health Nursing Consultants
Sanitarians
Children's Special Health Care Needs Staff
Emergency Medical Technician
Regulator for Bureau of Drugs and Narcotics
Communicable Disease Coordinators
Clerical Staff
Health Educator
Program Staff
AIDS Prevention
Sexually Transmitted Diseases
Women, Infants and Children
Immunization
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The Division of Local Health and Institutional Services provides
the liaison function between the SHA and local health units. The
Division plans, directs and evaluates the programs and operations
of the Section of Local Health Services, Bureau of Community
Health Nursing, Bureau of Primary Care, and the Missouri
Rehabilitation Center located at Mt. Vernon, Missouri. The
services and programs offered by the Division are provided
through the central office by district offices, where guidance
for implementation of these programs takes place. Services
include consultation to local health agencies and evaluation of
services provided by local agencies under contract with MDH.
The MDH has established a Department of Health/Local Health
Department "Partnership Council" for the following purpose:
To facilitate the work of public health in Missouri, the MDH
and local health departments (LHDs) will work in partnership
to seek mutual objectives, understanding, and solutions to
problems.
Responsibilities of the Council include the following:
1. Joint MDH and local health department problem solving
for issues involving LHDs
2. Setting agendas for quarterly LHD administrators'
meetings
3. Reviewing proposed contract and program guidance
changes
4. Establishing technical committees as necessary to
assist in contract and program guideline change review
The Council is composed of nine members nominated in the
following manner and officially recognized by the Department
Director as representing the interests of the metro and rural
health officers:
1. The metro health officers nominate three
representatives and assure that this representation is
geographically balanced.
2. The rural health officers nominate one representative
and one alternate from each of the MDH districts for a
total of six representatives and six alternates.
3. The council elects a chair and vice chair from the
membership. One officer must be a metro health officer
and one must be a rural health officer.
4. Staff support for the Partnership Council will be
provided by the Division of Local Health and
Institutional Services. Council members serve 2-year
terms. Terms are staggered.
The interaction between state and local public health agencies in
Missouri may be characterized as decentralized organizational
control. Under this arrangement, local government directly
operates health departments with or without a local board of
health.
F. Budget
Total FY 1988 Missouri SHA expenditures were $108,825,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $47,211,000
State Funds $50,292,000
Local Funds 0
Fees and Reimbursements $11,322,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
There are 110 local health departments in Missouri. These
consist of 102 county, 4 city, 3 city-county, and 1 multicounty
health departments. Responsibilities of these local units
include the following:
Assess needs of the communities served and plan
appropriate public health services;
Enforce local codes and ordinances related to public health;
Organize and conduct programs for the local area as needed;
and
Under contract, provide mandatory public health programs
imposed upon the MDH by statute and provide other optional
services consistent with local resources.
Counties may choose by referendum to impose a local tax to
support the local health department. Upon passage of the
referendum the county commission appoints an acting five-member
board of trustees to oversee the health department. At a special
election, or the next scheduled election, regular trustees are
elected to fill the positions. In counties that do not have
trustees, the county commission administers the local health
department.
B. Services Provided
The following information on services provided by local health
departments in Missouri is derived from a survey conducted by
NACHO during 1989. One hundred and one of the 110 health
departments in Missouri responded to the survey. Services
provided by 70 percent of health departments in the state
responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 23 ( 22.8%)
2. Morbidity Data 47 ( 46.5%)
3. Reportable Diseases 89 ( 88.1%)
4. Vital Records and Statistics 93 ( 92.1%)
B. Epidemiology/Surveillance
1. Chronic Diseases 61 ( 60.4%)
2. Communicable Diseases 101 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 21 ( 20.8%)
B. Health Planning 57 ( 56.4%)
C. Priority Setting 40 ( 39.6%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 68 ( 67.3%)
2. Health Facility Safety/Quality 33 ( 32.7%)
3. Rec. Facility Safety/Quality 42 ( 41.6%)
4. Other Facility Safety/Quality 21 ( 20.8%)
B. Licensing
1. Health Facilities 7 ( 6.9%)
2. Other Facilities 41 ( 40.6%)
C. Health Education 74 ( 73.3%)
D. Environmental
1. Air Quality 11 ( 10.9%)
2. Hazardous Waste Management 26 ( 25.7%)
3. Individual Water Supply Safety 77 ( 76.2%)
4. Noise Pollution 9 ( 8.9%)
5. Occupational Health and Safety 13 ( 12.9%)
6. Public Water Supply Safety 41 ( 40.6%)
7. Radiation Control 8 ( 7.9%)
8. Sewage Disposal Systems 66 ( 65.3%)
9. Solid Waste Management 26 ( 25.7%)
10. Vector and Animal Control 48 ( 47.5%)
11. Water Pollution 33 ( 32.7%)
E. Personal Health Services
1. AIDS Testing and Counseling 38 ( 37.6%)
2. Alcohol Abuse
3. Child Health 96 ( 95.0%)
4. Chronic Diseases 87 ( 86.1%)
5. Dental Health 51 ( 50.5%)
6. Drug Abuse 9 ( 8.9%)
7. Emergency Medical Service 3 ( 3.0%)
8. Family Planning 58 ( 57.4%)
9. Handicapped Children 26 ( 25.7%)
10. Home Health Care 67 ( 66.3%)
11. Hospitals -
12. Immunizations 99 ( 98.0%)
13. Laboratory Services 26 ( 25.7%)
14. Long-term Care Facilities 1 ( 1.0%)
15. Mental Health 6 ( 5.9%)
16. Obstetrical Care 5 ( 5.0%)
17. Prenatal Care 46 ( 45.5%)
18. Primary Care 12 ( 11.9%)
19. Sexually Transmitted Diseases 62 ( 61.4%)
20. Tuberculosis 90 ( 89.1%)
21. WIC 90 ( 89.1%)
C. Local (County) Health Officer
M.D. Required, County Commission Appointment
Local health officers are required to be physicians. They are
appointed by the local governing body. The health officer is
responsible for managing the local health department and its
programs.
Most counties no longer appoint the traditional county health
officer. The actual "health officer," however, is the
administrator of the health department. This position does not
require a physician. In fact most rural county health
departments do not employ a physician except to provide clinical
services.
D. Local Board of Health
Missouri has no local boards of health. In 81 counties, 5-member
boards of popularly elected trustees administer the local health
department. In other counties the county commissioners oversee
the operation of the health department.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdiction. The number of staff for a
local health department ranges from 1 to 500.
F. Budget
Total FY 1988 LPHA expenditures were $104,477,000 *. Total FY
1988 United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $37,741,000
State Funds $7,145,000
Local Funds $51,271,000
Fees and Reimbursements $8,320,000
Other Sources 0
Source Unknown 0
The SHA reported that there were additional fees and
reimbursements not retained by the local health department, but
which reverted to the general revenues of the local or state
government.
2Missouri Department of Health, 1990
Governor
Board of Health
Missouri Health Facilities Review Committee
State Cancer Commission
Ellis Rachel State Cancer Center
Director
Deputy Director
Local and State Partnership Council
Certificate of Need Program
Personnel and Training Office
Information Systems Office
Public Information Office
Minority Health Office
Governmental Affairs Office
Executive Assistant
Planning Assistant
Chief Counsel
Administration
Internal Audit
Bureau of General Services
Bureau of Financial Services
Bureau of Budget Services
Environmental Health and Epidemiology
State Public Health Lab
Office of Epidemiology
Bureau of Veterinary Public Health
Bureau of AIDS Prevention
Bureau of Environmental Epidemiology
Section of Disease Prevention
Bureau of Sexually Transmitted Diseases
Bureau of Immunization
Bureau of Communicable Disease Control
Bureau of Tuberculosis Control
Bureau of Radiological Health
Bureau of Community Sanitation
Local Health Institutional Services
Missouri Rehabilitation Center
Section of Local Health Services
Local Health Agencies
Bureau of Community Health Nursing
Bureau of Primary Care
Health Resources
Office of Injury Control
State Center for Health Statistics
Bureau of Health Resources Statistics
Bureau of Health Data Analysis
Bureau of Health Services Statistics
Bureau of Vital Records
Bureau of Emergency Medical Services
Bureau of Hospital Licensing & Certification
Bureau of Narcotics and Dangerous Drugs
Bureau of Home Health Licensing & Certification
Maternal, Child, and Family Health
Bureau of Dental Health
Office of Medical Services
Bureau of Special Health Care Needs
Bureau of Perinatal and Child Health
Section of Food and Nutrition Services
Supplemental Food Program
Bureau of Child and Adult Care Food Program
Chronic Disease and Family Health
Section of Food and Health Promotion
Bureau of Health Promotion
Bureau of Smoking, Tobacco, and Cancer
Bureau of High Risk Intervention
2Types of Local Health Departments by Jurisdiction
Missouri, 1990
Jurisdiction Co C C/Co M/Co N/Co
Adair X
Andrew X
Atchison X
Audrin X
Barry X
Barton X
Bates X
Benton X
Bollinger X
Butler X
Caldwell X
Callaway X
Camden X
Cape Girardeau X
Carroll X
Carter X
Cass X
Cedar X
Charlton X
Christian X
Clark X
Clay X
Clinton X
Cole X
Columbia-Boone X
Cooper X
Crawford X
Dade X
Dallas X
Daviess X
DeKalb X
Dent X
Douglas X
Dunklin X
Franklin X
Gasconade X
Gentry X
Grundy X
Harrison X
Henry X
Hickory X
Holt X
Howard X
Howell X
Independence X
Iron X
Jackson X
Jasper X
Jefferson X
Johnson X
Joplin City X
Kansas City X
Knox X
Laclede X
Lafayette X
Lawrence X
Lewis X
Lincoln X
Linn X
Livingston X
Macon X
Madison X
Maries X
Marion X
McDonald X
Mercer X
Miller X
Mississippi X
Moniteau X
Monroe X
Montgomery X
Morgan X
New Madrid X
Newton X
Nodaway X
Oregon X
Osage X
Ozark X
Pemiscot X
Perry X
Pettis X
Phelps X
Pike X
Platte X
Polk X
Pulaski X
Putnam X
Ralls X
Randolph X
Ray X
Reynolds X
Ripley X
Saline X
Schuyler X
Scotland X
Scott X
Shannon X
Shelby X
Springfield-Greene X
St. Charles X
St. Clair X
St. Francis X
St. Joseph-Buchanan X
St. Louis X
St. Louis City X
Ste Genevieve X
Stoddard X
Stone X
Sullivan X
Taney X
Texas X
Vernon X
Warren X
Washington X
Wayne X
Webster X
Worth X
Wright X
Co = County HD
C = City HD
C/Co = City/County HD
M/Co = Multicounty HD
n/Co = No County HD
1MONTANA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 805,000 245,803,000
Population Density (1988) 5.5 69.4
(per/sq.mi.)
Number of Counties 56 3,139
Median Age (1987) 31.3 31.7
Percent Below Poverty Level (1985) 16.1 14.0
(persons)
Percent of Population Rural (1980) 47.0 26.0
Percent of Population White (1980) 94.1 83.1
Percent of Population Non-white (1980) 5.9 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for Montana counties are established
by the state constitution and statutes. Authority for home rule
was established in the 1972 state constitution. There are two
categories of counties in Montana according to whether they have
enacted Home Rule Charter or not. Those that have enacted home
rule are charter counties and those who do not may be considered
general government power counties.
Commission Form - (53) - The general government power counties
have only the authority granted to them by the legislature. They
utilize the Commission Form of government with a three-member
board of commissioners elected from single-member districts or at
large. The commission has all legislative and administrative
responsibility for the county.
Home Rule Charter - (3) - These counties have adopted a charter
that is much like a constitution in that it establishes the
power, rights, and responsibilities of a county. Under a Home
Rule Charter the counties may adopt any form of government except
the Commission Form. The three counties that have adopted a
charter are Petroleum, Deer Lodge, and Silver Bow. Deer Lodge
and Petroleum have appointed county administrators, while Silver
Data for this state were updated November 1990.
Bow has an elected executive. Additionally, Anaconda-Deer Lodge
and Butte-Silver Bow have chosen to consolidate their city and
county governments.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Montana Department of Health and Environmental Sciences
(MDHES), the SHA, is a free-standing, independent agency. The
mission of MDHES is to protect and promote the health of the
people of Montana. In doing so, the Department is charged with
the ability to implement beneficial public health programs and
enforce public health laws and regulations. The Department also
cooperates with local and private sources in determining
Montana's health care needs, developing programs designed to help
meet those needs, and continually evaluating current public
health programs.
Department activities are carried out at the statewide level or
through local health programs. Those activities include a
variety of administrative and regulatory functions for approval,
construction or purchase of certain medical facilities,
inspection and certification of public health care facilities,
inspection and regulation of hazardous materials in the
environment, and administration of a number of Federally funded
health services designed to prevent deterioration of preexisting
health-related disorders.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Health Facility Licensing and Certifying Agency
Food Establishment Licensing Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Director of the Department of Health and Environmental
Sciences is the head of the SHA. The Office of the Director is
responsible for overall management and program support for the
Department, including coordination and provision of policy
development and administration. Additionally, the Director is
responsible for carrying out policy developed with the Governor,
carrying out provisions of relevant statutes passed into law by
the legislature. The Director is appointed by the Governor and
confirmed by the Senate.
C. State Board of Health/Council
Advisory and Policy-making
The Board of Health and Environmental Sciences is a seven-member
board appointed by the Governor. The Board is composed of two
licensed human health professionals, one doctor of veterinary
medicine, and four members with active interest in public health
and the welfare of the state. The board is a quasi-judicial body
that reviews actions on certain Department-issued licenses,
permits and variances. The Board is also authorized to adopt
rules, regulations, and standards for relevant public health
issues. Two primary duties of the Board are to advise the
Department in public health matters, and to hold hearings and
take testimony in matters relating to the duties of the Board.
The Board is also responsible for adopting, amending, and
repealing rules for the administration, implementation, and
enforcement of laws that deal with environmental protection and
public health.
D. Regional/District Health Offices
The state has not been divided down into administrative districts
or regions. A regional office in Billings, however, serves
environmental health and licensing, certification, and
construction program needs in eastern Montana. This office is
staffed by six individuals and functions as an extension of the
central office.
E. State-local Liaison
Decentralized Organizational Control, Informal Liaison Function
The Department of Health and Environmental Sciences has
historically designated the Administrator of the Health Services
Division as liaison to the local health departments. As liaison,
the Administrator works with the Director of the Department in
addressing concerns or matters having to do with all local public
health agencies.
The interaction between state and local public health agencies in
Montana may be characterized as decentralized organizational
control. Under this arrangement the local government directly
operates a health department and may or may not have a local
board of health.
F. Budget
Total FY 1988 Montana SHA expenditures were $27,404,084*. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
* Montana expenditure data were provided by SHA.
Source of Funds
Federal Grants and Contracts $21,496,000
State Funds $3,577,709
Local Funds 0
Fees and Reimbursements $2,330,751
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Montana has 49 local health departments that include 6
city-county and 43 county health departments. Seven counties do
not have health departments and receive public health services
from adjoining counties through a contractual arrangement.
Counties with health departments often contract for additional
public health services from a neighboring county. Public health
nurses and/or sanitarians who are based in one county may provide
services to several nearby counties.
B. Services Provided
The following information on services provided by local health
departments in Montana is derived from a survey conducted by
NACHO during 1989. Twenty-six of the 49 local health departments
in Montana responded to the survey. Services provided by at
least 70 percent of health departments in the state responding to
the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 6 ( 23.1%)
2. Morbidity Data 8 ( 30.8%)
3. Reportable Diseases 22 ( 84.6%)
4. Vital Records and Statistics 8 ( 30.8%)
B. Epidemiology/Surveillance
1. Chronic Diseases 8 ( 30.8%)
2. Communicable Diseases 24 ( 92.3%)
II. Policy Development
A. Health Code Dev. and Enforcement 11 ( 42.3%)
B. Health Planning 13 ( 50.0%)
C. Priority Setting 9 ( 34.6%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 14 ( 53.8%)
2. Health Facility Safety/Quality 12 ( 46.2%)
3. Rec. Facility Safety/Quality 10 ( 38.5%)
4. Other Facility Safety/Quality 7 ( 26.9%)
B. Licensing
1. Health Facilities 3 ( 11.5%)
2. Other Facilities 14 ( 53.8%)
C. Health Education 18 ( 69.2%)
D. Environmental
1. Air Quality 11 ( 42.3%)
2. Hazardous Waste Management 13 ( 50.0%)
3. Individual Water Supply Safety 18 ( 69.2%)
4. Noise Pollution 4 ( 15.4%)
5. Occupational Health and Safety 7 ( 26.9%)
6. Public Water Supply Safety 18 ( 69.2%)
7. Radiation Control 3 ( 11.5%)
8. Sewage Disposal Systems 17 ( 65.4%)
9. Solid Waste Management 16 ( 61.5%)
10. Vector and Animal Control 13 ( 50.0)
11. Water Pollution 17 ( 65.4%)
E. Personal Health Services
1. AIDS Testing and Counseling 13 ( 50.0%)
2. Alcohol Abuse 7 ( 26.9%)
3. Child Health 23 ( 88.5%)
4. Chronic Diseases 15 ( 57.7%)
5. Dental Health 7 ( 26.9%)
6. Drug Abuse 6 ( 23.1%)
7. Emergency Medical Service 7 ( 26.9%)
8. Family Planning 14 ( 53.8%)
9. Handicapped Children 15 ( 57.7%)
10. Home Health Care 16 ( 61.5%)
11. Hospitals 3 ( 11.5%)
12. Immunizations 23 ( 88.5%)
13. Laboratory Services 4 ( 15.4%)
14. Long-term Care Facilities 3 ( 11.5%)
15. Mental Health 5 ( 19.2%)
16. Obstetrical Care 3 ( 11.5%)
17. Prenatal Care 14 ( 53.8%)
18. Primary Care 5 ( 19.2%)
19. Sexually Transmitted Diseases 17 ( 65.4%)
20. Tuberculosis 13 ( 50.0%)
21. WIC 20 ( 76.9%)
C. Local Health Officer
No M.D. Requirement, Local Board of Health Appointment
The local health officer must be a physician or a person with a
master's degree in public health or equivalent and appropriate
experience as determined by MDHES. If the local board fails to
appoint a health officer, MDHES can appoint one for the local
jurisdiction.
Local health officers, operating under the direction of the local
board of health, have responsibility and authority to perform
actions such as make inspections for sanitary conditions, impose
and maintain quarantines, issue orders to remove filth, report
communicable diseases to MDHES, file complaints with the
appropriate court when rules and regulations of the local board
are violated, make quarterly reports of his/her activities, and
notify MDHES of changes in membership of the local board.
D. Local Board of Health
Policy-making
County boards of health consist of the county commissioners and
two members appointed by the commissioners or five persons
appointed by the commissioners. The terms of office are 3 years,
with the terms staggered. City boards of health for first- and
second-class cities consist of five persons appointed by the
governing body. Terms of office are staggered for a period of 3
years. By agreement, county commissioners and the governing body
of a first- or second-class city can form a city-county board of
health. The board consists of one person appointed by the
governing body of each participating city, one person appointed
by the county commissioners, and additional persons appointed by
the governing bodies of the entities involved. Total membership
is five persons with staggered terms of 3 years. Two or more
adjacent counties may unite to create a district board of
health. The governing body of each county and city included in
the district appoints one member. Additional members may be
appointed by mutual agreement of the governing bodies.
Local boards are responsible for appointing a local health
officer, electing officers of the board, employing necessary
staff, adopting bylaws to govern meetings, hold regular meetings,
supervise the destruction and removal of all sources of filth
which cause disease, guard against the introduction of
communicable disease, and supervise inspections of public
establishments for sanitary conditions.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdiction. The number of employees
for a local health department ranges from 1 to 56.
F. Budget
LPHA expenditure data are not available for Montana.
2Montana Department of Helath and Environmental Sciences, 1990
Governor
Director
Deputy Director
Health Services Division
Health Planning Bureau
Licensing, Certification and Construction Bureau
Preventive Health Services Bureau
Emergency Medical Services Bureau
Family/Maternal and Child Health Bureau
Environmental Sciences Division
Air Quality Bureau
Occupational Health Bureau
Water Quality Bureau
Food and Consumer Safety Bureau
Solid and Hazardous Waste Bureau
Centralized Services Division
Support Services Bureau
Chemistry Laboratory Bureau
Records and Statistics Bureau
Public Health Laboratory Bureau
2Types of Local Health Departments by Jurisdiction
Montana, 1990
Jurisdiction Co C/Co N/Co
Beaverhead X
Big Horn X
Blaine X
Broadwater X
Carbon X
Carter X
Cascade City-Co X
Chouteau X
Custer X
Daniels X
Dawson X
Deer Lodge X
Fallon X
Fergus X
Flathead City-Co X
Gallatin X
Garfield X
Glacier X
Golden Valley X
Granite X
Hill X
Jefferson X
Judith Basin X
Lake X
Lewis & Clark X
Liberty X
Lincoln X
Madison X
McCone X
Meagher X
Mineral X
Missoula-City Co X
Mussel Shell X
Park X
Petroleum X
Phillips X
Pondera X
Powder River X
Powell X
Prairie X
Ravalli X
Richland X
Roosevelt X
Rosebud X
Sanders X
Sheridan X
Silver Bow-C Co X
Stillwater X
Sweet Grass X
Teton X
Toole X
Treasure X
Valley X
Wheatland X
Wibaux X
Yellowstone C Co X
Co = County HD
C/Co = City/County HD
N/Co = No County HD
1NEBRASKA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,602,000 245,803,000
Population Density (1988) 20.9 69.4
(per/sq.mi.)
Number of Counties 93 3,139
Median Age (1987) 31.6 31.7
Percent Below Poverty Level (1985) 14.8 14.0
(persons)
Percent of Population Rural (1980) 37.0 26.0
Percent of Population White (1980) 94.9 83.1
Percent of Population Non-white (1980) 5.1 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
In Nebraska the state constitution and legislative acts provide
the legal framework for county governments. The counties exist
to perform the state functions, and their actions are limited to
the authority granted by the legislature. County governments are
either Commission or Township-Supervisor in form.
Commission Form - (66) - Commissions with 3- or 5-member boards
serve as the government for 66 counties.
Township Supervisors - (27) - Township-Supervisors with 7-member
boards function in the other 27 counties. The supervisors and
commissioners actually possess the same authority and
responsibilities and differ in name only. In both situations the
boards function as the legislative and executive bodies for the
county. The primary difference between the two forms of
government is the presence of township governments. These are
established by law and given authority to levy taxes to cover
their expenses.
Data for this state were updated October 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Department of Health, the SHA, is a free-standing,
independent agency. The mission of the Nebraska Department of
Health is to prevent health problems before they occur; to assure
Nebraska's health resources meet minimum acceptable standards,
and to increase both the competence and accessibility of these
health resources; and to collect, analyze, and report to the
people of Nebraska accurate information about the status of their
health and their health resources.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Director of Health is the head of the SHA. This position is
appointed by the Governor and confirmed by the Legislature. The
Director must be a physician and is responsible for the
administration of the Department of Health.
C. State Board of Health/Council
Advisory and Policy-making
The Nebraska Board of Health is made up of 15 members, 2 of which
must be physicians, 1 member each from the dental, veterinary,
civil engineering, pharmaceutical, nursing, optometry, podiatry,
osteopathic, chiropractic, and physical therapy professions. In
addition two members represent the lay public. Board members are
appointed by the Governor and serve 3-year terms.
The board serves in an advisory capacity to the Director and the
Department and in a policy-setting capacity to the Bureau of
Examining Boards.
D. Regional/District Health Offices
Five regional offices are located in Scotts Bluff, North Platte,
Kearney, Norfolk, and Omaha. The service areas of these offices
are not specified and actually vary from program to program.
These offices are staffed by 5 to 15 which include positions such
as the Regional Coordinator, nursing staff, environmental health
personnel, a nutritionist, disease control personnel and clerks.
The regional offices provide those services that are mandated by
state statutes to the counties that do not have health
departments and in some cases in counties that have health
departments. They also provide technical assistance to the local
health departments. The services provided by the offices vary
from site to site with some offering only two or three services
while others have a broader range. The following is a list of
services that different offices provide:
Environmental Health
Public Health Nursing
Health Education/Promotion
Dental Health
Emergency Medical Services
Health Facility Standards
Home Health Care
Communicable Disease Control
Nutrition
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The Director of the Bureau of Health Promotion and Disease
Prevention is responsible for the state-local liaison function.
As liaison the Director functions as a contact between state and
local health agencies to provide technical assistance,
consultation, and advise on budgets and programs. To facilitate
public health programs and activities, the NDH and local health
departments formed the Department of Health/Local Health
Department "Partnership Council." This council works in
partnership to seek mutual objectives, understandings, and
solutions to problems. Local health departments are represented
by the Local Health Director's Group, which functions in an
advisory capacity to the SHA.
The interaction between state and local public health agencies in
Nebraska can be characterized as decentralized organizational
control. Under this arrangement local government directly
operates the local health department and has a local board of
health.
F. Budget
Total FY 1988 Nebraska SHA expenditures were $27,675,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $18,215,000
State Funds $5,186,000
Local Funds 0
Fees and Reimbursements $3,881,000
Other $392,000
3III. Local Public Health Agencies (LPHAs)
A. General
Nebraska has 18 local health departments. These consist of 11
county health departments, 2 city/county health departments, 1
multicounty health department and 4 city health departments. The
multicounty unit is composed of five counties.
B. Services Provided
The following information on services provided by local health
departments in Nebraska is derived from a survey conducted by
NACHO during 1989. Fifteen of the 18 local health departments in
Nebraska responded to the survey. Services provided by at least
70 percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 4 ( 26.7%)
2. Morbidity Data 4 ( 26.7%)
3. Reportable Diseases 7 ( 46.7%)
4. Vital Records and Statistics 3 ( 20.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases 6 ( 40.0%)
2. Communicable Diseases 9 ( 60.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 6 ( 40.0%)
B. Health Planning 9 ( 60.0%)
C. Priority Setting 6 ( 40.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 3 ( 20.0%)
2. Health Facility Safety/Quality 4 ( 26.7%)
3. Rec. Facility Safety/Quality 4 ( 26.7%)
4. Other Facility Safety/Quality 2 ( 13.3%)
B. Licensing
1. Health Facilities -
2. Other Facilities 5 ( 33.3%)
C. Health Education 12 ( 80.0%)
D. Environmental
1. Air Quality 3 ( 20.0%)
2. Hazardous Waste Management 3 ( 20.0%)
3. Individual Water Supply Safety 8 ( 53.3%)
4. Noise Pollution 1 ( 6.7%)
5. Occupational Health and Safety 2 ( 13.3%)
6. Public Water Supply Safety 3 ( 20.0%)
7. Radiation Control 1 ( 6.7%)
8. Sewage Disposal Systems 5 ( 33.3%)
9. Solid Waste Management 5 ( 33.3%)
10. Vector and Animal Control 6 ( 40.0%)
11. Water Pollution 5 ( 33.3%)
E. Personal Health Services
1. AIDS Testing and Counseling 5 ( 33.3%)
2. Alcohol Abuse 1 ( 6.7%)
3. Child Health 11 ( 73.3%)
4. Chronic Diseases 11 ( 73.3%)
5. Dental Health 6 ( 40.0%)
6. Drug Abuse 1 ( 6.7%)
7. Emergency Medical Service 1 ( 6.7%)
8. Family Planning 2 ( 13.3%)
9. Handicapped Children 2 ( 13.3%)
10. Home Health Care 11 ( 73.3%)
11. Hospitals 1 ( 6.7%)
12. Immunizations 12 ( 80.0%)
13. Laboratory Services 3 ( 20.0%)
14. Long-term Care Facilities -
15. Mental Health 2 ( 13.3%)
16. Obstetrical Care 1 ( 6.7%)
17. Prenatal Care 4 ( 26.7%)
18. Primary Care 3 ( 20.0%)
19. Sexually Transmitted Diseases 3 ( 20.0%)
20. Tuberculosis 3 ( 20.0%)
21. WIC 3 ( 20.0%)
C. Local Health Officer
No M.D. Requirement, Board of Health Appointment
The local health officer is the chief administrator of the local
health department. This position is appointed by the local board
of health and approved by the county governing board. Appointees
must be either an M.D. or assisted by at least a part-time
medical advisor.
D. Local Board of Health
Policy-making
Local boards of health are made up of nine members including a
physician, a dentist, a county clerk or school superintendent, a
county commissioner, and five public-spirited citizens. The
board is appointed by the county commissioners for a county board
of health and appointed jointly by city council and county
commissioners when the board of health is for city/county.
State statute gives local boards of health overall responsibility
for the operation of local health departments.
E. Staff
The local jurisdiction is the employer of the staff of a local
health department. The number of staff employed by local health
departments ranges from 1 to 90.
F. Budget
Total FY 1988 LPHA expenditures were $8,690,000 *. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $541,000
State Funds 0
Local Funds* $8,000,000
Fees and Reimbursements $149,000
Other Sources 0
Source Unknown 0
2Nebraska Department of Health, 1990
Director of Health
Public Information
Legal Services
State Board of Health
Assistant to the Director
Deputy Director
Bureau of Examining Boards
Medical and Medical Support Professions
Nursing and Specialized Medical Professions
Rehabilitation Professions
Behavioral and Social Services Professions
Investigations and Enforcement
Bureau of Health Facilities Standards
Southeast Region
Northeast Region
Central Region
Western Region
Developmental Disabilities Facilities
Licensing and Training
Bureau of Environmental Health
Asbestos Control Division
Housing and Recreational Vehicles Division
Drinking Water and Environmental Sanitation Division
Radiological Health
Bureau of Administrative Services
Accounting
Budget
Personnel
Western R/O
Deputy Director
Laboratory Services
Epidemiology
Bureau of Health Planning and Data Management
Health Data Systems
Health Policy and Planning
Vital Statistics
Section of Hospital and Medical Facilities
Bureau of Family Health Services
Maternal and Child Health
Nutrition
Developmental Disabilities Planning
Dental Health
Community Health Nursing
Bureau of Health Promotion and Disease Prevention
Health Promotion and Education
Disease Control
Emergency Medical Services
Local Health Departments
Chronic Disease
2Types of Local Health Departments by Jurisdiction
Nebraska, 1990
Jurisdiction Co C C/Co M/Co N/Co
Adams X
Antelope X
Arthur X
Banner X
Blaine X
Boone X
Box Butte X
Boyd X
Brown X
Buffalo X
Burt X
Butler X
Cass X
Cedar X
Chase X
Cherry X
Cheyenne X
Clay X
Colfax X
Cuming X
Custer X
Dakota X
Dawes X
Dawson X
Deuel X
Dixon X
Dodge X
Douglas X
Dundy X
Fillmore X
Franklin X
Frontier X
Furnas X
Gage X
Garden X
Garfield X
Gosper X
Grand Isle-Hall X
Grant X
Greeley X
Hamilton X
Harlan X
Hastings X
Hayes X
Hitchcock X
Hooker X
Howard X
Jefferson X
Johnson X
Kearney X
Kearney X X
Keith
Keya Paha X
Kimball X
Knox X
Lincoln-Lancast X
Logan X
Loup X
Madison X
McPherson X
Merrick X
Morrill X
Nance X
Nemaha X
Norfolk X
Nuckolls X
Otoe X
Pawnee X
Perkins X
Phelps X
Pierce X
Platte X
Polk X
Red Willow X
Richardson X
Rock X
Saline X
Sarpy X
Saunders X
Scotts Bluff X
Seward X
Sheridan X
Sherman X
Sioux X
Stanton X
Thayer X X
Thomas
Thurston X
Valley X
Washington X
Wayne X
Webster X
Wheeler X
York X
Co = County HD C = City HD C/Co = City/County HD M/Co =Multico HD
1NEVADA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,054,000 245,803,000
Population Density (1988) 9.6 69.5
(per/sq.mi.)
Number of Counties 17 3,139
Median Age (1987) 31.9 31.7
Percent Below Poverty Level (1985) 14.4 14.0
(persons)
Percent of Population Rural (1980) 15.0 26.0
Percent of Population White (1980) 87.5 83.1
Percent of Population Non-white (1980) 12.5 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
Nevada counties derive their authority from the state
constitution, Nevada Revised Statutes and case law developed by
state and Federal courts.
Commission Form - (17) - All counties use the Commission Form of
government, with boards of three, five, or seven-members. The
members are elected at large from single-member districts.
Commissioners are permitted to appoint a county manager, and six
counties have chosen to employ one.
City-County Consolidation - (1) - City-county consolidations
are permitted, and Carson City-Ormsby County have merged.
This entity is considered an independent city by the U.S.
Census Bureau. A Commission Form of government with an
appointed city manager is used.
Data for this state were updated October 1990. II. State Health Agency (SHA)
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Nevada Health Division, the SHA, is a component of a
superagency named the Department of Human Resources. The mission
of the State Health Division is to promote and protect the health
of Nevadans and visitors to the state.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The administrator is the head of the SHA. The administrator is
appointed by the Director of the Department of Human Resources
with consent of the Governor. To qualify for appointment as
administrator an individual must have had 2 years' experience, or
the equivalent, as the administrator of: (1) a full-time county
or city health facility or department, or (2) a major health
program at a state or national level. The administrator is
responsible for management of the SHA and its programs.
The State Health Officer is a separate position with
responsibility in the Department. The State Health Officer is
the senior medical public health advisor in the state. The State
Health Officer is appointed by the Director of the Department.
To qualify, the State Health Officer must be a citizen of the
United States, be certified or eligible for certification by the
American Board of Preventive Medicine and be licensed or eligible
for licensure, as a doctor of medicine to practice in Nevada.
The State Health Officer shall enforce all laws and regulations
pertaining to public health and investigate the causes of
disease, epidemics, source of mortality, and nuisances affecting
public health.
C. State Board of Health/Council
Policy-making
The Nevada Board of Health is composed of seven members,
appointed by the Governor. Two of the members must be physicians
licensed to practice medicine for at least 5 years. The State
Board of Health is the supreme policy-making body for the State
Health Department.
D. Regional/District Health Offices
The health department does not divide the state into
administrative districts or regions. There are two locally
administered district health departments (Washoe and Clark
Counties) organized in accordance with applicable state statutes
and local ordinances.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
There is no single office or individual who is responsible for
the liaison between the SHA and local health units.
Communications usually flow through the normal chain of command.
The interaction between state and local public health agencies in
Nevada may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement
local health services may be provided by the SHA in all rural
jurisdictions and local governmental units, boards of health or
health departments in other jurisdictions.
F. Budget
Total FY 1988 Nevada SHA expenditures were $20,050,000. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $9,560,000
State Funds $8,802,000
Local Funds 0
Fees and Reimbursements $1,688,000
Other $877,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 15 local health departments in Nevada. These include
two autonomous, full-service health districts located in Reno
(Washoe County) and Las Vegas (Clark County) and 13 county
entities where public health services are provided by field
offices of the SHA. These offices are administered, supervised,
and funded by the SHA. Esmeralda and Eureka counties, two of the
smaller and more sparsely populated counties, do not have field
offices but receive public health services from field offices in
adjacent counties.
B. Services Provided
The following information on services provided by local health
districts is derived from a survey conducted by NACHO during
1989. Both of the full-service local health departments in
Nevada responded to the survey.
Services Provided by LPHAs Number of LPHAs
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 1
2. Morbidity Data 2
3. Reportable Diseases 2
4. Vital Records and Statistics 2
B. Epidemiology/Surveillance
1. Chronic Diseases 1
2. Communicable Diseases 2
II. Policy Development
A. Health Code Dev. and Enforcement 2
B. Health Planning 2
C. Priority Setting 2
III. Assurance Activities
A. Inspection
1. Food and Milk Control 2
2. Health Facility Safety/Quality 1
3. Rec. Facility Safety/Quality 2
4. Other Facility Safety/Quality 1
B. Licensing
1. Health Facilities -
2. Other Facilities 2
C. Health Education 1
D. Environmental
1. Air Quality 2
2. Hazardous Waste Management 2
3. Individual Water Supply Safety 2
4. Noise Pollution 1
5. Occupational Health and Safety -
6. Public Water Supply Safety 2
7. Radiation Control -
8. Sewage Disposal Systems 2
9. Solid Waste Management 2
10. Vector and Animal Control 2
11. Water Pollution 2
E. Personal Health Services
1. AIDS Testing and Counseling 2
2. Alcohol Abuse -
3. Child Health 2
4. Chronic Diseases 1
5. Dental Health -
6. Drug Abuse 1
7. Emergency Medical Service 2
8. Family Planning 2
9. Handicapped Children 1
10. Home Health Care 2
11. Hospitals -
12. Immunizations 2
13. Laboratory Services 1
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care 1
18. Primary Care -
19. Sexually Transmitted Diseases 2
20. Tuberculosis 2
21. WIC 2
C. Local Health Officer
No M.D. Requirement, Local Governing Body Appointment
Local health officers in the counties with autonomous health
departments are not required to be physicians. They are
appointed by the local governing body. The health officers are
responsible for managing the local health departments and public
health programs.
D. Local Board of Health
Only the two autonomous health districts have boards of health.
E. Staff
The staffs of the two autonomous local district health
departments are employed and supervised by the local
jurisdiction. The number of employees for the department in
Las Vegas is 190 and the one in Reno is 125. The county units
that are funded by the SHA are part of the State system and the
staffs are state employees.
F. Budget
Total FY 1988 LPHA expenditures were $14,728,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $6,263,000
State Funds $1,870,000
Local Funds $3,414,000
Fees and Reimbursements $3,084,000
Other Sources $97,000
Source Unknown 0
The SHA reported that these figures include the total amount of
additional monies expended by all local health departments.
2Nevada State Health Division, 1990
Director Department of Human Resources
State Health Officer
Communicable Disease
Laboratory
Special Children's Clinic
Epidemiology
Administrator
Administrative Services
Personnel
Financial Management
State Board of Health
Laboratory Advisory Board
Bureau Regulatory Health
Consumer Health Protection
Radiological Material
Low-Level Waste
Health Facilities
Administrative Services Officer
Vital Statistics
Cancer Registry
Systems Analyst
Emergency Medical Services
Personnel
Business Office
Maternal and Child Health
Metabolic Screening
Health Education
Genetic Services
Children's Special Health Care
Evaluations
Medical Payments
Primary Care
Community Health Services
Family Planning
Nursing
Women Infants and Children/Nutrition Program
2Types of Local Health Departments by Jurisdiction
Nevada, 1990
Jurisdiction Co C N/Co
Carson City X
Churchill X
Clark X
Douglas X
Elko X
Esmeralda X
Eureka X
Humboldt X
Lander X
Lincoln X
Lyon X
Mineral X
Nye X
Pershing X
Storey X
Washoe X
White Pine X
Co = County HD
C = City HD
N/Co = No County HD
1NEW HAMPSHIRE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,085,000 245,803,000
Population Density (1988) 120.6 69.4
(per/sq.mi.)
Number of Counties 10 3,139
Median Age (1987 31.9 31.7
Percent Below Poverty Level (1985) 6.0 14.0
(persons)
Percent of Population Rural (1980) 48.0 26.0
Percent of Population White (1980) 98.9 83.1
Percent of Population Non-white) (1980) 1.1 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and function of county governments in New Hampshire
are established by the state constitution and statutes.
Commission Form - (10) - All county governments are based on the
this form of government. Each county uses two governing bodies,
the board of commissioners and county delegation. Both bodies
are made up of three-member boards which are elected from
single-member districts. The county commissioners provide
administrative and budgetary control over the county government,
while the county delegation is responsible for appropriating
necessary funds for the county to function. Additionally,
counties may appoint a county administrator. All except one
county has chosen this option.
Home rule authority for New Hampshire counties exists, but no
counties have exercised this option. In another option, voters
may petition for a charter commission to study and recommend a
charter to meet the functional and structural needs of the
county. This procedure has not been used by any counties at the
current time.
For public health purposes and other governmental concerns, the
primary units of government are city or town.
Data for this state were updated January 1991. II. State Health Agency (SHA)
3II. State Health Agency (SHA)
A. General
Component of Superagency
The State Division of Public Health Services is one of five
divisions in the New Hampshire Department of Health and Human
Services (NHDHHS) and is therefore a component of a superagency.
The SHA has no relationship with the counties and they, except
for the operation of county nursing homes, have no public health
functions.
The mission of the NHDHHS is to provide the opportunities and
conditions necessary for people, individually and collectively,
to achieve and/or maintain their health in a safe environment.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
State Professions Licensing Agency
Institutional Licensing Agency
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The Division Director, who is required by state law to be a
physician licensed or eligible for licensure in the state with at
least 5 years' experience in public health, is responsible to the
Department Commissioner who, in turn, is responsible to the
Governor.
The Director's staff is responsible for coordination and
development of services, management oversight, planning, and
policy establishment. Crisis response and public information
services are also the responsibility of the Director.
C. State Board of Health/Council
There is no health council or board for the Division of Public
Health Services.
D. Regional/District Health Offices
The NHDHHS has not divided the state into administrative regions
or districts.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The Chief of the Bureau of Environmental Services has been
designated by the SHA as the state-local liaison. In this role
the Chief acts as a focal point for communications between the
state and local health departments. This role developed because
of the frequent communications that occur between the state and
local health agencies in the important environmental area. The
legal coordinator for the SHA also has frequent communications
with local health departments.
The interaction between state and local public health agencies in
New Hampshire may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement
local health services may be provided by the SHA in some
jurisdictions and by local governmental units, boards of health,
or health departments in other jurisdictions.
F. Budget
Total FY 1988 New Hampshire SHA expenditures were $23,024,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $12,075,000
State Funds $9,416,000
Local Funds 0
Fees and Reimbursements $975,000
Other $557,000
3III. Local Public Health Agencies (LPHAs)
A. General
New Hampshire has 13 local health departments, all of which are
city health departments. Only two of the health departments
provide a wide range of services, but neither fulfill the
complete roles usually ascribed to such entities. Each city/town
has a health officer, responsible under law for certain
health-related issues, primarily in the public sanitation
sector. Each township is required to have a board of health.
Cities, under state law, are "self-regulating." This means that
the state, for public health purposes, has no oversight or
regulatory responsibilities.
B. Services Provided
The following information on services provided by local health
departments in New Hampshire is derived from a survey conducted
by NACHO during 1989. All 13 local health departments in New
Hampshire responded to the survey. Services provided by at least
70 percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 1 ( 7.7%)
2. Morbidity Data 1 ( 7.7%)
3. Reportable Diseases 7 ( 53.8%)
4. Vital Records and Statistics 3 ( 23.1%)
B. Epidemiology/Surveillance
1. Chronic Diseases 2 ( 15.4%)
2. Communicable Diseases 6 ( 46.2%)
II. Policy Development
A. Health Code Dev. and Enforcement 12 ( 92.3%)
B. Health Planning 3 ( 23.1%)
C. Priority Setting 4 ( 30.8%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 10 ( 76.9%)
2. Health Facility Safety/Quality 5 ( 38.5%)
3. Rec. Facility Safety/Quality 8 ( 61.5%)
4. Other Facility Safety/Quality 7 ( 53.8%)
B. Licensing
1. Health Facilities 3 ( 23.1%)
2. Other Facilities 11 ( 84.6%)
C. Health Education 5 ( 38.5%)
D. Environmental
1. Air Quality 5 ( 38.5%)
2. Hazardous Waste Management 8 ( 61.5%)
3. Individual Water Supply Safety 8 ( 61.5%)
4. Noise Pollution 5 ( 38.5%)
5. Occupational Health and Safety 7 ( 53.8%)
6. Public Water Supply Safety 8 ( 61.5%)
7. Radiation Control 1 ( 7.7%)
8. Sewage Disposal Systems 12 ( 92.3%)
9. Solid Waste Management 6 ( 46.2%)
10. Vector and Animal Control 9 ( 69.2%)
11. Water Pollution 12 ( 92.3%)
E. Personal Health Services
1. AIDS Testing and Counseling 2 ( 15.4%)
2. Alcohol Abuse 1 ( 7.7%)
3. Child Health 3 ( 23.1%)
4. Chronic Diseases 1 ( 7.7%)
5. Dental Health 2 ( 15.4%)
6. Drug Abuse 1 ( 7.7%)
7. Emergency Medical Service -
8. Family Planning -
9. Handicapped Children 1 ( 7.7%)
10. Home Health Care 3 ( 23.1%)
11. Hospitals -
12. Immunizations 4 ( 30.8%)
13. Laboratory Services -
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care -
18. Primary Care 1 ( 7.7%)
19. Sexually Transmitted Diseases 2 ( 15.4%)
20. Tuberculosis 2 ( 15.4%)
21. WIC 1 ( 7.7%)
C. Local Health Officer
No M.D. Requirement, Director of Division of Public Health
Services Appointment
Local town health officers are nominated by the Boards of
Selectmen and are appointed by the Director of NHDHHS. Few
receive any salary and many are part-time with no public health
services background.
City health officers are usually better trained and most have
some staff available to them.
D. Local Board of Health
Policy-making
By state law, towns (but not cities), may have a board of
health. In operation, such boards are the Board of Selectmen.
They play no direct role in the delivery of public health
services.
E. Staff
The staffs of local health department are employed and supervised
by the local jurisdiction. The number of employees for a local
health department ranges from 1 to 39.
F. Budget
Total FY 1988 LPHA expenditures were $57,000. Total FY 1988 LPHA
expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $29,000
State Funds $28,000
Local Funds 0
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
These expenditures represent funds provided to two cities through
contracts with the SHA.
2New Hampshire Division of Public Health Services, 1990
Director
Deputy Director
Board of Nursing
Health Services Planning and Review Board
Office of Family and Community Health
Bureau of Maternal and Child Health
Bureau of Dental Health Services
Bureau of Special Medical Services
Bureau of WIC Nutrition Services
Office of Health Promotion
Bureau of Health Promotion
Bureau of Emergency Medical Services
Bureau of Child Care Standards and Licensing
Bureau of Health Facilities Administration
Office of Environmental Health and Hazard Assessment
Bureau of Environmental Health
Bureau of Radiological Health
Bureau of Health Risk Assessment
Office of Disease Prevention and Control
Bureau of Disease Control
Public Health Laboratories
2Types of Local Health Departments by Jurisdiction
New Hampshire, 1990
Jurisdiction C N/Co
Amherst X
Belknap X
Berlin X
Carroll X
Cheshire X
Claremont X
Concord X
Coos X
Dover X
Grafton X
Hillsborough X
Keene X
Merrimack X
Nashua X
Portsmouth X
Rochester X
Rockingham X
Salem X
Somerworth X
Stafford X
Sullivan X
C = City HD
N/Co = No County HD
1NEW JERSEY
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 7,721,000 245,803,000
Population Density (1988) 1,033.9 69.4
(per/sq.mi.)
Number of Counties 21 3,139
Median Age (1987) 34.1 31.7
Percent Below Poverty Level (1985) 8.3 14.0
(persons)
Percent of Population Rural (1980) 11.0 26.0
Percent of Population White (1980) 83.2 83.1
Percent of Population Non-white (1980) 16.8 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for county governments in New Jersey
are established by the constitution and statutes. Non-Charter
and Optional Charter Status are two forms of county government
that are permitted in New Jersey.
Non-Charter Option - (15) - This form of government has
legislative and administrative responsibilities that are under a
three-, five-, seven-, or nine-member Board of Freeholders who
are elected from single-member districts. Thirteen of these
counties have chosen to appoint an administrator to assist the
board with administrative duties.
Optional Charter Form - (6) - This form of government has been
adopted by six counties. Legislation authorizing the Charter
Form of government provides for the separation of legislative and
administrative powers within the counties. Executive authority
in these counties resides with an independently elected or
appointed official. Legislative responsibility is given to a
Board of Freeholders made up of five, seven, or nine members who
are elected from single-member districts, at large, or by a
combination of methods. Additionally, the Board of Freeholders
Data for this state were updated November 1990. elects one member
to serve as freeholder director for a 1-year term. This individual
has authority to appoint committees and boards and serves as a
member of other county boards. The two optional government structures
listed below are being used by charter counties.
County Executive Plan - (5) - This plan provides for a strong
elected chief executive officer with veto power and authority for
administration, budget, and appointments.
Board President Plan - (1) - With this option the board appoints
a county manager who has executive powers except for the power of
veto.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The SHA is the New Jersey Department of Health (NJDH). It is a
free-standing, independent agency. The current mission statement
in the Department's 1990 planning document reads as follows:
To execute legislative mandates, within the budget provided, to
assure the health and well being of New Jersey's citizens. The
Department's mission is achieved through programs designed to:
Collect vital statistics and other health data necessary to
determine the prevalence and cause of disease.
Prevent and control communicable and environmental diseases
through detection, unique diagnostic laboratory services,
immunization and other environmental health and public
health services.
Ensure public access to quality health care services
provided at a reasonable cost.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Commissioner of Health is the chief administrative officer of
the NJDH. The Commissioner is appointed by the Governor with
advice and consent of the Senate, and serves at the pleasure of
the Governor. There is a requirement that the Commissioner be a
licensed physician who is a graduate of a regularly chartered and
legally constituted medical school or college. The Commissioner
must also have skill in sanitary science, and have at least 5
years of full-time experience in an administrative or executive
capacity in a public health agency or 10 years of full-time
experience in community medical service. Responsibility of the
Commissioner includes the adoption of regulations governing the
internal management of the Department; administering the work of
the Department and laws under its jurisdiction; and enforcing
those laws through legal proceedings.
C. State Board of Health/Council
Policy-making
New Jersey has an eight-member Public Health Council that is
appointed by the Governor with the advice and consent of the
State Senate. The members are appointed with due regard for
their knowledge and interest in public health. Two members are
to be licensed physicians and one member must be a licensed
dentist. The terms of office are 7 years, but the original
appointments were made so that at least one member's term expires
each year. The chairman is elected by the members and serves in
this capacity for 1 year or until a successor is elected. The
Council has the power, by majority vote of the members, to
establish, amend, and repeal sanitary regulations that are
necessary to preserve and improve the public health in the
state. Other duties of the Public Health Council include:
requesting from the Commissioner any information concerning the
work of the department that they consider necessary; consider any
matter relating to the preservation and improvement of public
health and advise the Commissioner on these matters; submit to
the Commissioner any recommendations which it deems necessary for
proper conduct of the department; study and investigate public
health activities of the state and report to the Governor and
legislature.
There are a number of additional mandated boards, councils,
commissions, authorities, and other bodies which relate to the
NJDH, including these: the Drug Utilization Review Council; the
Health Care Administration Board; the Health Care Facilities
Financing Authority; the Hospital Rate Setting Commission; and
the Statewide Health Coordinating Council. Appointments to these
bodies are usually made by the Commissioner of Health or the
Governor. The members usually serve without compensation.
D. Regional/District Health Offices
In 1984 the Office of Local Health and Regional Operations was
consolidated into a centralized unit and renamed Local Health
Development Services. Presently all dealings with local health
departments are through the central office. A northern region
health office does exist which houses immunization, refugee
health, communicable disease, substance abuse programs, AIDS,
health facility inspections, sexually transmitted diseases, and
tuberculosis. The regional office staff provide consultation
support to the local health departments and do not provide direct
patient services through the regional office. Supervision for
program staff located in the regional office comes directly from
program chiefs in the central offices in Trenton.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The Local Health Development Unit is the Department's liaison
with local health departments. It has been structured to address
the diverse needs of local health departments with special
liaison positions to the activities mandated in minimum standards
which are found in other divisions of the Department. This unit
serves as the primary communication point for local health
departments and the NJDH. Categorical funding for local health
departments is provided through categorical programs.
The interaction between state and local public health agencies in
New Jersey may be characterized as decentralized organizational
control. Under this arrangement, local government directly
operates health departments with or without a local board of
health.
F. Budget
Total FY 1988 SHA expenditures were $196,235,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $82,620,000
State Funds $83,606,000
Local Funds 0
Fees and Reimbursements $6,925,000
Other $23,085,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are 113 operating local health jurisdictions in New
Jersey. These jurisdictions include 15 county health
departments, 19 city health departments, and 79 town/township
health departments (6 of the township units represent multiple
townships that have formed associations called Regional Health
Commissions to provide public health services). Under State
statutes, local boards of health have the following options of
delivery of services to meet minimum standards: local health
department; county health department; interlocal contract; or
regional health commission.
B. Services Provided
The following information on services provided by local health
departments in New Jersey is derived from a survey conducted by
NACHO during 1989. One hundred and one of the 113 local health
departments in New Jersey responded to the survey. Services
provided by at least 70 percent of health departments in the
state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 49 ( 48.5%)
2. Morbidity Data 66 ( 65.3%)
3. Reportable Diseases 91 ( 90.1%)
4. Vital Records and Statistics 86 ( 85.1%)
B. Epidemiology/Surveillance
1. Chronic Diseases 82 ( 81.2%)
2. Communicable Diseases 98 ( 97.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 95 ( 94.1%)
B. Health Planning 79 ( 78.2%)
C. Priority Setting 76 ( 75.2%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 99 ( 98.0%)
2. Health Facility Safety/Quality 66 ( 65.3%)
3. Rec. Facility Safety/Quality 89 ( 88.1%)
4. Other Facility Safety/Quality 84 ( 83.2%)
B. Licensing
1. Health Facilities 24 ( 23.8%)
2. Other Facilities 88 ( 87.1%)
C. Health Education 95 ( 94.1%)
D. Environmental
1. Air Quality 86 ( 85.1%)
2. Hazardous Waste Management 86 ( 85.1%)
3. Individual Water Supply Safety 86 ( 85.1%)
4. Noise Pollution 86 ( 85.1%)
5. Occupational Health and Safety 91 ( 90.1%)
6. Public Water Supply Safety 77 ( 76.2%)
7. Radiation Control 48 ( 47.5%)
8. Sewage Disposal Systems 85 ( 84.2%)
9. Solid Waste Management 84 ( 83.2%)
10. Vector and Animal Control 99 ( 98.0%)
11. Water Pollution 93 ( 92.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 23 ( 22.8%)
2. Alcohol Abuse 34 ( 33.7%)
3. Child Health 98 ( 97.0%)
4. Chronic Diseases 92 ( 91.1%)
5. Dental Health 42 ( 41.6%)
6. Drug Abuse 31 ( 30.7%)
7. Emergency Medical Service 12 ( 11.9%)
8. Family Planning 20 ( 19.8%)
9. Handicapped Children 17 ( 16.8%)
10. Home Health Care 42 ( 41.6%)
11. Hospitals 6 ( 5.9%)
12. Immunizations 100 ( 99.0%)
13. Laboratory Services 57 ( 56.4%)
14. Long-term Care Facilities 8 ( 7.9%)
15. Mental Health 17 ( 16.8%)
16. Obstetrical Care 12 ( 11.9%)
17. Prenatal Care 41 ( 40.6%)
18. Primary Care 12 ( 11.9%)
19. Sexually Transmitted Diseases 70 ( 69.3%)
20. Tuberculosis 75 ( 74.3%)
21. WIC 59 ( 58.4%)
C. Local Health Officer
No M.D. Requirement, Local Governing Body Appointment
State law mandates that each local health department be
administered by a full-time licensed health officer. Health
officers are appointed by the governing bodies of the
jurisdictions that employ them. The health officer functions as
the chief administrative officer of the board or authority, and
is accountable to the board or authority. The health officer, as
authorized by the board or authority, is the responsible agent
for all public health services and activities of the local health
agency and shall: direct and supervise all employees of the
local health department; plan, manage and implement the
programmatic components of the local health agency and prepare
the budget; develop and maintain a system of evaluation for all
public health services and activities of the local health
department. The health officer shall also maintain
administrative relationships and communication with support
services and community resources such as hospitals, emergency
medical services providers, government agencies, voluntary
organizations and other health care providers to promote
inter-agency cooperation and effective allocation of health
resources; enforce all public health laws, regulations, and
ordinances and ensure appropriate disposition of all enforcement
action; provide for open lines of communication within the
organization; develop a referral directory and implement a
referral log for health services provided by other agencies to
community residents; oversee the completion of the Community
Health Profile and the implementation of the Local Health Service
Plan as requested by the NJDH; determine and define the health
needs and priorities of the community based upon analyses and
interpretation of health statistics and other pertinent
information; and maintain proper records in accordance with the
local health agency records' retention schedule as promulgated by
the New Jersey Department of Education, Bureau of Archives and
History.
D. Local Board of Health
Policy-making
In New Jersey every municipality is required and other
jurisdictions are permitted to establish a board of health. The
boards are similar in some aspects such as the term of office,
usually staggered and not to exceed 5 years, but other aspects of
the boards vary with the jurisdiction. The following are some of
the variations:
County Board of Health - The board of freeholders may serve or
may appoint a board of health. If a board of health is
appointed, it will consist of at least five but no more than nine
members. Not more than two of the members will be members of the
freeholders' board.
Township Board of Health (townships under 20,000 population) -
The board is made up of members of the township committee, the
township assessor, the township clerk, and one physician
appointed by the township board.
Township Board of Health (townships over 20,000 population) - The
board is composed of five to seven members appointed in the same
manner as the township committee.
Municipality Board of Health - The board is composed of five to
seven members appointed by the governing body.
Municipality Board of Health (Municipality over 80,000 population
but not first class city) - The board is composed of 5 to 10
members appointed by the mayor.
First Class City Board of Health - The board contains 10 members
appointed by the mayor. Members must be citizens of the city.
At least half of the members must be physicians and not more than
one-half can be from the same political party.
Local boards of health possess broad, general powers to enact
ordinances and to make rules and regulations in the interest of
protecting and improving public health.
E. Staff
Local health department staffs are employed and supervised by the
local jurisdiction. The number of employees for local health
departments ranges from 1 to 225.
F. Budget
Total FY 1988 LPHA expenditures were $89,644,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $10,842,000
State Funds $15,989,000
Local Funds $57,725,000
Fees and Reimbursements 0
Other Sources $5,088,000
Source Unknown 0
The SHA reported that these figures include the amount of
additional local health department monies expended by all local
health departments.
2New Jersey State Department of Health, 1990
Commissioner of Health
Chief of Staff
Assistant Commissioner, Management and Administration
Director, Office of Legal Services
Director of Communications
Director, Office of Governmental Relations
Deputy Commissioner
Assistant Commissioner, Epidemiology and Disease Control
Assistant Commissioner, Occupational and Environmental
Health
Assistant Commissioner, Public Health and Environmental Labs
Deputy
Assistant Commissioner, Alcohol and Drug Abuse
Assistant Commissioner, AIDS Prevention and Control
Assistant Commissioner, Community Health Services
Deputy Commissioner
Assistant Commissioner, Health Facilities Evaluation and
Licensing
Assistant Commissioner, Health Planning and Resources
Development
2Types of Local Health Departments by Jurisdiction
New Jersey, 1990
Jurisdiction Co C N/Co T/T
Atlantic X
Atlantic X
Belleville X
Bergen X
Bergenfield X
Bernards X
Bloomfield X
Branchburg X
Bridgewater X
Burlington X
Camden X
Cape May X
Clifton X
Closter X
Colts Neck X
Cranford X
Cumberland X
Denville X
Dover X
DuRidge Reg. Comm X
East Hanover X
East Orange X
East Windsor X
Edison X
Elizabeth X
Elmwood Park X
Englewood X
Essex X
Ewing X
Fair Lawn X
Fairfield X
Fort Lee X
Franklin X
Freehold X
Gloucester X
Hackensack X
Hamilton X
Harrison X
Hazlet X
Hillsborough X
Hoboken X
Hopatcong X
Hudson X
Hunterdon X
Jefferson X
Jersey City X
Kearny X
Kinnelon X
Lawrence X
Lincoln Park X
Linden X
Livingston X
Long Beach X
Long Branch X
Madison Boro X
Manalapan X
Maplewood X
Matawan Boro X
Mercer X
Mid-Bergen Reg. X
Middle-Brook X
Middlesex X
Middletown X
Millburn X
Monmouth X
Monmouth Reg. Comm. X
Montclair X
Montgomery X
Montville X
Morris X
Morristown X
Mt. Olive X
N.W. Bergen X
Newark X
Ocean X
Old Bridge X
Palisades Park X
Paramus X
Parsippany X
Passaic X
Passaic X
Patterson X
Pequannock X
Piscataway X
Plainfield X
Pompton X
Princeton X
Rahway X
Ramsey X
Randolph X
Red Bank X
Rockaway X
Roxbury X
Salem X
Secaucus X
Somerset X
Somerville X
South Brunswick X
South Orange X
South Plainfield X
Sparta X
Summit X
Sussex X
Teaneck X
Trenton X
Union X
Union City X
Vernon X
Vineland X
Warren X
Washington X
Washington X
Wayne X
West Caldwell X
West Milford X
West Orange X
West Windsor X
Westfield X
Woodbridge X
Co = County HD
C = City HD
N/Co = No County HD
T/T = Town/Township HD
1NEW MEXICO
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,507,000 245,803,000
Population Density (1988) 12.4 69.4
(per/sq.mi.)
Number of Counties 33 3,139
Median Age (1987) 29.7 31.7
Percent Below Poverty Level (1985) 18.5 14.0
(persons)
Percent of Population Rural (1980) 28.0 26.0
Percent of Population White (1980) * 89.0 83.1
Percent of Population Non-white (1980) * 11.0 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The authority and framework for county governments in New Mexico
are found in the state constitution and statutes. Although the
constitution provides for charter government, it applies only to
1 county out of 33 through area limitations; therefore, the state
has taken an official position as a non-home rule state.
Commission Form - (33) - All counties except Los Alamos have this
form of government, with three to five members elected at large
from the districts in which they live. Thirty-two of the 33
counties have appointed administrators.
Incorporated County - (1) - The state constitution establishes
that any county with less than 144 square miles of area and more
than 10,000 population may become an Incorporated County. Los
Alamos is the only Incorporated County in the state. As an
Incorporated County, Los Alamos is provided with a home rule
charter which establishes the form of government, the officers,
and responsibilities of the officers and officials. The Los
Alamos county government includes a seven-member council which is
* These data were provided by the SHA.
Data for this state were updated April 1991.
elected at large and a strong administrator which is appointed.
The restrictive nature of the home rule provision prohibits the
eligibility of other counties. City-county consolidations are
permitted under state law, but none exists at present.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Public Health Division of the Health Department is named as
the SHA by the New Mexico Public Health Act. The mission of the
Public Health Division is to contribute to the achievement of the
highest level of health possible for the people of New Mexico by
promoting health, preventing disease, and minimizing the rate of
death and disability from injuries and illnesses.
The powers and authority of the Division are:
1. Receive grants, subsidies, donations, allotments or
bequests offered to the state by the Federal
government, individuals, or a foundation;
2. Supervise the health and hygiene of the people of the
state;
3. Investigate, control and abate the causes of disease;
4. Establish, maintain and enforce isolation and
quarantine;
5. Close public places and forbid gatherings of people
when necessary for the protection of public health;
6. Establish programs and adopt regulations to prevent
infant mortality, birth defects and morbidity;
7. Prescribe the duties of public health nurses and school
nurses;
8. Maintain and enforce regulations for the licensure of
health facilities;
9. Bring action in court for the enforcement of health
laws and regulations and orders issued by the
department;
10. Enter into agreements with other states to carry out
the powers and duties of the department;
11. Cooperate and enter into contracts or agreements with
the Federal government or any other person to carry out
the powers and duties of the department;
12. Maintain and enforce regulations for the control of
communicable diseases deemed to be dangerous to public
health;
13. Maintain and enforce regulations for immunization
against diseases deemed to be dangerous to the public
health;
14. Maintain and enforce such rules and regulations as may
be necessary to carry out provisions of the Public
Health Act and to publish it;
15. Supervise state public health activities, operate a
dental public health program, and operate state
laboratories for the investigation of public health
matters;
16. Sue and, with the consent of the legislature, be sued;
17. Regulate the practice of midwifery;
18. Administer legislation enacted pursuant to Title VI of
the Public Health Act as amended and supplemented;
19. Inspect such premises or vehicles as necessary to
ascertain the existence or nonexistence of conditions
dangerous to public health or safety; and
20. Do all other things necessary to carry out its duties.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The Director of the Public Health Division is appointed by the
Secretary of the Health Department and serves at the pleasure of
the Secretary. He/she is the chief administrator, expressing the
goals of the state health agency to optimize the health of New
Mexicans and focusing staff and financial resources so those
goals and statutory responsibilities are met. There is no M.D.
requirement for this position.
C. State Board of Health/Council
There is no State Board of Health or State Health Council in New
Mexico.
D. Regional/District Health Offices
The four health districts are administrative groupings of the 45
field health offices. All are state offices in the Field
Operations Bureau. The local field health offices report to the
district; the district in turn reports to the Chief of Field
Operations. District offices are staffed with nurses,
secretarial/clerical support staff, nurse practitioners,
physicians, dentists, dental hygienists and assistants, health
educators, nutritionists, administrators, disease prevention
specialists, and social workers. Each district has a District
Health Officer, who has an M.D. degree.
E. State-local Liaison
Centralized Organizational Control, Informal Liaison Function
Local health offices are part of the SHA and do not have an
individual or office that has specific responsibility for liaison
functions.
The interactions between state and local health agencies in New
Mexico may be characterized as centralized organizational
control. Under this arrangement local health departments are
operated by the SHA or a state board of health.
F. Budget
Total FY 1988 New Mexico SHA expenditures were $48,849,548.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $31,970,548
State Funds $16,432,100
Local Funds 0
Fees and Reimbursements $173,900
Other $273,000
These figures exclude WIC and Commodity Supplemental Food
Program.
Child Care Food, Summer Food Service $24,392,808
WIC/Commodity Supplemental Food $13,975,983
Child Care Food/Summer Food $10,480,757
3III. Local Public Health Agencies (LPHAs)
A. General
New Mexico has 46 field health offices that provide public health
services to local areas. Although these units provide the same
basic services as local public health agencies in other states,
New Mexico does not consider them local health units because they
are branches of the state health agency. In addition to the 46
units, Los Alamos County has a small locally funded office. The
Los Alamos office receives assistance from the SHA in the form of
vaccines, birth control supplies, tuberculosis medications, and
the like.
B. Services Provided
The following information on services provided by local public
health and environmental improvement offices in New Mexico is
derived primarily from information provided by the Public Health
Division Central Office. Data for two items (indicated with an
asterisk) are derived from a survey conducted by NACHO during
1989. Twenty-seven of the 46 local public health offices in New
Mexico responded to the survey. The Public Health Division
provided information on all 46 local public health offices.
Services provided by 70 percent of local public health offices in
the state are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 46 (100.0%)
2. Morbidity Data -
3. Reportable Diseases 46 (100.0%)
4. Vital Records and Statistics 16 ( 34.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases -
2. Communicable Diseases 46 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement * 7 ( 25.9%)
B. Health Planning 46 (100.0%)
C. Priority Setting 46 (100.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control -
2. Health Facility Safety/Quality -
3. Rec. Facility Safety/Quality -
4. Other Facility Safety/Quality -
B. Licensing
1. Health Facilities * 3 ( 11.1%)
2. Other Facilities -
C. Health Education 46 (100.0%)
D. Environmental
1. Air Quality -
2. Hazardous Waste Management -
3. Individual Water Supply Safety -
4. Noise Pollution -
5. Occupational Health and Safety -
6. Public Water Supply Safety -
7. Radiation Control -
8. Sewage Disposal Systems -
9. Solid Waste Management -
10. Vector and Animal Control -
11. Water Pollution -
E. Personal Health Services
1. AIDS Testing and Counseling 46 (100.0%)
2. Alcohol Abuse 46 (100.0%)
3. Child Health 46 (100.0%)
4. Chronic Diseases 46 (100.0%)
5. Dental Health -
6. Drug Abuse (education) 46 (100.0%)
7. Emergency Medical Service -
8. Family Planning 44 ( 95.0%)
9. Handicapped Children 46 (100.0%)
10. Home Health Care -
11. Hospitals -
12. Immunizations 46 (100.0%)
13. Laboratory Services (limited) 46 (100.0%)
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care 22 ( 47.0%)
18. Primary Care -
19. Sexually Transmitted Diseases 46 (100.0%)
20. Tuberculosis 46 (100.0%)
21. WIC 46 (100.0%)
Environmental health problems are under the purview of the New
Mexico Environment Department, which maintains a network of 22
local offices throughout the state. The Health Department and
the Environment Department were until recently a part of the same
agency. Reportable diseases may be reported to district health
officers, the Office of Epidemiology, or in the case of sexually
transmitted diseases, directly to that program. Vital records
and statistics are kept by the central office. Birth and death
certificates are available through 16 field offices and the
central office in Santa Fe. All field health offices provide WIC
nutrition services.
C. Local Health Officer
M.D. Requirement, State Personnel System Appointment
District Health Officers provide coverage for the field health
offices in their districts. They are employed through the
regular state personnel system just as are all state health
agency employees. As part of community health promotion, health
officers provide information on health issues to local, elected
officials and maintain positive relationships with them.
District Health Officers are, by state statute, responsible for
the health of the public. Besides providing direct patient
services, they maintain standing orders, as well as provide
quality assurance and supervision of clinicians. Health officers
are involved in the medical community, serving as liaison to
other agencies, private physicians, and associations, enhancing
awareness of public health and portraying health goals and
messages to the public decision makers. They are also an
integral part of the planning and evaluation process and the
district management team.
D. Local Board of Health
New Mexico does not have local boards of health.
E. Staff
The field health offices are staffed by state personnel employed
by the Public Health Division. The Division employs
approximately 650 persons, about three-fourths of whom are based
in field health offices. Field office staff members are assisted
by district staff who may travel throughout the state to consult
or conduct presentations, training or disease investigation.
F. Budget
Because local public health service units are part of the New
Mexico Public Health Division, they do not consider them to be
local health units. Therefore, the budget information for these
units is included in the budget of the SHA. The counties do
provide building space and offices.
2New Mexico Department of Health, 1990
Governor
Secretary
Deputy Secretary
Chief Medical Officer
Office of Epidemiology
Office of Planning and Evaluation
Office of Internal Audit
Office of Public Affairs
Office of General Counsel
Administrative Services Division
Scientific Laboratory Division
Public Health Division
Developmental Disabilities Division
Mental Health Division
Behavioral Health Services Division
2Types of Local Health Departments by Jurisdiction
New Mexico, 1990
Jurisdiction Co N/Co
Bernalillo X
Catron X
Chaves X
Cibola X
Colfax X
Curry X
De Baca X
Dona Ana X
Eddy X
Grant X
Guadalupe X
Harding X
Hidalgo X
Lea X
Lincoln X
Los Alamos X
Luna X
McKinley X
Mora X
Otero X
Quay X
Rio Arriba X
Roosevelt X
San Juan X
San Miguel X
Sandoval X
Santa Fe X
Sierra X
Socorro X
Taos X
Torrance X
Union X
Valencia X
Co = County HD
N/Co = No County HD
1NEW YORK
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 17,909,000 245,803,000
Population Density (1988) 378.0 69.4
(per/sq.mi.)
Number of Counties 62 3,139
Median Age (1987) 33.3 31.7
Percent Below Poverty Level (1985) 15.8 14.0
(persons)
Percent of Population Rural (1980) 15.0 26.0
Percent of Population White (1980) 79.5 83.1
Percent of Population Non-White (1980) 20.5 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for county governments in New York
are established in the state constitution and statutes. County
governments fall into either Charter or Non-Charter status. The
legislative body of counties is known as Board of Supervisors,
County Legislature, or Board of Representatives. The boards
range in number from 6 to 39 members and are elected at large,
from single-member districts, or by a combination of methods.
The votes of board members elected from single-member districts
are weighed according to the population in the district. All
counties have the right to appoint a county administrator, but
only charter counties can elect a county executive.
Non-Charter Status - (38) - Seventeen of these counties have
appointed County Administrators and two have hired County
Managers. The appointed administrator may function under the
title of County Manager, County Administrator, or by some other
title.
Charter Status - (19) - Sixteen of these counties have elected
County Executives, two have County Administrators, and one has a
County Manager.
Data for this state were updated January 1991. The five boroughs
in New York City represent counties for certain purposes but do
not have truly functional county governments. The consolidation
of the city and county governments in New York City is the only
consolidation in the state.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The SHA, the New York Department of Health, is a free-standing,
independent agency. The Department of Health is established as
an agency by the state constitution and the New York State Public
Health Law. The Department is charged with: operating three
health facilities; regulating specified types of health
facilities; setting Medicaid and Blue Cross rates, and issuing
facility certificates of need; developing public health
initiatives in the fields of environment, community health,
laboratories, and research; and functioning as liaison with local
health units, including State Aid.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Commissioner is the head of the Department of Health, the
SHA. The Governor appoints the Commissioner with the consent of
the State Senate. The Commissioner must be a physician with at
least 10 years' experience in the actual practice of his/her
profession, and with skill and experience in public health duties
and sanitary science. Responsibility for managing the Department
of Health rests with the Commissioner.
C. State Board of Health/Council
Policy-making
The Public Health Council is established by the Public Health
Law. Its members are appointed to 6-year terms of office by the
Governor with consent of the Senate. The Council is composed of
15 members including the Commissioner of Health. The functions
of the Council are to assist in the public health rule-making
process and to review the qualifications of those who wish to
establish health facilities.
D. Regional/District Health Offices
The state is divided into three public health regions, each with
a regional office. Within the regions are 10 district offices
which provide direct environmental services to some of the
smaller counties. The regional offices assist local health
departments. District offices actually function as if they were
a unit of local government, but direction is from the State
Department of Health.
The regional offices are staffed by approximately 75 to 150
employees. The Regional Director is the head of the regional
office. The staff includes administrative personnel, clerks,
program consultants, and some service personnel such as sexually
transmitted disease control personnel.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The Director of Field Operations acts as liaison between the
state and local public health agencies. In this capacity, the
Director serves as the primary focus of communications between
the SHA and local public health agencies. Additionally, the
Director administers the program which provides State Aid to the
local health departments. This involves assuring that local
health departments meet established standards for receiving State
Aid.
The interaction between state and local public health agencies in
New York may be characterized as mixed centralized and
decentralized control. Under this arrangement, local health
services may be provided by the SHA in some jurisdictions and by
local governmental units, boards of health, or health departments
in other jurisdictions.
F. Budget
Total FY 1988 New York SHA expenditures were $695,766,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $249,659,000
State Funds $445,834,000
Local Funds 0
Fees and Reimbursements $273,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
New York has 59 local public health units including 58 county
health departments and 1 city health department. Thirty-six of
the 59 units provide some level of "full public health
services." The remaining 23 units offer public health nursing
services augmented by environmental services from the district
offices.
Local units are elements of local government. As such, direction
and primary financing are derived from the counties and cities.
Substantial state funds flow to the local units, for which
specified and negotiated services are provided.
B. Services Provided
The following information on services provided by local health
departments in New York is derived from a survey conducted by
NACHO during 1989. Fifty-seven of the 59 local health
departments in New York responded to the survey. Services
provided by at least 70 percent of health departments in the
state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 27 ( 47.4%)
2. Morbidity Data 43 ( 75.4%)
3. Reportable Diseases 54 ( 94.7%)
4. Vital Records and Statistics 41 ( 71.9%)
B. Epidemiology/Surveillance
1. Chronic Diseases 43 ( 75.4%)
2. Communicable Diseases 56 ( 98.2%)
II. Policy Development
A. Health Code Dev. and Enforcement 36 ( 63.2%)
B. Health Planning 47 ( 82.5)
C. Priority Setting 46 ( 80.7%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 30 ( 52.6%)
2. Health Facility Safety/Quality 11 ( 19.3%)
3. Rec. Facility Safety/Quality 32 ( 56.1%)
4. Other Facility Safety/Quality 16 ( 28.1%)
B. Licensing
1. Health Facilities 4 ( 7.0%)
2. Other Facilities 31 ( 54.4%)
C. Health Education 47 ( 82.5%)
D. Environmental
1. Air Quality 19 ( 33.3%)
2. Hazardous Waste Management 25 ( 43.9%)
3. Individual Water Supply Safety 38 ( 66.7%)
4. Noise Pollution 9 ( 15.8%)
5. Occupational Health and Safety 14 ( 24.6%)
6. Public Water Supply Safety 36 ( 63.2%)
7. Radiation Control 14 ( 24.6%)
8. Sewage Disposal Systems 38 ( 66.7%)
9. Solid Waste Management 21 ( 36.8%)
10. Vector and Animal Control 35 ( 61.4%)
11. Water Pollution 28 ( 49.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 41 ( 71.9%)
2. Alcohol Abuse 7 ( 12.3%)
3. Child Health 54 ( 94.7%)
4. Chronic Diseases 50 ( 87.7%)
5. Dental Health 35 ( 61.4%)
6. Drug Abuse 4 ( 7.0%)
7. Emergency Medical Service 17 ( 29.8%)
8. Family Planning 25 ( 43.9%)
9. Handicapped Children 53 ( 93.0%)
10. Home Health Care 54 ( 94.7%)
11. Hospitals -
12. Immunizations 55 ( 96.5%)
13. Laboratory Services 18 ( 31.6%)
14. Long-term Care Facilities 17 ( 29.8%)
15. Mental Health 5 ( 8.8%)
16. Obstetrical Care 8 ( 14.0%)
17. Prenatal Care 38 ( 66.7%)
18. Primary Care 23 ( 40.4%)
19. Sexually Transmitted Diseases 52 ( 91.2%)
20. Tuberculosis 56 ( 98.2%)
21. WIC 34 ( 59.6%)
C. Local Health Officer
M.D. Requirement for Full-service Units, Local Governing Body
Appointment
There are two types of local health officers in New York State:
one type serves the cities, towns, or villages in counties which
do not operate full-service health departments; the other type is
the Commissioner or Public Health Director who serves in counties
with full-service health departments. Health officers have
responsibility for managing the local health department. The
health officers are appointed and supervised by the local
governing boards.
D. Local Board of Health
Policy-making
Local boards of health are specified in the Public Health Law.
Depending on circumstances, the board may be the local governing
body or a separate entity. In areas where the health department
is not a full-service unit, the governing body functions as the
board of health. In full-service areas the governing body
appoints a five-member board of health. The boards help shape
policy, but the governing body has emerged, with its fiscal
controls, as the primary entity for the past 20 years.
E. Staff
Staffs of local health departments are employed and supervised by
the local health department. The number of staff employed by a
local health department ranges from 1 to 4,243.
F. Budget
Total FY 1988 LPHA expenditures were $371,171,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $12,585,000
State Funds $82,258,000
Local Funds $195,019,000
Fees and Reimbursements $81,309,000
Other Sources 0
Source Unknown 0
2New York State Department of Health, 1990
At time of printing, State Health Agency undergoing
reorganization
2Types of Local Health Departments by Jurisdiction
New York, 1990
Jurisdiction Co C
Albany X
Allegany X
Broome X
Cattaraugus X
Cayuga X
Chautauqua X
Chemung X
Chenango X
Clinton X
Columbia X
Cortland X
Delaware X
Dutchess X
Erie X
Essex X
Franklin X
Fulton X
Genesee X
Greene X
Hamilton X
Herkimer X
Jefferson X
Lewis X
Livingston X
Madison X
Monroe X
Montgomery X
Nassau X
New York City
Niagara X
Oneida X
Onondaga X
Ontario X
Orange X
Orleans X
Oswego X
Otsego X
Putnam X
Rensselaer X
Rockland X
Saratoga X
Schenectady X
Schoharie X
Schuyler X
Seneca X
St. Lawrence X
Steuben X
Suffolk X
Sullivan X
Tioga X
Tompkins X
Ulster X
Warren X
Washington X
Wayne X
Westchester X
Wyoming X
Yates X
Co = County HD
C = City HD
1NORTH CAROLINA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 6,487,000 245,803,000
Population Density (1988) 132.8 69.4
(per/sq.mi.)
Number of Counties 100 3,139
Median Age (1987) 31.6 31.7
Percent Below Poverty Level (1985) 15.2 14.0
(persons)
Percent of Population Rural (1980) 52.0 26.0
Percent of Population White (1980) 75.8 83.1
Percent of Population Non-white (1980) 24.2 16.9
Median Years of Education (1980) 12.2 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The powers and duties of county governments in North Carolina are
established in the state constitution and statutes.
Commission Form - (100) - Law defines the county governing body
as a board of commissioners. The board of commissioners,
however, functions much like a council-manager system. The board
may contain any number of members but usually has from three to
nine. Five is the most common number of commissioners. The
commissioners are usually elected at large. A growing trend,
however, is for boards to be composed of a mixture of members
elected at large and from single-member districts.
The responsibilities of boards of commissioners fall into the
following four major areas: establishment of fiscal policy,
including developing budget and determining property tax rates;
regulation of private conduct, making ordinances, enforcing laws,
establishing zoning and development regulations; general
administration, implementation of all fiscal and personnel
policies; and determination of what programs and services the
county government will provide. Statutes provide North Carolina
with a variety of options as to the services they can provide.
Data for this state were updated January 1991.
Unlike most county governments in the United States, however,
North Carolina counties do not have the authority or
responsibility for roads.
Because of the complexity of the responsibility of commissioners,
98 of 100 counties have chosen to employ a county manager or
administrator. This individual is responsible to the board for
administering all departments of the county government, except
for the departments with separately elected heads.
State laws permit city-county consolidations, but none has yet
taken place. The North Carolina Constitution and Statutes do not
contain home rule authority for the counties. Statutes do,
however, give the counties considerable authority to manage their
own affairs.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Department of Environment, Health, and Natural Resources
(DEHNR) is the newest department in North Carolina State
government and has broad responsibility for the development of
resources, policies and delivery of services that protect,
promote and preserve North Carolina's natural resources, as well
as public and private environmental health. The department is
organized into 25 major divisions, seven of which are charged
with the administrative and statutory responsibility for carrying
out public health programs in North Carolina. These seven
divisions and the Office of the State Health Director are
considered the SHA. DEHNR public health divisions are as
follows: Adult Health, Dental Health, Environmental Health,
Epidemiology, Laboratory Services, Maternal and Child Health, and
Post-Mortem Medicolegal Examination. In addition to these
divisions, housed within the State Health Director's Office are
the Office of the Chief Nurse, Office of Health Education and
Communications, Office of Local Health Services, and the
Governor's Council on Physical Fitness and Health.
The primary role of the seven health service divisions is to
strengthen local health departments and to improve the health of
the people of North Carolina. The health divisions monitor
public health achievements and performance and provide
incentives, as well as assistance, to assure that no community
falls below minimum standards. Further, the divisions are
responsible for studying, coordinating and enhancing health
efforts involving or serving multiple communities and/or the
state as a whole. Finally, the public health divisions are
themselves providers of statewide services not otherwise
available.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The State Health Director is the head of the SHA. The Director
is appointed by the Secretary of DEHNR. The position requires a
physician licensed to practice medicine in North Carolina. The
Director is responsible for the oversight of DEHNR's seven public
health divisions. The Health Director serves as the department's
Assistant Secretary for Health, performing duties and exercising
authority assigned by the Secretary. The scope of the delegated
authority includes but is not limited to:
1. Exercising rule-making power granted to the
Secretary of the department under General
Statutes Chapter 130A.
2. Requiring local health departments to enforce
rules of the Commission for Health Services
pursuant to General Statutes 130A-4(b).
3. Abating public health nuisances and imminent
hazards pursuant to General Statutes 130a-27.
4. Making final agency decisions in appeals
concerning the interpretation and enforcement
of provisions of General Statutes Chapter
130A or rules adopted by the Commission for
Health Services or the State Health Director,
except that if the initial decision which is
the subject matter of the appeal was made by
the State Health Director, then the
Secretary shall make the final agency
decision.
C. State Board of Health/Council
Policy-making
The Commission for Health Services of DEHNR consists of 12
members, 4 of whom are elected by the North Carolina Medical
Society and 8 of whom are appointed by the Governor. The
Governor's appointments include a licensed pharmacist, a
registered engineer experienced in sanitary engineering or soil
science, a licensed dentist, a licensed veterinarian, a licensed
optometrist, and a registered nurse. Commission members are
appointed for a term of 4 years.
The Commission for Health Services has the authority and duty to
adopt rules to protect and promote the public health. The
Commission is authorized to adopt rules necessary to implement
the public health programs administered by DEHNR as provided in
Chapter 130A North Carolina General Statutes. The following is a
partial list of public health issues which fall under the
Commission's authority:
Communicable disease control, including immunization
requirements and control measures for AIDS and HIV
infection
Adolescent pregnancy prevention projects
Sickle Cell Program
Children's Special Health Service Program
Home health services funds
Restaurant sanitation standards
Sewage collection, treatment, and disposal
Standards for public water supply systems
Hazardous waste management
Solid waste management
Mandated services for local health departments
State Cancer Registry
D. Regional/District Health Offices
To maintain a closer working relationship with health services
providers, most DEHNR public health divisions staff seven
regional offices. From these offices, technical assistance is
provided to local health departments, other health care
providers, and local governmental units other than health
departments. Regional public health staff also monitor local
health programs and, under certain circumstances, provide direct
services.
The administrative operations of the regional offices are
overseen by regional managers. Division staff located in the
regional offices are supervised by division
supervisors/coordinators or program representatives in the
central office in Raleigh.
E. State-local Liaison
Shared Organizational Control, Formal Liaison Function
All local health directors in the state belong to the non-profit
Local Health Director's Association. The Association serves as a
bridge between local and state public health policy-makers. The
Association president appoints local health directors to standing
and special committees to serve as liaison to the public health
divisions. Each committee is charged to review and advise the
health divisions about policies affecting the delivery of public
health programs in local communities.
The interaction between state and local public health agencies in
North Carolina may be characterized as shared organizational
control. Under this arrangement, local health departments are
under the authority of the SHA as well as the local government
and board of health.
F. Budget
Total FY 1988 North Carolina SHA expenditures were $178,155,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $78,155,000
State Funds $80,041,000
Local Funds 0
Fees and Reimbursements 0
Other $20,677,000
3III. Local Public Health Agencies (LPHAs)
A. General
North Carolina has 87 local health departments, consisting of 80
county and 7 multicounty health departments, which provide public
health services to all 100 counties.
B. Services Provided
The following information on services provided by local health
departments in North Carolina is derived from a survey conducted
by NACHO during 1989. Sixty-nine of the 87 local health
departments in North Carolina responded to the survey. Services
provided by at least 70 percent of health departments in the
state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 46 ( 66.7%)
2. Morbidity Data 54 ( 78.3%)
3. Reportable Diseases 69 (100.0%)
4. Vital Records and Statistics 69 (100.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases 48 ( 69.6%)
2. Communicable Diseases 68 ( 98.6%)
II. Policy Development
A. Health Code Dev. and Enforcement 39 ( 56.5%)
B. Health Planning 56 ( 81.2%)
C. Priority Setting 51 ( 73.9%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 62 ( 89.9%)
2. Health Facility Safety/Quality 53 ( 76.8%)
3. Rec. Facility Safety/Quality 26 ( 37.7%)
4. Other Facility Safety/Quality 18 ( 26.1%)
B. Licensing
1. Health Facilities 19 ( 27.5%)
2. Other Facilities 51 ( 73.9%)
C. Health Education 64 ( 92.8%)
D. Environmental
1. Air Quality 12 ( 17.4%)
2. Hazardous Waste Management 21 ( 30.4%)
3. Individual Water Supply Safety 65 ( 94.2%)
4. Noise Pollution 7 ( 10.1%)
5. Occupational Health and Safety 15 ( 21.7%)
6. Public Water Supply Safety 36 ( 52.2%)
7. Radiation Control 6 ( 8.7%)
8. Sewage Disposal Systems 67 ( 97.1%)
9. Solid Waste Management 36 ( 52.2%)
10. Vector and Animal Control 55 ( 79.7%)
11. Water Pollution 45 ( 65.2%)
E. Personal Health Services
1. AIDS Testing and Counseling 69 (100.0%)
2. Alcohol Abuse 6 ( 8.7%)
3. Child Health 69 (100.0%)
4. Chronic Diseases 61 ( 88.4%)
5. Dental Health 62 ( 89.9%)
6. Drug Abuse 11 ( 15.9%)
7. Emergency Medical Service 1 ( 1.4%)
8. Family Planning 65 ( 94.2%)
9. Handicapped Children 46 ( 66.7%)
10. Home Health Care 48 ( 69.6%)
11. Hospitals 3 ( 4.3%)
12. Immunizations 69 (100.0%)
13. Laboratory Services 64 ( 92.8%)
14. Long-term Care Facilities 4 ( 5.8%)
15. Mental Health 1 ( 1.4%)
16. Obstetrical Care 37 ( 53.6%)
17. Prenatal Care 66 ( 95.7%)
18. Primary Care 24 ( 34.8%)
19. Sexually Transmitted Diseases 68 ( 98.6%)
20. Tuberculosis 69 (100.0%)
21. WIC 66 ( 95.7%)
C. Local Health Officer
No M.D. Requirement, Local Board of Health Appointment
The local health director is the administrative head of the local
health department. The local board of health, after consulting
with appropriate county board or board of commissioners, can
appoint a local health director. Equal emphasis is placed on
education and experience in determining the qualifications of a
local health director, but he/she shall not be required to be a
physician.
As the administrative head of the local health department, the
local health director performs the public health duties
prescribed by and under the supervision of the local board of
health. The local health director serves as secretary to the
board of health, is the administrative head of the health
department carrying out programs at the direction of the board,
and is financially responsible both to the board of health and
the county commissioners. The local health director is given
the following powers and duties pursuant to General Statutes
Chapter 130A:
To administer programs as directed by the local board of
health.
To enforce the rules of the local board of health.
To investigate the causes of infectious, communicable and
other diseases.
To exercise quarantine authority and isolation and to
promote the benefits of good health.
To advise local officials concerning public health matters.
To enforce the immunization requirements.
To examine and investigate cases of venereal disease.
To examine and investigate cases of tuberculosis.
To examine, investigate and control rabies.
To abate public health nuisances and imminent hazards.
To employ and dismiss employees of the local health
department.
To enter contracts, in accordance with the Local Government
Finance Act, General Statutes Chapter 159, on behalf of the
local health department.
D. Local Board of Health
Policy-making
The local board of health is the policy-making, rule-making and
adjudicatory body for the county (local) health department. The
members of the local board of health are appointed by the county
commissioners. All boards are composed of 11 members. The
composition of a local board must reasonably reflect the
population makeup of the county and must include: one physician
licensed to practice medicine in the state, one licensed dentist,
one licensed optometrist, one licensed veterinarian, one
registered nurse, a licensed pharmacist, one professional
engineer, one county commissioner, and three representing the
general public. If, however, one of the designated professionals
has only one person residing in the county, the county
commissioners shall have the option of appointing a member of the
general public. The term of office for board members is 3
years. No member may serve more than three consecutive 3-year
terms unless the member is the only person residing in the county
who represents one of the professions designated. Local boards
of health in North Carolina have the responsibility to protect
and promote the public health. Thus, local boards have the
authority to adopt rules necessary for that purpose. The local
board may adopt a more stringent rule in an area regulated by the
Commission for Health Services or the Environmental Management
Commission where, in the opinion of the board, a more stringent
rule is required to protect the public health; otherwise, the
rules of the Commission for Health Services or the Environmental
Management Commission shall prevail over the rules of the local
board of health. The local board may not adopt rules concerning
the grading and permitting of food and lodging facilities. The
local board may, however, adopt rules concerning sanitary sewage
collection, treatment and disposal systems, which are not
designed to discharge effluent to the land surface or surface
waters and which are not public or community systems.
The local board of health may, in its rules, adopt by reference
any code, standard, rule or regulation which has been adopted by
any agency of North Carolina, another state, any agency of the
United States, or by a generally recognized association.
The local board may impose a fee for services to be rendered by a
local health department, except where the imposition of a fee is
prohibited by statute or where an employee of the local health
department is performing the service as an agent of the state.
The relationship between the local board of health, health
director and county government is one of cooperation and
collaboration. The local board of health is the legal
representative of the community's various public health services
rendered by the health department. The county commissioners are
authorized to appropriate funds from property tax levies and to
allocate other revenues whose utilization is not otherwise
restricted by law for the local health department's use. A
capital reserve fund can be established by commissioners to buy,
erect, repair or alter public health facilities. A local health
department's director and the local board of health ultimately
are responsible for organizing and administering the health
department's activities.
E. Staff
The staff of local health departments are employed and supervised
by the local jurisdiction. The number of staff employed by local
health departments ranges from 6 to 318.
F. Budget
Total FY 1988 LPHA Expenditures were $158,517,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $22,416,000
State Funds $28,331,000
Local Funds $107,770,000
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
2North Carolina Department of Environment, Health,
and Natural Resources, 1990
Secretary
Budget Officer
General Counsel
Personnel Director
Wildlife Resources
Administrative Assistant
Deputy Secretary, Environment and Natural Resources
Albemarle/Pamlico
Governmental Waste Management Environmental Education
Highway Environment Evaluation
Deputy Secretary, Health and Administration
Legislative Affairs
Public Affairs
Regional Managers
Asheville
Fayetteville
Mooresville
Raleigh
Washington
Wilmington
Winston-Salem
Assistant Secretary, Environment Protection
Coastal Management
Environmental Management
Solid Waste Management
Land Resources
Office of Waste Reduction
Radiation Protection
Water Resources
Assistant Secretary, Natural Resources
Forest Resources
Marine Fisheries
Parks and Recreation
Soil and Water Conservation
Special Projects
Zoological Park
Assistant Secretary Health and State Health Director
Deputy State Health Director
Adult Health
Dental Health
Environmental Health
Epidemiology
Maternal-Child Health
Assistant State Health Director
Health Education
Laboratory Services
Local Health Services
Post Mortem Medicolegal Examination
Governor's Council on Physical Fitness and Health
Public Health Nursing
Assistant Secretary Administration
Computer Systems
Fiscal Management
General Services
Office of General Counsel
Office of Personnel
Planning and Assessment
Statistics and Information
2Types of Local Health Departments by Jurisdiction
North Carolina, 1990
Jurisdiction Co M/Co
Alamance X
Alexander X
Alleghany X
Anson X
Ashe X
Avery X
Beaufort X
Bertie X
Bladen X
Brunswick X
Buncombe X
Burke X
Cabarrus X
Caldwell X
Camden X
Carteret X
Caswell X
Catawba X
Chatham X
Cherokee X
Chowan X
Clay X
Cleveland X
Columbus X
Craven X
Cumberland X
Currituck X
Dare X
Davidson X
Davie X
Duplin X
Durham X
Edgecombe X
Forsyth X
Franklin X
Gaston X
Gates X
Graham X
Granville X
Greene X
Guilford X
Halifax X
Harnett X
Haywood X
Henderson X
Hertford X
Hoke X
Hyde X
Iredell X
Jackson X
Johnston X
Jones X
Lee X
Lenoir X
Lincoln X
Macon X
Madison X
Martin X
McDowell X
Mecklenburg X
Mitchell X
Montgomery X
Moore X
Nash X
New Hanover X
North Hampton X
Onslow X
Orange X
Pamlico X
Pasquotank X
Pender X
Perquimans X
Person X
Pitt X
Polk X
Randolph X
Richmond X
Robeson X
Rockingham X
Rowan X
Rutherford X
Sampson X
Scotland X
Stanly X
Stokes X
Surry X
Swain X
Transylvania X
Tyrrell X
Union X
Vance X
Wake X
Warren X
Washington X
Wautauga X
Wayne X
Wilkes X
Wilson X
Yadkin X
Yancy X
Co = County HD
M/Co = Multicounty HD
1NORTH DAKOTA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 667,000 245,803,000
Population Density (1988) 9.6 69.4
(per/sq.mi.)
Number of Counties 53 3,139
Median Age (1987) 30.3 31.7
Percent Below Poverty Level (1985) 15.9 14.0
(persons)
Percent of Population Rural (1980) 51.0 26.0
Percent of Population White (1980) 95.8 83.1
Percent of Population Non-white (1980) 4.2 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The state constitution and statutes provide the authority and
structure for counties in North Dakota. The Commission Form
serves as the basis for county governments in the state.
Commission Form - (53) - Boards of commissioners consist of three
or five members and are elected from single-member districts.
Three options from the pure commission form of government is
available to counties.
Home Rule Charter - (1) - Walsh County has chosen this
option. Under this option the board of commissioners has
expanded authority in the areas of county elections,
financial and fiscal affairs, penalties for violation of
ordinances, resolutions and regulations, and expansion of
taxation.
Data for this state were updated April 1991.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The SHA is the North Dakota Department of Health and Consolidated
Laboratories (NDDHCL), a free-standing, independent agency. In
carrying out its public health responsibilities, the Department:
inspects and licenses health facilities, hotels,
motels, boardinghouses, and food establishments;
certifies hospitals, nursing homes, home health
agencies, laboratories, and other health facilities for
Medicare and Medicaid certification; registers and
preserves vital records; trains and licenses emergency
health services; provides education and preventive
health service to mothers, infants, and children,
including family planning and nutrition service;
develops dental health education and tooth decay
prevention service; coordinates and promotes local
public health service; provides communicable and
chronic disease control programs; provides health
education and promotion activities; coordinates a
uniform program of public health nursing including home
health care; provides consultative, advisory, and
enforcement service on all phases of environmental
health encompassing water supply, water and air
pollution control, environmental health and
recreational facilities, solid waste disposal,
radiation control, and noise and hazardous waste
control; provides forensic analysis services; and
registers and analyzes agricultural and petroleum
products.
The mission statement for NDDHCL reads as follows:
We, as public employees, are dedicated to the goal of
assuring that North Dakota is a healthy place to live and to
the belief that each person should have an equal opportunity
to enjoy good health. To accomplish this mission, we are
committed to the protection of healthy lifestyles,
protection and enhancement of the environment, and provision
of quality health care services for the people of North
Dakota.
The following are some broad areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Health Planning and Development Agency
Health Professions Licensing Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The State Health Officer, the administrative head of the SHA, is
appointed by the Governor for a term of 4 years. The individual
must be a physician who has graduated from a regular school of
medicine of a class A standing, has experience in public health,
and be licensed to practice medicine in the state.
Responsibilities of the State Health Officer include: enforcing
regulations of the public health council; developing and
coordinating local health services; allocating health funds
subject to approval of the health council; collecting and
distributing health education materials; maintaining a central
health laboratory; establishing services for medical hospitals,
such as licensing and consultation on construction planning; and
enforcing minimum standards of performance for local departments
of health; collecting and tabulating vital health statistics.
C. State Board of Health/Council
Policy-making
The health council is composed of 15 members appointed by the
Governor for 3-year terms. Two members are appointed from a list
of names recommended by the State Hospital Association, two
members from the State Medical Association, one member from the
State Dental Association, one member from the State Optometric
Association, one member from the State Nurses' Association, and
one member from the State Pharmaceutical Association. The other
seven members are consumers of health care services and not
employed in the health care field. These members represent
business, agriculture, organized labor, and senior citizens.
Acting in an advisory capacity to the council are the State
Health Officer, the Attorney General, the Director of
Institutions, the State Fire Marshal, the Executive Secretary of
the State Board of Nursing, the Executive Director of the
Department of Human Services, and the Executive Director of the
Indian Affairs Commission.
The council establishes standards, rules, and regulations for the
maintenance of public health, including sanitation and disease
control; develops, establishes, and enforces basic standards for
hospitals and related medical institutions; holds hearing related
to licensing of medical facilities; and directs the State Health
Officer to do all things required in the proper performance of
the various responsibilities placed upon the NDDHCL.
D. Regional/District Health Offices
The state is not divided into administrative regions or
districts.
E. State-local Liaison
Decentralized Organizational Control, Informal Liaison Function
The coordination of local health services is performed by the
Division of Public Health Services. In this role the Division
serves as primary point of contact between the SHA and the local
health departments. They act as consultants, provide
administrative services, provide some continuing education, and
conduct some research for local health departments.
The interaction between state and local public health agencies in
North Dakota may be characterized as decentralized organizational
control. Under this arrangement local boards of health directly
operate health departments.
F. Budget
Total FY 1988 SHA expenditures were $17,487,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $11,733,000
State Funds $5,252,000
Local Funds 0
Fees and Reimbursements $196,000
Other $305,000
3III. Local Public Health Agencies (LPHAs)
A. General
North Dakota has 22 local health departments consisting of 7
multicounty, 4 city/county, and 11 county health departments.
Local health departments are autonomous from the SHA.
B. Services Provided
The following information on services provided by local health
departments in North Dakota is derived from a survey conducted by
NACHO during 1989. Nineteen of the 21 local health departments
existing in North Dakota at the time of the survey responded to
the survey. Services provided by 70 percent of health
departments in the state responding to the survey are underlined.
Services Provided by LPHAs
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 5 ( 26.3%)
2. Morbidity Data 3 ( 15.8%)
3. Reportable Diseases 16 ( 84.2%)
4. Vital Records and Statistics 3 ( 15.8%)
B. Epidemiology/Surveillance
1. Chronic Diseases 7 ( 36.8%)
2. Communicable Diseases 16 ( 84.2%)
II. Policy Development
A. Health Code Dev. and Enforcement 5 ( 26.3%)
B. Health Planning 12 ( 63.2%)
C. Priority Setting 10 ( 52.6%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 5 ( 26.3%)
2. Health Facility Safety/Quality 3 ( 15.8%)
3. Rec. Facility Safety/Quality 5 ( 26.3%)
4. Other Facility Safety/Quality 3 ( 15.8%)
B. Licensing
1. Health Facilities -
2. Other Facilities 3 ( 15.8%)
C. Health Education 15 ( 78.9%)
D. Environmental
1. Air Quality 4 ( 21.1%)
2. Hazardous Waste Management 7 ( 36.8%)
3. Individual Water Supply Safety 10 ( 52.6%)
4. Noise Pollution 2 ( 10.5%)
5. Occupational Health and Safety 2 ( 10.5%)
6. Public Water Supply Safety 11 ( 57.9%)
7. Radiation Control 2 ( 10.5%)
8. Sewage Disposal Systems 9 ( 47.4%)
9. Solid Waste Management 8 ( 42.1%)
10. Vector and Animal Control 11 ( 57.9%)
11. Water Pollution 10 ( 52.6%)
E. Personal Health Services
1. AIDS Testing and Counseling 10 ( 52.6%)
2. Alcohol Abuse 2 ( 10.5%)
3. Child Health 18 ( 94.7%)
4. Chronic Diseases 15 ( 78.9%)
5. Dental Health 5 ( 26.3%)
6. Drug Abuse 4 ( 21.1%)
7. Emergency Medical Service 1 ( 5.3%)
8. Family Planning 7 ( 36.8%)
9. Handicapped Children 4 ( 21.1%)
10. Home Health Care 13 ( 68.4%)
11. Hospitals -
12. Immunizations 19 (100.0%)
13. Laboratory Services 4 ( 21.1%)
14. Long-term Care Facilities -
15. Mental Health 5 ( 26.3%)
16. Obstetrical Care 3 ( 15.8%)
17. Prenatal Care 7 ( 36.8%)
18. Primary Care 3 ( 15.8%)
19. Sexually Transmitted Diseases 9 ( 47.4%)
20. Tuberculosis 15 ( 78.9%)
21. WIC 14 ( 73.7%)
C. Local Health Officer
M.D. Requirement, Local Board of Health Appointment
The county board of health appoints a county health officer for a
term of 5 years. The health officer must be a physician licensed
to practice medicine in the state. It is not necessary for the
health officer to be a resident of the county at the time of
appointment. The county health officer is employed and
supervised by the county board of health.
The power and responsibilities of the county health officer
include the following:
1. Exercise the powers of the county board of health under
the supervision of such board and of the NDDHCL
throughout the county outside the corporate limits of
cities.
2. Make sanitary inspections of such places as deemed
advisable when it is believed there is probability that
a health-threatening condition exists within the
jurisdiction, and take such action as deemed necessary
for the protection of the public health.
3. Investigate, subject to the supervisory control of the
NDDHCL, public water and ice supplies which are
suspected of being contaminated, and cause them to be
condemned when it is necessary.
4. Enforce cleanliness in schools, and inspect
overcrowded, poorly ventilated, and unsanitary or
unsafe schoolhouses and, when necessary, report cases
of unsanitary or unsafe school buildings to the county
board of health for investigation.
5. Enforce all laws, rules, and regulations relating to
the preservation of the life and health of the people
of the county.
6. Keeps record of all proceedings of the county board of
health and of official acts by the health officer.
D. Local Board of Health
Policy-making
County boards of health consist of five members appointed by the
county commission. The five members include one physician, one
dentist, one business or professional person, one farmer, and one
county commissioner. The terms of office are 5 years with
appointments, timed so that one member's term expires each year.
The board cannot be composed of all male or all female members.
In cities with a Council Form of government the board of health
consists of four alderman appointed by the mayor at the first
meeting of the city council in April each year, the city
engineer, and the city health officer.
In cities with a Commission Form of government the city
commissioners may appoint a board of health or serve as the board
of health. If the commission serves as the board of health, the
city physician is the executive officer of the board of health.
An appointed board of health is under the supervision of the
NDDHLC. This board consists of five members, including one
physician, one dentist, one business or professional person, one
city commissioner, and one other person appointed by the mayor,
subject to confirmation by the city commission.
District, county, and city boards of health are subject to the
supervisory control of the NDDHCL and the State Health Officer.
They have the following powers and duties within their
jurisdictions:
1. To employ persons as may be necessary to carry into
effect the regulations established by it and the
provisions of the title.
2. To inquire into all nuisances, sources of filth, and
causes of sickness, and make regulations regarding the
same as necessary for the public health and safety.
3. To adopt such quarantine and sanitary measures as are
necessary when an infectious or contagious disease
exists in its jurisdiction, but quarantine measures
must be in compliance with other statutes.
4. To enter into and examine at any time all buildings,
lots and places of any description within its
jurisdiction for the purpose of ascertaining if the
conditions may affect public health.
5. To make rules in district health units and county
health departments and to recommend to city councils or
city commissioners, as the case may be, ordinances for
the protection of public health and safety.
6. To keep records and make reports as may be required by
the NDDHCL.
7. To prepare a budget for the next fiscal year at the
time and in the manner in which a county budget is
adopted. The budget must be submitted to the county
commissioners for approval. In the case of a city, the
budget must be submitted to the governing body of the
city for approval.
County Boards of health, subject to the supervisory control of
the NDDHCL and the State Health Officer, have the following
additional powers:
1. To supervise all matters relating to the preservation
of the life and health of the people of the county,
including the supervision of public water supplies and
sewage systems.
2. To isolate, kill, or remove any animal affected with a
contagious or infectious disease when such animal is a
menace to the health of human beings.
3. To make and enforce orders in local matters when an
emergency exists, or when the local board of health has
neglected or refused to act with promptness or
efficiency, or when the local board has not been
established.
E. Staff
Local staffs are employed and supervised by the jurisdiction for
which they serve. The number of employees for local health
departments ranges from 1 to 34.
F. Budget
Total FY 1988 LPHA expenditures were $9,739,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $4,216,000
State Funds $525,000
Local Funds $3,333,000
Fees and Reimbursements $1,333,000
Other Sources $332,000
Source Unknown 0
2North Dakota State Department of Health, 1990
Governor
State Health Council
State Health Officer
Health Services Branch
Preventive Health Section
Community Health Nursing
Disease Control
Maternal and Child Health
Health Education and Promotion
Health Resources Section
Emergency Health Services
Health Facilities
Health Resource Analysis
Environmental Health
Environmental Engineering
Waste Management
Water Supply and Pollution Control
2Types of Local Health Departments by Jurisdiction
North Dakota, 1990
Jurisdiction Co C/Co M/Co N/Co
Adams
Benson
Billings
Bismark-Burleig X
Bottineau
Bowman
Burke
Cavalier
Dickey X
Divide
Dunn
Eddy
Emmons X
Fargo-Cass Co X
Foster X
Golden Valley
Grand Forks C/C X
Grant
Griggs
Hettinger
Kidder X
La Moure X
Logan
McHenry
McKenzie
McLean
Mcintosh X
Mercer
Morton
Mountrail
Nelson
Oliver
Pembina X
Pierce
Ramsey
Ransom X
Renville
Richland X
Rolette X
Sargent X
Sheridan
Slope
Stark
Steele X
Stutsman
Towner X
Traill X
Valley-Barnes C X
Walsh X
Ward X
Wells X
Williams X
Co = County HD
C/Co = City/County HD
M/Co = Multicounty HD
N/Co = No county HD
1OHIO
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 10,855,000 245,803,000
Population Density (1988) 264.7 69.4
(per/sq.mi.)
Number of Counties 88 3,139
Median Age (1987) 31.9 31.7
Percent Below Poverty Level (1985) 12.8 14.0
(persons)
Percent of Population Rural (1980) 27.0 26.0
Percent of Population White (1980) 88.9 83.1
Percent of Population Non-white (1980) 11.1 16.9
Median Years of Education (1980) 12.4 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for county government in Ohio are
established by the state constitution and revised code. All
counties operate under a Commission Form of government unless
voters choose an optional form.
Commission Form - (86) - All except one county operates with a
county commission. The commission is made up of a three-member
board that is elected at large, from single-member districts, or
by a combination of methods. Twenty-two counties have appointed
county administrators to assist the board with administrative
responsibilities.
Home Rule Charter - (1) - Summit County citizens adopted a home
rule charter in 1979. Under this charter they have a county
executive who is elected at large. Their legislative board
consists of 11 members, 8 of whom are elected from single-member
districts and 3 elected at large. All counties can adopt a
charter by a simple majority vote, but only Summit has chosen to
move in this direction.
Data for this state were updated November 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The name of the SHA is the Ohio Department of Health (ODH). It
is a free-standing, independent agency. The ODH shall protect
and improve the health of all Ohio citizens by preventing
disease, disability and premature death, securing a healthy
environment and assuring that health providers meet state and
Federal requirements. The ODH shall emphasize health promotion,
disease prevention, health education, and provide accountable
leadership on universal health concerns while assuring that all
Ohio citizens have access to quality affordable health services.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Director of Health is appointed by the Governor with advice
and consent of the Senate. The Director must be a physician
licensed to practice medicine in the state and have had
experience in pursuing some phase of medical practice and
additional experience in public health administration.
The Director of Health is responsible for performing all duties
that are incident to the position of chief executive officer.
These duties include administering the laws relating to health
and sanitation and the regulations of the health department;
preparing sanitary and public health regulations for
consideration by the public health council and submitting the
council recommendations for new legislation; and attending
meetings of the public health council.
C. State Board of Health/Council
Advisory
The Public Health Council is composed of seven members, appointed
by the Governor, including at least three physicians licensed to
practice medicine in the state.
The Public Health Council has the following duties and
responsibilities:
Adopt, amend, or rescind sanitary rules to be of general
application throughout the state.
Take evidence in appeals from the decision of the Director
of Health in matters coming before the Director for official
action.
Conduct hearings in cases where the law requires the
Department to hold hearings and make decisions based on the
evidence presented at the hearings.
Prescribe by rule the number of functions of divisions and
bureaus and the qualifications of the chiefs of divisions
and bureaus within the department.
Enact and amend bylaws in relation to its meetings and the
transaction of business.
Consider any matter relating to the preservation and
improvement of public health and advise the Director on the
matter with any recommendations it considers wise.
D. Regional/District Health Offices
ODH has divided the state into four geographical areas called
districts. Each of the districts has an office which assists the
local health departments with their programs by providing
technical assistance and consultation. They are also responsible
for coordinating a peer review process utilizing staff from the
local agencies to conduct quality assurance reviews of other
local health department staffs. District employees are hired and
supervised at the state level. There are no patient services
from the district offices. The following is a list of programs
representative of the district office advisory and administrative
staff:
Communicable Diseases
Immunizations
Crippled Children Program
MCH/WIC
Dental
Sexually Transmitted Diseases
Occupational Health
Nutrition
Environmental Health
E. State-local Liaison
Shared Organizational Control, Formal Liaison Function
The Bureau of Local Health Departments fulfills the state-local
liaison function for the SHA. In this role its serves as the
primary focus for communications between the SHA and the local
health departments.
The interaction between state and local public health agencies in
Ohio may be characterized as shared organizational control.
Under this arrangement, local health departments are under the
authority of the SHA, as well as the local government and board
of health.
F. Budget
Total FY 1988 Ohio SHA expenditures were $182,966,000. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $114,355,000
State Funds $40,469,000
Local Funds 0
Fees and Reimbursements $27,992,000
Other $151,000
3III. Local Public Health Agencies (LPHAs)
A. General
There are currently 153 LPHAs in Ohio which include 25 county, 63
city-county, and 65 city health departments. Ohio uses the word
"district" to denote all local health departments (county, city
or combined district). LPHAs receive money from the state on a
competitive basis according to their need. The state determines
how this money is to be spent.
B. Services Provided
The following information on services provided by local health
departments in Ohio is derived from a survey conducted by NACHO
during 1989. One hundred and forty-nine of the 153 local health
departments in Ohio responded to the survey. Services provided
by 70 percent of health departments in the state responding to
the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 46 ( 30.9%)
2. Morbidity Data 81 ( 54.4%)
3. Reportable Diseases 133 ( 89.3%)
4. Vital Records and Statistics 130 ( 87.2%)
B. Epidemiology/Surveillance
1. Chronic Diseases 90 ( 60.4%)
2. Communicable Diseases 137 ( 91.9%)
II. Policy Development
A. Health Code Dev. and Enforcement 116 ( 77.9%)
B. Health Planning 88 ( 59.1%)
C. Priority Setting 82 ( 55.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 118 ( 79.2%)
2. Health Facility Safety/Quality 94 ( 63.1%)
3. Rec. Facility Safety/Quality 121 ( 81.2%)
4. Other Facility Safety/Quality 49 ( 32.9%)
B. Licensing
1. Health Facilities 61 ( 40.9%)
2. Other Facilities 141 ( 94.6%)
C. Health Education 122 ( 81.9%)
D. Environmental
1. Air Quality 36 ( 24.2%)
2. Hazardous Waste Management 70 ( 47.0%)
3. Individual Water Supply Safety 114 ( 76.5%)
4. Noise Pollution 17 ( 11.4%)
5. Occupational Health and Safety 33 ( 22.1%)
6. Public Water Supply Safety 78 ( 52.3%)
7. Radiation Control 31 ( 20.8%)
8. Sewage Disposal Systems 118 ( 79.2%)
9. Solid Waste Management 116 ( 77.9%)
10. Vector and Animal Control 139 ( 93.3%)
11. Water Pollution 91 ( 61.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 30 ( 20.1%)
2. Alcohol Abuse 26 ( 17.4%)
3. Child Health 127 ( 85.2%)
4. Chronic Diseases 95 ( 63.8%)
5. Dental Health 48 ( 32.2%)
6. Drug Abuse 30 ( 20.1%)
7. Emergency Medical Service 11 ( 7.4%)
8. Family Planning 47 ( 31.5%)
9. Handicapped Children 113 ( 75.8%)
10. Home Health Care 70 ( 47.0%)
11. Hospitals 12 ( 8.1%)
12. Immunizations 141 ( 94.6%)
13. Laboratory Services 52 ( 34.9%)
14. Long-term Care Facilities 5 ( 3.4%)
15. Mental Health 11 ( 7.4%)
16. Obstetrical Care 21 ( 14.1%)
17. Prenatal Care 63 ( 42.3%)
18. Primary Care 42 ( 28.2%)
19. Sexually Transmitted Diseases 102 ( 68.5%)
20. Tuberculosis 104 ( 69.8%)
21. WIC 82 ( 55.0%)
C. Local Health Officer
No M.D. Requirement, District Board of Health Appointment
Local health officers in Ohio are called Commissioners of
Health. They are appointed by the district board of health to
terms not to exceed 5 years. Commissioners must be a licensed
physician, a licensed dentist, a licensed veterinarian,
chiropractor, podiatrist, or the holder of a master's degree in
public health, or related health field as determined by the board
of health. The commissioner serves as the secretary and chief
executive officer of the board of health. Commissioners are
responsible for carrying out all orders of the board of health
and for enforcing all sanitary laws and regulations in the
district. If the commissioner is not a physician, the board is
responsible for employing a medical director to provide adequate
medical direction.
D. Local Board of Health
Advisory
In Ohio the state is divided into health districts. Cities
constitute city districts, and the townships and villages in each
county are combined into what is known as general health
districts. In these districts the board of health consists of
five members who are appointed by the district advisory council.
The law stipulates that one member of the board must be a
physician and that appointments will be made with due regard to
equal representation of all parts of the district. The board
members are appointed for 5-year terms of office. Original
appointments to the board were made in such a way to ensure that
the term of office of one member expires each year. In city
health districts the legislative authority of the city is
authorized to establish a board of health. The board consists of
five members appointed by the mayor and confirmed by the
legislative authority. The term of office is 5 years. As with
the general health districts, the original appointments were made
so that one member's term of office expires each year. Two or
more health districts, city or general districts, may combine to
form one combined health district. This district can establish a
board of health with the number of members, terms of office and
method of appointment established in the contract between the
jurisdictions that are combining.
Each board of health is responsible for the administration and
management of the local health department in a manner that should
ensure that the local health department plans, organizes,
manages, and coordinates health needs of the population in an
effective manner. Boards of health have specific responsibility
to study and record the prevalence of disease and provide for
prompt diagnosis and control of communicable diseases. Boards
may also provide the following: medical and dental supervision
of school children; free treatment for venereal diseases;
inspection of schools, public institutions, jails, workhouses,
children's homes, infirmaries, county homes, and other
charitable, benevolent and correctional institutions; inspection
of dairies, stores, restaurants, hotels and other places where
food is manufactured, handled, stored, or sold; inspection and
abatement of nuisances to public health; and taking such steps as
necessary to protect the public and prevent disease.
E. Staff
LPHA staffs are employed and supervised at the local level. The
number of staff for a local health department ranges from 4 to
315.
F. Budget
Total FY 1988 expenditures were $147,948,000. Total FY 1988
United States LPHA were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $32,642,000
State Funds $3,551,000
Local Funds $73,900,000
Fees and Reimbursements $36,931,000
Other Sources 0
Source Unknown $924,000
The SHA reported that these figures include the total amount of
additional local health department monies expended by all local
health departments in the state.
2Ohio Department of Health, 1990
Public Health Council
Board of Examiners of Nursing Home Administrators
Hearing Aid Dealers and Fitters Licensing Board
Chief of Staff
Minority Affairs and Compliance
Health Policy and Analysis
Personnel Services
Health Resources
Internal Audit Unit
Legislative Affairs
Legal Services
Budget Policy
Public Affairs
Assistant Director
Employee Assistance Program
Division of Preventive Medicine
Bureau of Communicable Diseases
Bureau of Chronic Diseases
Bureau of Occupational Health
Bureau of Health Promotion and Education
Bureau of Epidemiology and Toxicology
Division of Environmental Health
Bureau of Technical Environmental Health
Bureau of Local Environmental Health Services
Bureau of State Environmental Health Services
Division of Administrative Services
Bureau of Data Services
Bureau of Purchasing Management Services
Bureau of District and Facilities Management
Bureau of Fiscal Management
Bureau of Vital Statistics
Division of Maternal and Child Health
Bureau for Children with Medical Handicaps
Bureau of Maternal and Child Health
Bureau of Dental Health
Bureau of Women, Infants and Children
Division of Medical Services
Bureau of Adult Care Facilities and Rest Homes
Bureau of Enforcement
Bureau of Medicare and Medical Certification
Division of Supportive Services
Bureau of Local Health Departments
Bureau of Nursing
Bureau of Public Health Laboratories
Bureau of Nutrition
Migrant Breast Center
Bureau of Employee Health
2Types of Local Health Departments by Jurisdiction
Ohio, 1990
Jurisdiction Co C C/Co
Adams X
Akron X
Allen X
Alliance X
Ashland X
Ashland X
Ashtabula X
Ashtabula X
Athens X
Auglaize X
Barberton X
Bellaire X
Bellevue X
Belmont X
Belpre X
Bexley X
Brown X
Bryan X
Bucyrus X
Butler X
Campbell X
Canton X
Carroll X
Champaign X
Cincinnati X
Clark X
Clermont X
Cleveland X
Cleveland Hts X
Clinton X
Columbiana X
Columbus X
Conneaut X
Coshocton X
Coshocton X
Crawford X
Cuyahoga X
Defiance X
Delaware X
Drake X
East Cleveland X
East Liverpool X
East Palestine X
Elyria X
Erie X
Fairfield X
Fayette X
Findlay X
Franklin X
Fulton X
Galion X
Gallia X
Gallipolis X
Geauga X
Giard X
Grandview Hts X
Greene X
Guernsey X
Hamilton X
Hamilton X
Hancock X
Hardin X
Harrison X
Henry X
Highland X
Hocking X
Holmes X
Huron X
Indian Hill X
Ironton X
Jackson X
Jefferson X
Kent X
Knox X
Lake X
Lakewood X
Lancaster X
Lawrence X
Licking X
Logan X
Lorain X
Lorain X
Lucas X
Madison X
Mahoning X
Marietta X
Marion X
Marion X
Martins Ferry X
Massillon X
Medina X
Meigs X
Mercer X
Miami X
Middletown X
Mingo Junction X
Monroe X
Montgomery X
Morgan X
Morrow X
Muskingum X
New Carlisle X
New Philadelphia X
Newark X
Niles X
Noble X
Norwood X
Oakwood X
Ottawa X
Paulding X
Perry X
Pickaway X
Pike X
Piqua X
Portage X
Portsmouth X
Preble X
Putnam X
Ravenna X
Reading X
Richland X
Ross X
Salem X
Sandusky X
Scioto X
Seneca X
Shaker Hts X
Sharonville X
Shelby X
Shelby X
Springdale X
Springfield X
St. Bernard X
Stark X
Struthers X
Stubenville X
Summit X
Toledo X
Toronto X
Troy X
Trumbull X
Tuscarawas X
Union X
Upper Arlington X
Van Wert X
Vinton X
Warren X
Warren X
Washington X
Wayne X
Wellsville X
Williams X
Wood X
Wyandot X
Youngstown X
Co = County HD
C = City HD
C/Co = City/County HD
1OKLAHOMA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 3,242,000 245,803,000
Population Density (1988) 47.2 69.4
(per/sq.mi.)
Number of Counties 77 3,139
Median Age 31.3 31.7
Percent Below Poverty Level (1985) 16.1 14.0
(persons)
Percent of Population Rural (1980) 33.0 26.0
Percent of Population White (1980) 85.9 83.1
Percent of Population Non-white (1980) 14.1 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The Oklahoma Constitution and Statutes provide authority and
establish the framework for county governments.
Commission Form - (77) - All counties use this form of government
and have three-member boards. Each commissioner is elected from
one of the equally populated districts that make up the counties.
The boards of commissioners serve as the administrative and
executive bodies for the counties.
The counties are administrative arms of the state, with services
and responsibilities established by the state. There is no
authority for home rule, charters or other alternative forms of
county governments.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Oklahoma State Department of Health, the SHA, is a
free-standing, independent agency. The mission of the SHA is to
Data for this state were updated October 1990. promote health and
prevent disease among the citizens of Oklahoma.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in State
State Professions Licensing Agency (for plumbers,
electricians and professional counselors)
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The Commissioner of Health is the Chief Executive Officer of the
SHA. The Commissioner is appointed by the State Board of Health
and serves at their pleasure. Duties of the Commissioner include
general supervision of health and appointing authority of the
agency in hiring staff. The Commissioner also investigates,
inspects and enforces the Public Health Code, rules, and
regulations of the Board of Health; and serves as official chief
health officer of the state.
C. State Board of Health/Council
Policy-making
The State Board of Health is composed of nine members appointed
by the Governor and confirmed by the Senate for 9-year terms of
office. They represent geographic regions of the state. At
least four members must be licensed physicians and members of the
Oklahoma State Medical Association. One member must be a
psychiatrist and represent the state "at large." Responsibilities
of the Board include adopting rules, regulations, and standards;
accepting and dispersing grants, allotments, gifts, and
appropriations; and establishing the organizational lines of the
agency necessary to carry out the provisions of the Public Health
Code.
D. Regional/District Health Offices
The only regions or districts that exist are informal in nature
and subject to constant change. There are no regional offices.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
County health agencies which are not city-county health agencies
are under the Deputy Commissioner for Local Health and local
boards of health. Regional administrators serve as liaison and
managers. City-county health agencies are decentralized but
follow the State Board of Health rules and standards.
The interaction between state and local public health agencies in
Oklahoma may be characterized as mixed centralized and
decentralized organizational control. Mandated local health
services may be provided by the SHA in some jurisdictions.
F. Budget
Total FY 1988 SHA expenditures were $89,781,789*. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $34,225,887
State Funds $33,389,014
Local Funds $14,235,314
Fees and Reimbursements $7,931,574
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
There are 69 local health departments in Oklahoma. Sixty-seven
are county health departments and two are city-county health
departments.
Oklahoma counties are entitled to services required by statute;
however, only those counties which elect to support a
comprehensive local health department (those that provide a wide
range of services), with up to 2.5 mills on property or funds
from the county treasury, have complete services. To date, 69 of
the 77 counties have comprehensive health departments. The
remaining eight counties have no health departments but do have
county superintendents of health, appointed by the Commissioner
of Health. Any public health services available to these
counties are provided by neighboring counties or the SHA.
* These data were provided by the SHA. They exclude WIC Federal
funds and Tulsa and Oklahoma city-county health departments.
Every county with a comprehensive local health department has a
local medical director appointed by the Commissioner. The local
administrators, who manage the day-to-day activities of the
department, are responsible for a regional function covering
multiple counties (average three). Except for "autonomous"
counties (Oklahoma and Tulsa), the authority is centralized in
the SHA.
Counties with more than 225,000 population are considered
"autonomous" counties and have free-standing health departments
that are semi-autonomous from the SHA. Oklahoma and Tulsa
counties fall into this category.
B. Services Provided
The following information on services provided by local health
departments in Oklahoma was obtained from the SHA.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment -
2. Morbidity Data -
3. Reportable Diseases 69 (100.0%)
4. Vital Records and Statistics 69 (100.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases 69 (100.0%)
2. Communicable Diseases 69 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 69 (100.0%)
B. Health Planning -
C. Priority Setting 69 (100.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 69 (100.0%)
2. Health Facility Safety/Quality 69 (100.0%)
3. Rec. Facility Safety/Quality 69 (100.0%)
4. Other Facility Safety/Quality -
B. Licensing
1. Health Facilities -
2. Other Facilities -
C. Health Education 69 (100.0%)
D. Environmental
1. Air Quality -
2. Hazardous Waste Management -
3. Individual Water Supply Safety 69 (100.0%)
4. Noise Pollution -
5. Occupational Health and Safety -
6. Public Water Supply Safety 69 (100.0%)
7. Radiation Control -
8. Sewage Disposal Systems 69 (100.0%)
9. Solid Waste Management 69 (100.0%)
10. Vector and Animal Control 69 (100.0%)
11. Water Pollution -
E. Personal Health Services
1. AIDS Testing and Counseling 69 (100.0%)
2. Alcohol Abuse -
3. Child Health 69 (100.0%)
4. Chronic Diseases 69 (100.0%)
5. Dental Health -
6. Drug Abuse -
7. Emergency Medical Service -
8. Family Planning 69 (100.0%)
9. Handicapped Children -
10. Home Health Care -
11. Hospitals -
12. Immunizations 69 (100.0%)
13. Laboratory Services -
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care 69 (100.0%)
18. Primary Care 69 (100.0%)
19. Sexually Transmitted Diseases 69 (100.0%)
20. Tuberculosis 69 (100.0%)
21. WIC 69 (100.0%)
C. Local Health Officer
M.D. Requirement, Commissioner Appointment
Local health officers, roughly synonymous with Medical Directors,
are appointed and supervised by the Commissioner of Health.
Their duties are to abolish nuisances, control disease, prevent
the spread of disease, enforce health regulations, and perform
other duties and functions as may be required by the
Commissioner. If the local health officer serves less than full
time (and they all do except in the "autonomous" counties), the
Commissioner may delegate nonmedical administrative duties to
another employee of the county, the administrative director. The
local health officer relates primarily to staff, while the
administrative director deals directly with the local board, the
county government and the state.
D. Local Board of Health
Policy-making
The local board of health in all counties except "autonomous"
counties consists of five members. Board members are appointed
by a variety of different people. Two members are appointed by
the Commissioner of Health. One member who must be a school
administrator is appointed by the county judge. County
commissioners appoint two members, one of whom is a medical
person and another person who serves at the pleasure of the
county commissioners and is usually a county commissioner. All
members serve 4-year terms, except for the latter appointment
which has no specific term of office. The two "autonomous"
counties have 9-member boards and are autonomous from the SHA
except that they must follow the rules and regulations of the
State Board of Health and the qualifications of the members must
be approved by the Commissioner of Health. The local board must
meet at least twice a year. The duties of the board include
calling for the election of a local health department;
responsibility for maintaining a local health department;
responsibility for preparing and submitting to the County Excise
Board a request for local funds to operate the department; and
advising the SHA of health matters. Local boards may also adopt
regulations that are subject to approval by the Commissioner and
consistent with the state law and State Board of Health
regulations.
E. Staff
Local staffs are considered to be state employees, although the
actual salary may come from a combination of many sources. All
personnel actions are approved by the Commissioner of Health.
Candidates for employment at local health departments are
interviewed by local staff with central office oversight.
Although in "autonomous" counties the staff is employed and
supervised by the local management, these counties do use the job
specifications that the state has established. The number of
employees for local health departments ranges from 6 to 185.
F. Budget
Total FY 1988 LPHA expenditures were $49,125,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $8,028,000
State Funds $17,373,000
Local Funds $21,494,000
Fees and Reimbursements $2,172,000
Other Sources $58,000
Source Unknown 0
The SHA reported that these figures include the total of
additional local health department monies expended by all local
health departments.
2Oklahoma State Department of Health, 1990
State Board of Health
Commissioner of Health
Health Planning Services
Personal Health Services
Deputy Commissioner
Chronic Disease Service
Dental Service
Epidemiology Services
Health Education and Information Service
Laboratory Service
Maternal and Child Health Services
Nutrition/WIC Service
Local Health Services
Deputy Commissioner
Medical Consultant
Local Health Administration
Child Guidance Services
Nursing Services
Professional Counselors' Licensing
Administrative Services
Deputy Commissioner and State Registrar
Central Services Division
Fiscal Service
Personnel Services
Vital Records
Special Health Services
Deputy Commissioner
Long-Term Care Services
Medical Facilities Service
Eldercare Services
Certificate of Need Division
Environmental Health Services
Deputy Commissioner
Air Quality Service
Food Protection Service
General Environmental Services
Occupational Licensing Service
Radiation and Special Hazards Service
State Environmental Laboratory Service
Waste Management Service
Water Quality Service
2Types of Local Health Departments by Jurisdiction
Oklahoma, 1990
Jurisdiction Co C/Co N/Co
Adair X
Alfalfa X
Beaver
Beckham X
Blaine X
Bryan X
Caddo X
Canadian X
Carter X
Cherokee X
Choctaw X
Cimarron X
Cleveland X
Coal X
Comanche X
Cotton X
Craig X
Creek X
Custer X
Delaware X
Dewey X
Ellis X
Garfield X
Garvin X
Grady X
Grant X
Greer X
Harmon X
Harper X
Haskell X
Hughes X
Jackson X
Jefferson X
Johnston X
Kay X
Kingfisher X
Kiowa X
Latimer X
LeFlore X
Lincoln X
Logan X
Love X
Major X
Marshall X
Mayes X
McClain X
McCurtain X
McIntosh X
Murray X
Muskogee X
Noble X
Nowata X
Okfuskee X
Oklahoma City C X
Okmulgee X
Osage X
Ottawa X
Pawnee X
Payne X
Pittsburg X
Pontotoc X
Pottawatomie X
Pushmataha X
Roger Mills X
Rogers X
Seminole X
Stephens X
Swquoyah X
Texas X
Tillman X
Tulsa City Co X
Wagoner X
Washata X
Washington X
Woods X
Woodward X
Co = County HD
C/Co = City/County HD
N/Co = No County HD
1OREGON
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) * 2,741,000 245,803,000
Population Density (1988) * 28.5 69.4
(per/sq.mi.)
Number of Counties 36 3,139
Median Age (1987) 32.6 31.7
Percent Below Poverty Level (1985) 11.9 14.0
(persons)
Percent of Population Rural (1980) 32.0 26.0
Percent of Population White (1980) 94.6 83.1
Percent of Population Non-white (1980) 5.4 16.9
Median Years of Education (1980) 12.7 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for county governments in Oregon are
established in the state constitution and statutes. Oregon
counties operate either under General Law or Home Rule Charters.
General Law - (29) - These counties have governments that operate
under provision of General Law. Fifteen of these have a
commission and 13 functions with a county court system made up of
a county judge and 2 commissioners. The judge has administrative
responsibilities for the county functions, as well as juvenile
court and probate responsibilities. Five of the General Law
counties have appointed a county administrator to assist the
board.
Home Rule Charters - (7) - Home rule provisions in the
constitution permit counties to adopt, amend, or repeal
charters. The legislative body is made up of three- or
five-member boards of commissioners who are elected at large,
from single-member districts or by a combination of methods.
Five charter counties have appointed an administrative officer.
Multnomah County has a board chair who is elected at large and
has administrative responsibility.
* These data were provided by the SHA.
Data for this state were updated November 1990.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Health Division is the SHA in Oregon. It is a component of a
superagency called the Department of Human Resources. Functions
of the Health Division are, for the most part, supportive to
county and regional health departments. Local health agencies
have primary obligation for the direct delivery of public health
services to Oregon's population. The Division's broad mission is
to protect, preserve, and promote the health of all Oregonians.
Its main functions include: monitoring the health of the public;
monitoring the activities of businesses whose practices may
affect the health of all citizens through licensing/certification
or a permit system; establishing standards and priorities for
public health services by working with local health departments
that provide the majority of direct public health services;
providing health information to a wide variety of individuals and
health providers for the purposes of health planning, treatment,
services development, and evaluation.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The Administrator of the Health Division is head of the SHA.
This official is appointed by the Director of the Department of
Human Resources. If the Administrator is a physician, he may
also be the State Public Health Officer. If the Administrator is
a non-physician, however, he/she appoints the State Health
Officer who also serves as Deputy Administrator of the Health
Division and is responsible for the medical and paramedical
aspects of health programs.
C. State Board of Health/Council
Advisory
Oregon has a Public Health Advisory Board which consists of 15
members appointed by the Governor for 4-year terms. The board
serves as an advisory body to the Assistant Director for Health
by reviewing statewide health issues and participating in public
health policy development.
D. Regional/District Health Offices
The Health Division has no regional or district offices.
E. State-local Liaison
Decentralized Organizational Control, No Formal Liaison Function
There is not an individual or office that has responsibility for
liaison between the SHA and local health departments. However,
there are organizations that provide this function. The
Conference of Local Health Officials, which is authorized by
statute, consists of all local health officers, public health
administrators, nursing directors, and supervising sanitarians.
The Conference executive committee, with the chairperson, advises
the assistant director for health on implementing Oregon's public
health laws and the rules of the Health Division. In addition,
the Public Health Management Council, an unofficial group of
local public health administrators, advises the assistant
director for health on state and local health program direction
and administration.
The interaction between state and local public health agencies in
Oregon may be characterized as decentralized organizational
control. Under this arrangement local governments directly
operate health departments with or without a local board of
health.
F. Budget
Total FY 1988 SHA expenditures were $39,106,000*. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants $25,174,000*
State Funds $8,491,000
Local Funds 0
Fees and Reimbursements 0
Other $5,441,000*
* These data were provided by the SHA.
3III. Local Public Health Agencies (LPHAs)
A. General
Oregon has 34 local public health departments. These consist of
33 county health departments and 1 multicounty health department
(regional health department) that covers 2 rural counties (Wasco
and Sherman). In two counties (Columbia, Wheeler) the local
government contracts with private health clinics to perform as
the health department. One county (Gilliam) has no health
department.
While the Health Division is responsible for overseeing the
expenditures of Federal and state public health funds, the
relationship between local health departments and the SHA is
mainly one of consultation and periodic performance review.
Funding called State Support for Public Health is provided to
local health departments if they have services in the following
mandated areas: communicable disease control; parent and child
health (including family planning); health information and
referral; vital statistics; and environmental health. The
current level of funding is 55 cents per capita. Counties which
provide only part of the required services receive funding
proportional to the services they provide.
B. Services Provided
The following information on services provided by local health
departments in Oregon is derived from a survey conducted by NACHO
during 1989. Thirty-three of the 35 local health departments in
Oregon responded to the survey. Services provided by 70 percent
of health departments in the state responding to the survey are
underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 8 ( 24.2%)
2. Morbidity Data 23 ( 69.7%)
3. Reportable Diseases 33 (100.0%)
4. Vital Records and Statistics 31 ( 93.9%)
B. Epidemiology/Surveillance
1. Chronic Diseases 9 ( 27.3%)
2. Communicable Diseases 32 ( 97.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 19 ( 57.6%)
B. Health Planning 27 ( 81.8%)
C. Priority Setting 22 ( 66.7%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 16 ( 48.5%)
2. Health Facility Safety/Quality 7 ( 21.2%)
3. Rec. Facility Safety/Quality 14 ( 42.4%)
4. Other Facility Safety/Quality 6 ( 18.2%)
B. Licensing
1. Health Facilities 1 ( 3.0%)
2. Other Facilities 19 ( 57.6%)
C. Health Education 26 ( 78.8%)
D. Environmental
1. Air Quality 11 ( 33.3%)
2. Hazardous Waste Management 17 ( 51.5%)
3. Individual Water Supply Safety 20 ( 60.6%)
4. Noise Pollution 4 ( 12.1%)
5. Occupational Health and Safety 2 ( 6.1%)
6. Public Water Supply Safety 18 ( 54.5%)
7. Radiation Control 4 ( 12.1%)
8. Sewage Disposal Systems 15 ( 45.5%)
9. Solid Waste Management 15 ( 45.5%)
10. Vector and Animal Control 16 ( 48.5%)
11. Water Pollution 15 ( 45.5%)
E. Personal Health Services
1. AIDS Testing and Counseling 33 (100.0%)
2. Alcohol Abuse 7 ( 21.2%)
3. Child Health 28 ( 84.8%)
4. Chronic Diseases 14 ( 42.4%)
5. Dental Health 8 ( 24.2%)
6. Drug Abuse 8 ( 24.2%)
7. Emergency Medical Service 7 ( 21.2%)
8. Family Planning 31 ( 93.9%)
9. Handicapped Children 11 ( 33.3%)
10. Home Health Care 4 ( 12.1%)
11. Hospitals -
12. Immunizations 33 (100.0%)
13. Laboratory Services 20 ( 60.6%)
14. Long-term Care Facilities -
15. Mental Health 9 ( 27.3%)
16. Obstetrical Care 5 ( 15.2%)
17. Prenatal Care 29 ( 87.9%)
18. Primary Care 10 ( 30.3%)
19. Sexually Transmitted Diseases 32 ( 97.0%)
20. Tuberculosis 33 (100.0%)
21. WIC 29 ( 87.9%)
Because the statute does not spell out the elements of the
required environmental health services, and because the licensing
fees collected are not sufficient to support the program, some
rural counties do not provide any environmental health services
beyond nuisance follow-up services. In these counties the Health
Division provides minimal services to assure safe public food and
water supplies.
C. Local Health Officer
M.D. or D.O. Requirement, Local Governing Body Appointment
Each county is required by statute to have a licensed medical
doctor as the local health officer. The Conference of Local
Health Officials developed model standards for health officer
responsibilities and qualifications. The health officer must be
licensed in Oregon as a medical doctor or doctor of osteopathy,
have 2 years of practice as a licensed physician, and have
training and/or experience in epidemiology or public health.
Duties for the health officer include the following: provide
medical direction for clinical activities, including developing
and signing standing orders and protocols; provide consultation
on medical issues to health department personnel; act as liaison
between local health department and local medical community; may
provide direct clinical service; promote public health in the
community; and represent the agency to community groups, other
agencies, and the media. The scope of health officer services
varies widely, usually in relation to the size of the county
health department. Rural counties receive very limited health
officer time--in some cases only 1-2 hours per week. There are
three full-time health officers in Oregon, and one of these is
also the administrator of a health department.
D. Local Board of Health
Policy-making
In most counties the Board of Commissioners declared themselves
the local board of health, in addition to being the statutory
local health authority. This eliminated the administrative and
budgetary confusion created by having two bodies legally
responsible for public health matters in the county. The few
boards of health that continue to exist as separate entities are
advisory only and relate primarily to the public health
administrator.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdiction. The number of full-time
employees for local health departments ranges from 1 to 388.
F. Budget
Total FY 1988 LPHA expenditures were $34,265,494*. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts,
State Funds $11,796,152*
Local Funds, Fees and
Reimbursements $21,243,031*
Other Sources $1,226,314*
Source Unknown 0
The SHA reported that there were additional fees and
reimbursements not retained by the local health departments, but
which reverted to the general revenues of the local or state
* These data were provided by the SHA.
2Oregon State Health Division, 1990
Administrator
Executive Assistant
Oregon Health 2000
Deputy Administrator/State Health Officer
Administrative Services
Licensing Boards
Fiscal Services
Information Systems
Personnel
Purchasing/Services
State Medical Examiner
Environmental Health
Drinking Water Systems
Emergency Medical Services and Injury Prevention
Environmental Services and Consultation
Health Care Survey Section
Radiation Control
Epidemiology and Health Statistics
Center for Health Statistics
Communicable Diseases
Non-Communicable Diseases
Sexually Transmitted Diseases
Health Services
Family Planning/Adolescent Health
Field Services
Maternal/Child Dental Health
Immunizations
Women, Infants and Children
Minority Health
Public Health Laboratory
General Microbiology
Laboratory Support
Newborn Screening
Quality Assurance and Consultation
Virology/Immunology
2Types of Local Health Departments by Jurisdiction
Oregon, 1990
Jurisdiction Co M/Co N/Co
Baker X
Benton X
Clackamas X
Clatsop X
Columbia X
Coos X
Crook X
Curry X
Deschutes X
Douglas X
Gilliam X
Grant X
Harney X
Hood River X
Jackson X
Jefferson X
Josephine X
Klamath X
Lake X
Lane X
Lincoln X
Linn X
Malheur X
Marion X
Morrow X
Multomah X
Polk X
Sherman X
Tillamook X
Umatilla X
Union X
Wallowa X
Wasco X
Washington X
Wheeler X
Yamhill X
Co = County HD
M/Co = Multicounty HD
N/Co = No County HD
1PENNSYLVANIA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 12,002,000 245,803,000
Population Density (1988) 267.4 69.4
(per/sq.mi.)
Number of Counties 67 3,139
Median Age (1987) 33.8 31.7
Percent Below Poverty Level (1985) 10.5 14.0
(persons)
Percent of Population Rural (1980) 31.0 26.0
Percent of Population White (1980) 89.8 83.1
Percent of Population Non-white (1980) 10.2 16.9
Median Years of Education (1980) 12.4 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The Pennsylvania Constitution and Statutes provide a basis for
the structure and function of county governments in the
commonwealth. The counties may select one of three variations in
government structure. The choices are Commission, Home Rule
Charter, and Optional County Plan.
Commission Form - (61) - These counties have three-member boards,
elected at large, which are delegated executive, administrative
and legislative powers. Four of the commission counties have
appointed an administrator. In some counties the chief clerk has
been given responsibility for many administrative duties.
Several counties have restructured the chief clerk position to
increase the responsibility and make the position similar to that
of an administrator, but with fewer responsibilities.
Home Rule Charter - (6) - In 1972 the legislature enacted
provisions for Home Rule Charters and the Optional County Plan.
Adoption of home rule can begin with action by the county
commission or by a citizens' referendum.
Optional County Plan - (0) - At the present time, no counties
have adopted the Optional County Plan.
Data for this state were updated October 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The SHA is an independent, free-standing agency known as the
Pennsylvania Department of Health (PDH). Department functions
are divided among the following five Deputy Secretaries: Deputy
Secretary for Public Health Programs; Deputy Secretary for Drug
and Alcohol Programs; Deputy Secretary for Administration; Deputy
Secretary for Community Health; and Deputy Secretary for Planning
and Quality Assurance. The mission of the PDH is to develop an
effective public health system which promotes the optimal health
of Pennsylvania's citizens and reduces their need for medical
care by the following means:
Assisting citizens to adopt healthful behaviors
Eliminating preventable illnesses
Reducing the severity of illness and disability
Facilitating access to high quality health care in the
appropriate setting
Identifying and eliminating health hazards
The following are some broad areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
Some other areas of responsibility for the SHA include
communicable and non-communicable disease investigation and
control, statewide implementation of maternal and child health
programs, and state agency for drug and alcoholism programs.
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The head of the PDH is the Secretary of Health. The Secretary is
a cabinet-level officer appointed by the Governor. Requirements
are an M.D. degree and at least 10 years' experience. The
Secretary's duties are to protect the health of the people of the
state, and to determine and deploy the most efficient and
practical means for the preventing and suppressing disease.
C. State Board of Health/Council
Advisory
PDH has an Advisory Health Board which consists of the Secretary
of Health, who serves as chair, and 12 other members, including
at least 5 licensed physicians, 1 licensed dentist, 1 licensed
pharmacist, 1 licensed RN, 1 engineer registered with the
commonwealth, and 3 other individuals. The board is appointed by
the Governor and has the following duties and responsibilities:
advise the Secretary of Health; make rules and regulations deemed
necessary for disease prevention, health protection, and for
efficient operation of the Department; prescribe minimum health
activities and minimum standards of performance of health
services for counties or other political subdivisions.
D. Regional/District Health Offices
The PDH has the authority, with approval of the Governor, to
divide the commonwealth into health districts and to appoint a
health officer for each district. The District Health Officer
reports to the Deputy Secretary for Community Health and is
responsible for implementing delegated programs and activities.
The commonwealth is divided into 6 health service districts, for
operating the 62 state health centers in those counties that do
not operate their own health agency. The following list
represents the organization and the principal positions for the
district health offices:
District Executive Director
Health Educator
Nursing Services
District Nurse Administrator
Community Health Nurse Supervisors
Diabetes Facilitator
Program Services
District Epidemiology Program Services Supervisor
Chronic Disease Representative(s)
Tuberculosis Representative
Immunization Representative
Sexually Transmitted Disease Representative(s)
Consultant Services
District Medical Director
Dental Hygienist
Environmental Health Specialist
Nutritionist
Physical Therapist
Administrative Services
Administrative Officer
District Office Secretaries
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The Deputy Secretary for Community Health serves as the liaison
between the SHA and local health agencies. In this capacity the
Deputy Secretary serves as a primary communication point between
local health and the SHA. Communications and discussions between
district directors, city and county health departments, and the
SHA are facilitated through meetings organized by the Deputy
Secretary to discuss policy, standards, and operations.
Additionally, the Deputy Secretary appoints committees and
workgroups from the local health officials to deal with important
issues facing the public health community.
The Deputy Secretary for Community Health directly supervises the
six district offices and the 62 state health centers, wherein the
state assumes major responsibility for public health functions.
In the remaining counties, county health departments assume this
role under enabling legislation. The Deputy Secretary for
Community Health establishes required program standards, monitors
program activities and approves funding to qualifying agencies.
The interaction between state and local public health agencies in
Pennsylvania may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement
public health services in Pennsylvania may be provided by the SHA
in some jurisdictions and by local government units, boards of
health, or health departments in other jurisdictions.
F. Budget
Total FY 1988 SHA expenditures were $265,948,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $119,659,000
State Funds $142,231,000
Local Funds 0
Fees and Reimbursements $4,058,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
There are 70 LPHAs in Pennsylvania which provide a wide range of
services. These LPHAs fall into two different groups. The first
of these groups is known as local health departments. These
health units are semi-autonomous from the state and serve
counties, cities, and city/county jurisdictions. Currently there
are eight of these units. They consist of one city-county, three
city, and four county health departments. An additional county
health department is scheduled to begin operation in 1991, when
Montgomery County begins functioning. These health departments
must meet established standards and provide certain mandated
services. Upon meeting established requirements, the local
health departments are eligible for financial support from the
state in the form of matching funds. They can receive up to
$4.50 per capita for health and an additional $1.50 per capita
for environmental health.
The second type of LPHA is the State Health Center System. Each
county in the state that is not served by a local health
department is served by a unit of the State Health Center
System. There are 62 service units in the State Health Center
System. This system is funded entirely by the state and staffed
and administered by state employees. These units are divided
into six administrative districts.
A third type of LPHA exists in the state, which is made up of
boards of health and health officers from boroughs, townships and
cities. The 240 units in this category do not receive funds from
the state and are generally autonomous from the PDH in their
operation and services. They have a limited number of staff and
services.
B. Services Provided
The following information on services provided by local health
departments in Pennsylvania is derived from a survey conducted by
NACHO during 1989. Since only 7 of the 68 health departments in
Pennsylvania responded to the survey, the results may not be
representative of the total state. Services provided by 70
percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 4 ( 57.1%)
2. Morbidity Data 6 ( 85.7%)
3. Reportable Diseases 7 (100.0%)
4. Vital Records and Statistics 2 ( 28.6%)
B. Epidemiology/Surveillance
1. Chronic Diseases 6 ( 85.7%)
2. Communicable Diseases 7 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 7 (100.0%)
B. Health Planning 7 (100.0%)
C. Priority Setting 6 ( 85.7%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 7 (100.0%)
2. Health Facility Safety/Quality 6 ( 85.7%)
3. Rec. Facility Safety/Quality 6 ( 85.7%)
4. Other Facility Safety/Quality 3 ( 42.9%)
B. Licensing
1. Health Facilities 2 ( 28.6%)
2. Other Facilities 7 (100.0%)
C. Health Education 7 (100.0%)
D. Environmental
1. Air Quality 3 ( 42.9%)
2. Hazardous Waste Management 4 ( 57.1%)
3. Individual Water Supply Safety 5 ( 71.4%)
4. Noise Pollution 2 ( 28.6%)
5. Occupational Health and Safety 1 ( 14.3%)
6. Public Water Supply Safety 4 ( 57.1%)
7. Radiation Control 3 ( 42.9%)
8. Sewage Disposal Systems 5 ( 71.4%)
9. Solid Waste Management 5 ( 71.4%)
10. Vector and Animal Control 7 (100.0%)
11. Water Pollution 5 ( 71.4%)
E. Personal Health Services
1. AIDS Testing and Counseling 7 (100.0%)
2. Alcohol Abuse 2 ( 28.6%)
3. Child Health 7 (100.0%)
4. Chronic Diseases 7 (100.0%)
5. Dental Health 2 ( 28.6%)
6. Drug Abuse 2 ( 28.6%)
7. Emergency Medical Service 3 ( 42.9%)
8. Family Planning 1 ( 14.3%)
9. Handicapped Children 3 ( 42.9%)
10. Home Health Care 2 ( 28.6%)
11. Hospitals -
12. Immunizations 7 (100.0%)
13. Laboratory Services 4 ( 57.1%)
14. Long-term Care Facilities 1 ( 14.3%)
15. Mental Health 1 ( 14.3%)
16. Obstetrical Care 1 ( 14.3%)
17. Prenatal Care 3 ( 42.9%)
18. Primary Care 1 ( 14.3%)
19. Sexually Transmitted Diseases 7 (100.0%)
20. Tuberculosis 7 (100.0%)
21. WIC 4 ( 57.1%)
The cities, boroughs, and townships which have boards of health
and health officers usually provide a limited range of services
to their jurisdictions. Most of the services provided include
food protection, health education, disease reporting, and
investigation of public health complaints.
C. Local Health Officer
No M.D. Requirement, Local Governing Body Appointment
A variety of health codes require the appointment of local boards
of health and health officers or sanitary officers at the level
of cities, townships and boroughs. Currently there are 242 local
health officers/sanitary officers in Pennsylvania.
D. Local Board of Health
Policy-making
Local boards of health for cities, townships, and boroughs are
established by several different laws, some of which specify
that the council will serve as the board of health if one is not
appointed. The boards of health consist of five members, with
one or two specified to be physicians if any reside in the
jurisdiction.
E. Staff
The semi-autonomous local health departments employ and supervise
their own staffs. The State Health Center System staffs are
employed and supervised by the state. The number of employees
for either of these types of units ranges from 20 to 1,614.
Boroughs, townships, and cities which have boards of health and
health officers generally have a very limited staff, but the
exact numbers are not known.
F. Budget
Total FY 1988 LPHA expenditures were $65,878,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $5,044,000
State Funds $24,930,000
Local Funds 0
Fees and Reimbursements 0
Other Sources 0
Source Unknown $35,903,000
The SHA reported that these figures include the total amount of
additional local health department monies expended by all local
health departments.
2Pennsylvania Department of Health, 1990
Secretary of Health
Deputy Secretary for Public Health Programs
Bureau of HIV/AIDS
Bureau of Special Public Health Services
Bureau of Epidemiology and Disease Prevention
Bureau of Maternal and Child Preventive Programs
Deputy Secretary for Administration
State Health Data Center
Bureau of Financial Management
Bureau of Personnel
Bureau of Administrative Services
Deputy Secretary for Planning and Quality Assurance
Bureau of Laboratories
Bureau of Planning
Bureau of Health Financing and Program Development
Bureau of Quality Assurance
Deputy Secretary for Drug and Alcohol Programs
Bureau of Program Services
Bureau of Community Services
Deputy Secretary for Community Health
Southeastern District
South Central District
Southwestern District
Northeastern District
North Central District
Northwestern District
Local Health Departments
Allegheny
Allentown
Bethlehem
Bucks
Chester
Erie
Philadelphia
York
2Types of Local Health Departments by Jurisdiction
Pennsylvania, 1990
Jurisdiction Co C C/Co
Adams X
Allegheny X
Allentown X
Armstrong X
Beaver X
Bedford X
Berks X
Bethlehem X
Blair X
Bradford X
Bucks X
Butler X
Cambria X
Cameron X
Carbon X
Centre X
Chester X
Clarion X
Clearfield X
Clinton X
Columbia X
Crawford X
Cumberland X
Dauphin X
Delaware X
Elk X
Erie X
Fayette X
Forest X
Franklin X
Fulton X
Greene X
Huntingdon X
Indiana X
Jefferson X
Juniata X
Lackawanna X
Lancaster X
Lawrence X
Lebanon X
Lehigh X
Luzerne X
Lycoming X
McKean X
Mercer X
Mifflin X
Monroe X
Montgomery X
Montour X
Northampton X
Northumberland X
Perry X
Philadelphia X
Pike X
Potter X
Schuylkill X
Snyder X
Somerset X
Sullivan X
Susquehanna X
Tioga X
Union X
Venango X
Warren X
Washington X
Wayne X
Westmoreland X
Wyoming X
York X
York City X
Co = County HD
C = City HD
C/Co = City/County HD
1RHODE ISLAND
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 993,000 245,803,000
Population Density (1988) 941.2 69.4
(per/sq.mi.)
Number of Counties 5 3,139
Median Age (1987) 33.2 31.7
Percent Below Poverty Level (1985) 9.0 14.0
(persons)
Percent of Population Rural (1980) 13.0 26.0
Percent of Population White (1980) 94.7 83.1
Percent of Population Non-white (1980) 5.3 16.9
Median Years of Education (1980) 12.3 12.5
(25 years of age and over)
B. County Government Structure
There are no functioning county governments in Rhode Island.
Local government consists of 39 cities and towns represented in
the State Legislature by 50 Senators and 100 Representatives.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Rhode Island Department of Health (RIDH) is a free-standing
independent agency that serves as the SHA. The primary mission
of the Department is to promote the health of the population and
to prevent disease through lifestyle change, environmental
protection, and health care delivery.
Public health services in Rhode Island are for the most part
delivered on a contractual mechanism. The SHA contracts with
community health centers, visiting nursing associations, and
hospital outpatient departments for the provision of services. A
few services, such as STD services, are delivered directly by the
SHA.
Data for this state were updated October 1990.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
State Professions' Licensing Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Director of Health is the head of the SHA. This individual
must be a physician graduated from an acceptable medical college
and must have a minimum of 1 year of graduate instruction in
public health administration, or board certification in a medical
specialty, and a minimum of 5 years' full-time experience in
health administration. The Governor appoints, with Senate
approval, the Director of Health for a 5-year term.
C. State Board of Health/Council
Advisory
Rhode Island has no State Board of Health. However, there are
numerous advisory councils associated with the RIDH for specific
issues or programs. There are two types of councils: standing
committees have a legislative base and are program oriented; ad
hoc committees have no legal mandate and are appointed to address
issues and problems as needed. Both types of committees are
formed and appointed in a variety of ways including appointment
by the Governor, program directors, and the Director of Health.
They both serve as conduits for input into health department
activity by outside sources.
D. Regional/District Health Offices
There are no regional or district public health offices in Rhode
Island.
E. State-local Liaison
Since there are no local public health departments in Rhode
Island, there is no state-local liaison.
F. Budget
Total FY 1988 Rhode Island SHA expenditures were $35,643,138.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
These data were provided by the SHA.
Source of Funds
Federal Grants and Contracts $13,076,420
State Funds $21,118,078
Local Funds 0
Fees and Reimbursements 0
Other $1,948,631
3III. Local Public Health Agencies (LPHAs)
A. General
There are no local public health agencies in Rhode Island. All
public health services are provided by the State Department of
Health.
B. Services Provided
There are no local public health agencies to provide services.
C. Local Health Officer
There are no local health officers in Rhode Island.
D. Local Board of Health
There are no local boards of health in Rhode Island.
E. Staff
There are no local public health department staffs.
F. Budget
There is no budget for local public health agencies.
2Rhode Island Department of Health, 1990
Director of Health
Office of Medical Examiner
Associate Director Environmental Health
Environmental Health Risk Assessment
Food Protection
Drinking Water Quality
Occupational and Radiological Health
Health Laboratories
Associate Director Health Services Regulation
Facilities Regulation
Professional Regulation
Drug Control
Medical Licensure and Discipline
Health Systems Development
Medical Director Family Health
Primary Care
Dental Health
Children with Special Health Care Needs
Nutrition
Women, Infants and Children (WIC)
Medical Director Disease Control
Communicable Disease
Sexually Transmitted Disease/AIDS
Chronic Disease
Vital Records
Health Promotion
2Types of Local Health Departments by Jurisdiction
Rhode Island, 1990
Rhode Island does not have local health departments
1SOUTH CAROLINA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 3,469,000 245,803,000
Population Density (1988) 114.9 69.4
(per/sq.mi.)
Number of Counties 46 3,139
Median Age (1987) 30.1 31.7
Percent Below Poverty Level (1985) 15.2 14.0
(persons)
Percent of Population Rural (1980) 46.0 26.0
Percent of Population White (1980) 68.8 83.1
Percent of Population Non-white (1980) 31.2 16.9
Median Years of Education (1980) 12.1 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
Authority for the operation of county governments in South
Carolina is provided in the state constitution and statutes. A
Home Rule Act was passed in 1975 which gave counties the option
of four different forms of governments.
Council Form - (0) - This option delegates all legislative and
executive authority to the council, which may be elected at large
or from single-member districts.
Council-supervisor - (8) - This option authorizes a supervisor
who is elected separately from the council and serves as the
chief executive officer for the county.
Council-administrator or council-manager - (38) - These options
are quite similar in function. Under these forms of government
the council is permitted to appoint a manager or administrator to
carry out the policy and administrative functions.
Home Rule Authority - In 1975 the South Carolina Constitution was
amended to give additional power to county governments. Even
with these laws the counties still have somewhat restricted
authority. They are limited to levying property taxes and
business license taxes. Since they are athorized to raise taxes
for a wider variety of services, many counties have increased
services beyond those traditionally provided.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The South Carolina Department of Health and Environmental Control
(SCDHEC) is the SHA. It is a free-standing, independent agency.
The mission of SCDHEC is to protect the public's health and
environment. As the principal advisor to the state on public
health, the Department has the responsibility and authority to
prevent, abate, and control pollution and health problems.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The Commissioner is the chief executive officer of the
Department. The Commissioner is appointed by the Board of Health
and Environmental Control and serves at the pleasure of the
Board. There is no specific tenure for the Commissioner.
Responsibilities of the Commissioner include enforcing
environmental quality and health regulations for which the
Department has responsibility, advocating the availability of
public health services, and assuring that good quality public
health services are available.
C. State Board of Health/Council
Policy-making
The State Board of Health and Environmental Control is made up of
seven members who are appointed by the Governor with advice and
consent of the Senate. A Board member is appointed from each of
the six Congressional districts and one member at large. The
term of office is 4 years.
The Board makes policy, approves the budget, approves
Department-sponsored legislation and acts as an adjudicatory body
for appeals of Department regulatory decisions. The Board hires
and reviews the performance of the Commissioner. The Board
chooses its own officers on an annual basis.
D. Regional/District Health Offices
The 46 counties of South Carolina are divided into 15 public
health districts and 12 environmental control districts. Health
districts are comprised of two to six counties, with a health
department in each county. The district administration and
district core management staffs are all headed by a district
health officer who reports to the Deputy Commissioner for Health
Services.
Each health district provides personal and environmental health
services to the residents of the district. Each health district
has a vital records registrar to record vital events in the
district's counties. County health departments are linked
directly to the district office; the district office is linked
directly to the central office. Health service delivery planning
is done centrally with local input, allowing latitude for
districts and counties to adapt the plan to fit local
situations. Funds are budgeted centrally with district input.
Reporting to state and Federal funding sources is a
responsibility of the central office but depends on accurate and
timely local reporting of activities.
E. State-local Liaison
Centralized Organizational Control, Formal Liaison Function
The state-local liaison is the Deputy Commissioner for Health
Services. The Deputy Commissioner supervises the district health
officers, as well as the bureau directors and discipline offices
(nursing, nutrition, health education, social work, and
dentistry), in the central office. Therefore, this
organizational position is pivotal to making the central office
responsive to local needs and to setting priorities for activity
and budgetary support.
The interaction between state and local public health agencies in
South Carolina may be characterized as centralized organizational
control. Under this arrangement local health departments
function directly under the state's authority and are operated by
the SHA or a state board of health.
F. Budget
Total FY 1988 South Carolina SHA expenditures were $181,958,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $68,482,000
State Funds $77,380,000
Local Funds $2,891,000
Fees and Reimbursements $33,205,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
There is a county health center in each of the 46 counties. In
addition, there may be other sites within a county where
clinic-based health services are provided. Each county health
department is part of a district structure. There are two to six
counties in a district. Management of health services is
provided through the district office. The district health
director provides direction and oversight for all activities
within the district. The director may or may not be a public
health physician. The district administrator is responsible for
fiscal management, budget preparation and oversight, and
personnel procedure compliance. The district nursing director
oversees all nursing services. The district environmental health
director is responsible for all environmental health programs in
the district's counties. At the district office are specialized
discipline staff such as social workers, health educators, and
nutritionists who provide services to the residents of all
counties in a district. In most districts is a director for the
specific disciplines who is generally part of the district
management staff.
District offices are linked directly to the central office since
the district health director reports directly to the Deputy
Commissioner for Health Services.
B. Services Provided
The following information on services provided by local health
departments in South Carolina is derived from a survey conducted
by NACHO during 1989. Fourteen of the 46 local health
departments in South Carolina responded to the survey. Services
provided by at least 70 percent of health departments in the
state responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 8 ( 57.1%)
2. Morbidity Data 10 ( 71.4%)
3. Reportable Diseases 12 ( 85.7%)
4. Vital Records and Statistics 13 ( 92.9%)
B. Epidemiology/Surveillance
1. Chronic Diseases 10 ( 71.4%)
2. Communicable Diseases 14 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 4 ( 28.6%)
B. Health Planning 10 ( 71.4%)
C. Priority Setting 9 ( 64.3%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 13 ( 92.9%)
2. Health Facility Safety/Quality 7 ( 50.0%)
3. Rec. Facility Safety/Quality 6 ( 42.9%)
4. Other Facility Safety/Quality 5 ( 35.7%)
B. Licensing
1. Health Facilities -
2. Other Facilities 12 ( 85.7%)
C. Health Education 13 ( 92.9%)
D. Environmental
1. Air Quality 5 ( 35.7%)
2. Hazardous Waste Management 6 ( 42.9%)
3. Individual Water Supply Safety 12 ( 85.7%)
4. Noise Pollution 5 ( 35.7%)
5. Occupational Health and Safety 7 ( 50.0%)
6. Public Water Supply Safety 6 ( 42.9%)
7. Radiation Control 5 ( 35.7%)
8. Sewage Disposal Systems 14 (100.0%)
9. Solid Waste Management 7 ( 50.0%)
10. Vector and Animal Control 14 (100.0%)
11. Water Pollution 8 ( 57.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 14 (100.0%)
2. Alcohol Abuse 1 ( 7.1%)
3. Child Health 14 (100.0%)
4. Chronic Diseases 12 ( 85.7%)
5. Dental Health 9 ( 64.3%)
6. Drug Abuse 4 ( 28.6%)
7. Emergency Medical Service 2 ( 14.3%)
8. Family Planning 14 (100.0%)
9. Handicapped Children 13 ( 92.9%)
10. Home Health Care 14 (100.0%)
11. Hospitals -
12. Immunizations 14 (100.0%)
13. Laboratory Services 11 ( 78.6%)
14. Long-term Care Facilities 1 ( 7.1%)
15. Mental Health 1 ( 7.1%)
16. Obstetrical Care 8 ( 57.1%)
17. Prenatal Care 13 ( 92.9%)
18. Primary Care 6 ( 42.9%)
19. Sexually Transmitted Diseases 14 (100.0%)
20. Tuberculosis 14 (100.0%)
21. WIC 14 (100.0%)
C. Local Health Officer
No M.D. Requirement, Assistant Commissioner Appointment
The district health director serves as the local health officer
for each of the counties in the district, except for one county
which has a private physician as part-time county health
officer. Responsibilities of this position include the direction
and oversight of all public health activities within the
district.
D. Local Board of Health
Advisory
A few counties have boards of health but they are advisory in
function. Members may be appointed by the county governing body,
the local legislative delegation, or may represent the local
medical community. Additionally, there are several district
advisory boards of health.
E. Staff
All Department staffs, whether located in the state's central
office, in the districts, or county health departments, are
considered state employees. They are all subject to uniform
policies, procedures, and benefits. The number of staff for a
local health department ranges from 10 to 255.
F. Budget
Total FY 1988 LPHA expenditures were $76,890,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $17,192,000
State Funds $34,038,000
Local Funds $2,891,000
Fees and Reimbursements $22,769,000
Other Sources 0
Source Unknown 0
2South Carolina Department of Health and Environmentsl Control, 199
Board of Health and Environmental Control
Commissioner
Office of General Counsel
Office of External Affairs
Office of Assessment and Quality
Office of Planning and Policy Development
Office of Internal Audits
Office of Minority Health
Assistant to the Commissioner
Special Medical Consultant
Vital Records and Public Health Statistics
Drug Control
Deputy Commissioner for Health Regulation
Assistant Deputy Commissioner
Health Facilities and Services Development
Health Facilities Regulations
Bureau of Certification
Deputy Commissioner for Administrative Services
Budgets
Business Management
Information Resource Management
Personnel Services
Deputy Commissioner for Environmental Quality Control
Assistant Deputy Commissioner
Air Quality Control
Analytical and Biological Services
Solid and Hazardous Waste Management
Drinking Water Protection
Water Supply and Special Programs
District Services
Appalachia I
Appalachia II
Appalachia III
Catawba
Low Country
Lower Savannah
Midlands
Pee Dee
Trident
Upper Savannah
Waccamaw
Wateree
Program Management
Radiological Health
Deputy Commissioner for Health Services
District Health Directors
Appalachia I
Appalachia II
Appalachia III
Catawba
Low Country
Lower Savannah
Edisto
East Midlands
West Midlands
Pee Dee I
Pee Dee II
Trident
Upper Savannah
Waccamaw
Wateree
Environmental Health
Preventive Health Services
Maternal and Child Health
Laboratories
Health Promotion
Home Health and Long-Term Care
2Types of Local Health Departments by Jurisdiction
South Carolina, 1990
Jurisdiction Co
Abbeville X
Aiken X
Allendale X
Anderson X
Bamberg X
Barnwell X
Beaufort X
Berkeley X
Calhoun X
Charleston X
Cherokee X
Chester X
Chesterfield X
Clarendon X
Colleton X
Darlington X
Dillon X
Dorchester X
Edgefield X
Fairfield X
Florence X
Georgetown X
Greenville X
Greenwood X
Hampton X
Horry X
Jasper X
Kershaw X
Lancaster X
Laurens X
Lee X
Lexington X
Marion X
Marlboro X
McCormick X
Newberry X
Oconee X
Orangeburg X
Pickens X
Richland X
Saluda X
Spartanburg X
Sumter X
Union X
Williamsburg X
York X
Co = County HD
1SOUTH DAKOTA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 713,000 245,803,000
Population Density (1988) 9.4 69.4
(per/sq.mi.)
Number of Counties 66 3,139
Median Age (1987) 31.0 31.7
Percent Below Poverty Level (1985) 17.3 14.0
(persons)
Percent of Population Rural (1980) 54.0 26.0
Percent of Population White (1980) 92.6 83.1
Percent of Population Non-white (1980) 7.4 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The South Dakota Constitution and Statutes establish the
structure of county governments and provide them with authority
to operate.
Commission Form - (66) - County Commission is the form of
government used throughout the state. The commissions are made
of three- to five-member boards who are usually elected from
single-member districts; however, 14 counties elect the
commissioners at large.
Home Rule Charter - (2) - Counties are permitted by the
constitution to approve or amend a charter by public
referendum. The adoption of a home rule charter provides
counties with authority to function in any area that is not
prohibited by the state constitution or statutes. Todd and
Shannon currently are the only counties that have adopted
home rule charters.
City-County Consolidation - (1) - A simplified method of
consolidation for city-counties or county-county is also
permitted. The consolidation of Washabaugh County into
Jackson County in 1979 is the only consolidation that has
taken place.
Data for this state were updated December 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The South Dakota Department of Health, the SHA, is a
free-standing, independent agency. The mission of the agency is
promoting health and disease prevention to protect the health of
South Dakotans.
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Secretary of Health, the head of the SHA, is a cabinet-level
officer appointed by the Governor and confirmed by the
legislature. The Secretary is responsible for ensuring the
following functions:
1. Promoting and protecting the health of the public by
preventing and controlling communicable diseases
2. Providing a delivery system for public health services
for the elderly, families, adolescents, mothers and
children (including but not limited to community health
nursing, maternal and child health programs, nutrition
services and children's comprehensive health care)
3. Certifying medical facilities and insuring the sanitary
condition of certain public establishments
4. Maintaining a vital records system
5. Performing necessary health planning to assure access
to quality health care services
6. Providing public health laboratory support services
C. State Board of Health/Council
No State Board of Health
D. Regional/District Health Offices
The state does not have formal regions or districts. Individual
programs informally subdivide the state into geographical regions
for operational and manpower distribution purposes to assure
adequate coverage and appropriate delivery of public health
services. These regions, however, are informally established,
and vary from program to program.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
No single individual or office has responsibility for the
state-local liaison function. Communication between the SHA and
local areas often takes place at the program level.
The interaction between state and local public health agencies in
South Dakota may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement
local health services may be provided by the SHA in some
jurisdictions and by local governmental units, boards of health,
or health departments in other jurisdictions.
F. Budget
Total FY 1988 South Dakota SHA expenditures were $20,688,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $13,971,000
State Funds $3,831,000
Local Funds 0
Fees and Reimbursements $2,785,000
Other $101,000
3III. Local Public Health Agencies (LPHAs)
A. General
South Dakota has seven local health departments, consisting of
three county and four city health departments. Any public health
services that exist in the other areas are provided by the SHA.
Sanitarians, usually covering multiple county areas, provide food
protection and other services to these areas. In addition,
public health nurses provide basic public health care in most
counties.
B. Services Provided
The following information on services provided by local health
departments in South Dakota is derived from a survey conducted by
NACHO during 1989. Six of the seven local health departments in
South Dakota responded to the survey. Services provided by at
least 70 percent of health departments in the state responding to
the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 1 ( 16.7%)
2. Morbidity Data 1 ( 16.7%)
3. Reportable Diseases 2 ( 33.3%)
4. Vital Records and Statistics 1 ( 16.7%)
B. Epidemiology/Surveillance
1. Chronic Diseases 2 ( 33.3%)
2. Communicable Diseases 3 ( 50.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 2 ( 33.3%)
B. Health Planning 1 ( 16.7%)
C. Priority Setting 1 ( 16.7%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 1 ( 16.7%)
2. Health Facility Safety/Quality 1 ( 16.7%)
3. Rec. Facility Safety/Quality 2 ( 33.3%)
4. Other Facility Safety/Quality 1 ( 16.7%)
B. Licensing
1. Health Facilities 1 ( 16.7%)
2. Other Facilities 5 ( 83.3%)
C. Health Education 1 ( 16.7%)
D. Environmental
1. Air Quality 1 ( 16.7%)
2. Hazardous Waste Management 1 ( 16.7%)
3. Individual Water Supply Safety 1 ( 16.7%)
4. Noise Pollution 1 ( 16.7%)
5. Occupational Health and Safety 1 ( 16.7%)
6. Public Water Supply Safety 5 ( 83.3%)
7. Radiation Control -
8. Sewage Disposal Systems 3 ( 50.0%)
9. Solid Waste Management 3 ( 50.0%)
10. Vector and Animal Control 5 ( 83.3%)
11. Water Pollution 2 ( 33.3%)
E. Personal Health Services
1. AIDS Testing and Counseling 2 ( 33.3%)
2. Alcohol Abuse 1 ( 16.7%)
3. Child Health 2 ( 33.3%)
4. Chronic Diseases 1 ( 16.7%)
5. Dental Health -
6. Drug Abuse -
7. Emergency Medical Service -
8. Family Planning 2 ( 33.3%)
9. Handicapped Children 1 ( 16.7%)
10. Home Health Care 1 ( 16.7%)
11. Hospitals -
12. Immunizations 2 ( 33.3%)
13. Laboratory Services 2 ( 33.3%)
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care -
18. Primary Care 1 ( 16.7%)
19. Sexually Transmitted Diseases 2 ( 33.3%)
20. Tuberculosis 1 ( 16.7%)
21. WIC 2 ( 33.3%)
C. Local Health Officer
M.D. Requirement, Local Board of Health or Governing Body
Appointment
Local health officers are required to be physicians. They are
appointed by the local board of health or the local governing
body if no board of health exists. Their responsibilities
include administering the local health department, enforcing
state public health laws and rules and regulations, and enforcing
local public health regulations and ordinances.
D. Local Board of Health
Policy-making
Local boards of health may be for cities, counties or multiple
jurisdictional areas. City boards of health consist of 21
members appointed by the governing body. The members represent a
broad mix of health professionals, business leaders, and
industrial representatives. County boards of health are composed
of seven members appointed by the county governing body. Members
include one county commissioner, a physician, and five
individuals selected from the county electorate. The boards are
responsible for establishing local health regulations and
recommending health issues to the local governing body for their
enactment as ordinances. Although the statutes authorize the
appointment of boards of health, many areas of South Dakota do
not have them.
E. Staff
The staffs of local health departments are employed and
supervised by the local jurisdictions. The number of employees
for a local health department ranges from 1 to 42.
F. Budget
Total 1988 LPHA expenditures were not available.
2South Dakota State Department of Health, 1990
Secretary of Health
Office of Rural Health
USD School of Medicine
Office of Medical Services
Executive Assistant
Legal Counsel
Support Services
Center for Health Policy and Statistics
Laboratory Services
Division of Public Health
Licensure and Certification
Communicable Disease
Division of Health Services
Community Health Service
Maternal and Child Health
West River Community Health Center, Rapid City
Health Education/Promotion
2Types of Local Health Departments by Jurisdiction
South Dakota, 1990
Jurisdiction Co C N/Co
Aberdeen X
Aurora X
Beadle X
Bennett X
Bon Homme X
Brookings X
Brookings X
Brown X
Brule X
Buffalo X
Butte X
Campbell X
Charles Mix X
Clark X
Clay X
Codington X
Corson X
Custer X
Davison X
Day X
Deuel X
Dewey X
Douglas X
Edmunds X
Fall River X
Faulk X
Grant X
Gregory X
Haakon X
Hamlin X
Hand X
Hanson X
Harding X
Hughes X
Huron X
Hutchinson X
Hyde X
Jackson X
Jerauld X
Jones X
Kingsbury X
Lake X
Lawrence X
Lincoln X
Lyman X
Marshall X
McCook X
McPherson X
Meade X
Mellette X
Miner X
Minnehaha X
Moody X
Pennington X
Perkins X
Potter X
Roberts X
Sanborn X
Shannon X
Sioux Falls X
Spink X
Stanley X
Sully X
Todd X
Tripp X
Turner X
Union X
Walworth X
Yankton X
Ziebach X
Co = County HD
C = City HD
N/Co = No County HD
1TENNESSEE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 4,895,000 245,803,000
Population Density (1988) 118.9 69.4
(per/sq.mi.)
Number of Counties 95 3,139
Median Age (1987) 32.0 31.7
Percent Below Poverty Level (1985) 18.1 14.0
(persons)
Percent of Population Rural (1980) 40.0 26.0
Percent of Population White (1980) 83.5 83.1
Percent of Population Non-white (1980) 16.5 16.9
Median Years of Education (1980) 12.2 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
All 95 Tennessee counties derive their powers from the state
constitution and statutes. They establish the legal framework
for county governments and list the duties and powers of the
governing bodies. There are four different structures of
government to choose from: Commission, County Charter,
City-County Consolidation, and County Manager Status. To date,
no counties have chosen the County Manager Status.
Commission Form - (92) - The commission consists of a board of 9
to 25 county commissioners, which are elected from single-member
districts. They serve as the county legislative body. They have
a county executive who is elected at large and serves as the
administrative head of the county.
County Charter - (1) - Shelby County is Tennessee's only charter
county. The county charter separates the county's legislative,
executive, and judicial functions, as in all of Tennessee's
counties. A stronger elected executive, who possesses veto
powers over commission ordinances and resolutions, is a major
result of the charter. A commission remains as the legislative
body of the county and has the authority to adopt county
ordinances.
Data for this state were updated January 1991.
City-county Consolidation - (2) - The state's two existing
city-county consolidations are Nashville-Davidson County and
Lynchburg-Moore County. Both use a metro council as the
legislative body and a metro executive with executive and
administrative authority and limited veto power over metro
council ordinances and resolutions.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The SHA in Tennessee is called the Tennessee Department of Health
and Environment (TDHE). It is a free-standing, independent
agency that consists of four bureaus (see attached table of
organization). The SHA establishes goals and objectives for the
state and broad guidelines for implementation by regional
offices. State funds are distributed to local health departments
by at least two mechanisms. One involves "Aid to Local Health
Departments," whereby funds are deposited into an individual
account for each county. This account includes funds derived
from fees and reimbursements, local appropriations, and other
sources, and is used in the operation of the health departments.
Resources may also be routed to local health departments through
the regional offices.
The following is a list of some areas of responsibility for the
SHA:
State Public Health Authority
Medicaid Single State Agency
Lead Environmental Agency in State
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
State Professions Licensing Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal
Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The head of the SHA is the Commissioner of Health and
Environment. The Commissioner is a cabinet-level appointee who
reports directly to the Governor. The Commissioner is not
required to be a physician.
When the Commissioner is not a physician, a Chief Medical Officer
is appointed. This individual is selected from a group of three
candidates who are submitted by the Tennessee Medical
Association. The Governor and the Commissioner of the TDHE
select the Chief Medical Officer. The Chief Medical Officer
serves primarily as an advisor to the Commissioner.
C. State Board of Health/Council
Advisory
A State Public Health Council consists of 12 members appointed by
the Governor and serves in an advisory capacity to the
Commissioner. The six physician members of the council are
recommended by the Tennessee Medical Society and two appointed
from each grand division of the state.
D. Regional/District Health Offices
The state is divided into 10 administrative regions (see attached
map), 6 of which are metro regions (Shelby County Region,
Jackson/Madison County Region, Davidson County Region, Hamilton
County Region, Knox County Region, and Sullivan County Region)
and 4 of which are rural regions (West Tennessee Region, Middle
Tennessee Region, Central Region, and East Tennessee Region).
The metro regions are single-county regions in which regional
functions are performed by county health department staff. Metro
regions have more autonomy than rural regions because a greater
share of their budget is derived locally. Each region has a
regional office that is staffed by state, contract, or by county
employees in the case of some metro regions. The regional
offices are responsible for addressing goals and objectives that
are established by the state. To accomplish this, the regions
assess the specific needs of the counties in the region and
assist the counties in providing services to meet the needs.
They provide resources to counties in the form of technical
assistance or positions funded by the region. Regions have the
option of pursuing additional funding through grants or other
mechanisms that may be available. Additionally, the regional
office is responsible for supervising local staffs in the
region. The following are some of the principal positions
included in the approximately 30-member staffs that comprise
regional offices:
Regional Director
Regional Medical Director
Regional Nursing Director
Regional Environmental Health Director
Regional Communicable Disease Director
Regional Accountant
Procurement Officer
Personnel Officer
Quality Assurance Director
Systems Support -- Computer Specialist
Local Health Coordinator -- Liaison between local health
departments and the regional office
Clerical Consultant
All the regions have community health agencies that consist of
local people appointed by the Governor to oversee health policy
for the region and to develop health care programs to ensure
access to primary care centers and to private health care
providers. To assist with providing primary health care in rural
areas, the Health Access Act was enacted. This Act serves to
promote recruitment of medical practitioners in medically
underserved rural areas and also provides financial incentives to
physicians who are willing to contract to work for specified
periods in these areas.
E. State-Local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
The state does not have a formal state and local liaison office
or function at the state level. Communications flow through the
chain of command.
The interaction of state and local public health agencies in
Tennessee may be characterized as a mixed centralized and
decentralized organizational control. Under this arrangement,
local health services may be provided by the SHA in some
jurisdictions or by local health departments in other
jurisdictions.
F. Budget
Total FY 1988 SHA expenditures (SHA expenditures listed for
Tennessee consist of the expenditures for only one bureau, the
Bureau of Health Services) were $178,597,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $73,514,000
State Funds $77,966,000
Local Funds $5,310,000
Fees and Reimbursements $19,466,000
Other $2,341,000
3III. Local Public Health Agencies (LPHAs)
A. General
Tennessee has 94 county health departments and one city-county
health department. Tremendous variation exists in the size of
these agencies and the level of services provided. The number of
employees ranges from 3 to 679 and budgets range from $74,500 to
$17,432,765.
B. Services Provided
The following information on services provided by local health
departments in Tennessee is derived from a survey conducted by
NACHO during 1989. Seventy-one of the 95 local health
departments in Tennessee responded to the survey. Services
provided by 70 percent of health departments in the state
responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 24 ( 33.8%)
2. Morbidity Data 45 ( 63.4%)
3. Reportable Diseases 59 ( 83.1%)
4. Vital Records and Statistics 71 (100.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases 39 ( 54.9%)
2. Communicable Diseases 71 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 18 ( 25.4%)
B. Health Planning 30 ( 42.3%)
C. Priority Setting 25 ( 35.2%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 49 ( 69.0%)
2. Health Facility Safety/Quality 28 ( 39.4%)
3. Rec. Facility Safety/Quality 33 ( 46.5%)
4. Other Facility Safety/Quality 11 ( 15.5%)
B. Licensing
1. Health Facilities 12 ( 16.9%)
2. Other Facilities 30 ( 42.3%)
C. Health Education 48 ( 67.6%)
D. Environmental
1. Air Quality 34 ( 47.9%)
2. Hazardous Waste Management 32 ( 45.1%)
3. Individual Water Supply Safety 64 ( 90.1%)
4. Noise Pollution 3 ( 4.2%)
5. Occupational Health and Safety 7 ( 9.9%)
6. Public Water Supply Safety 52 ( 73.2%)
7. Radiation Control 22 ( 31.0%)
8. Sewage Disposal Systems 65 ( 91.5%)
9. Solid Waste Management 53 ( 74.6%)
10. Vector and Animal Control 46 ( 64.8%)
11. Water Pollution 39 ( 54.9%)
E. Personal Health Services
1. AIDS Testing and Counseling 50 ( 70.4%)
2. Alcohol Abuse 5 ( 7.0%)
3. Child Health 69 ( 97.2%)
4. Chronic Diseases 51 ( 71.8%)
5. Dental Health 50 ( 70.4%)
6. Drug Abuse 7 ( 9.9%)
7. Emergency Medical Service 9 ( 12.7%)
8. Family Planning 66 ( 93.0%)
9. Handicapped Children 59 ( 83.1%)
10. Home Health Care 43 ( 60.6%)
11. Hospitals -
12. Immunizations 70 ( 98.6%)
13. Laboratory Services 45 ( 63.4%)
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care 1 ( 1.4%)
17. Prenatal Care 52 ( 73.2%)
18. Primary Care 30 ( 42.3%)
19. Sexually Transmitted Diseases 69 ( 97.2%)
20. Tuberculosis 69 ( 97.2%)
21. WIC 70 ( 98.6%)
C. Local Health Officer
M.D. Requirement, Commission Appointment
County health officers are appointed by the county commission but
are usually supervised and evaluated by the regional office. An
exception occurs in metro regions where the health officer is
nominated and evaluated by the board of health. Even in this
case, appointing authority remains with the county
commission/metro council. In many small counties the regional
medical director serves as the health officer for some or all
counties in the region and is appointed by the commission in each
county.
D. Local Board of Health
Policy-making
The existence and composition of county boards of health are
provided for by state law. A county legislative body may
establish a board of health that consists of up to 11 members.
The board includes the county executive, two physicians nominated
by the county medical society, one dentist nominated by the
county dental society, one registered nurse nominated by the
county nurses association, a pharmacist nominated by the county
pharmaceutical society, the county superintendent of education,
and the county health director and county health officer who
serve as ex officio members. The county legislative body may
appoint a doctor of veterinary medicine and a citizen
representative to the board. The county legislative body may
directly appoint any member when a nomination is not made in a
timely manner. The board serves a term of 4 years. Statutes
specify that the boards of health have the following powers and
duties:
1. To govern the policies of full-time county health
departments.
2. Through the county health director and/or county health
officer, to enforce rules and regulations.
3. To adopt rules and regulations as may be necessary or
appropriate to protect the general health and safety of
the citizens of the county.
4. To require an annual budget be prepared and to
present the budget to the county legislative body.
E. Staff
County health department staff may be state employees, county
employees, and/or contract employees. The medical director
and/or administrator is supervised by the regional office.
Front-line supervision for other positions is usually performed
by local health department personnel.
F. Budget
Total FY 1988 LPHA expenditures were $61,755,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $6,188,000
State Funds $13,102,000
Local Funds $27,068,000
Fees and Reimbursements $14,531,000
Other Sources $867,000
2Tennessee Department of Health and Environment, 1990
Governor
Public Health Council
Commissioner
Deputy Commissioner
Internal Audit
Laboratory Services
Research and Development
Personnel
General Counsel
Administrative Services
Bureau of Health Services
Health Assessment
Primary Care/Indigent Care
Physician Placement
Program Services
Health Promotion/Disease Control
Communicable Disease Control
AIDS
Community Health
Maternal and Child Health
Regional Offices
Local Health Departments
Bureau of Medicaid
Medical Support
Staff Support
Systems Operations
Policy Planning
Regional Offices
Bureau of Environment
Air Pollution Control
Radiological Health
Food & General Sanitation
Solid/Hazardous Waste
Superfund
Construction Grants & Loans
Ground Water Protection
Water Pollution Control
Water Supply
Field Offices
Bureau of Manpower and Facilities
Emergency Medical Services
Health-Related Boards
Health Care Facilities
Field Offices
2Types of Local Health Departments by Jurisdiction
Tennessee, 1990
Jurisdiction Co C/Co
Anderson X
Bedford X
Benton X
Bledsoe X
Blount X
Bradley X
Campbell X
Cannon X
Carroll X
Carter X
Cheatham X
Chester X
Claiborne X
Clay X
Cocke X
Coffee X
Crockett X
Cumberland X
Davidson X
De Kalb X
Decatur X
Dickson X
Dyer X
Fayette X
Fentress X
Franklin X
Gibson X
Giles X
Grainger X
Greene X
Grundy X
Hamblen X
Hamilton X
Hancock X
Hardeman X
Hardin X
Hawkins X
Haywood X
Henderson X
Henry X
Hickman X
Houston X
Humphreys X
Jackson X
Jefferson X
Johnson X
Knox X
Lake X
Lauderdale X
Lawrence X
Lewis X
Lincoln X
Loudon X
Macon X
Madison X
Marion X
Marshall X
Maury X
McMinn X
McNairy X
Meigs X
Monroe X
Montgomery X
Moore X
Morgan X
Obion X
Overton X
Perry X
Pickett X
Polk X
Putnam X
Rhea X
Roane X
Robertson X
Rutherford X
Scott X
Sequatchie X
Sevier X
Shelby X
Smith X
Stewart X
Sullivan X
Sumner X
Tipton X
Trousdale X
Unicoi X
Union X
Van Buren X
Warren X
Washington X
Wayne X
Weakley X
White X
Williamson X
Wilson X
Co = County HD C/Co = City/County HD
1TEXAS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 16,837,000 245,803,000
Population Density (1988) 64.2 69.4
(per/sq.mi.)
Number of Counties 254 3,139
Median Age (1987) 29.6 31.7
Percent Below Poverty Level (1985) 15.9 14.0
(persons)
Percent of Population Rural (1980) 20.0 26.0
Percent of Population White (1980) 78.7 83.1
Percent of Population Non-white (1980) 21.3 16.9
Median Years of Education (1980) 12.4 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The framework and authority for county governments in Texas are
contained in the state constitution and statutes.
Commissioners Court - (254) - The court made up of a county judge
and four commissioners is the general form of county
governments. All 254 counties have exactly the same form of
government, except for urban counties which may have more
commissioners. The commissioners are elected from individual
commissioner precincts, and the judge is elected at large.
Counties in Texas have limited authority and serve as an
administrative element of the state. The power delegated to
counties is limited and granted for specific functions. No
provisions exist for home rule authority, charter, or other
governmental structures.
Data for this state were revised November 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Texas Department of Health (TDH), a free-standing,
independent agency, is the SHA and is charged with protecting and
promoting the health and well-being of the people of Texas. The
department's responsibilities include:
Personal health promotion, maintenance and treatment
services
Infectious disease control and prevention services
Environmental and consumer health protection services
Laboratory services
Health facility architectural plan review
Public health education and information services
Administrative services
The following are some broad areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Agency for Children with Special Health Care Needs
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Not Cabinet-level Appointment
The Commissioner is the head of the SHA and the state's chief
health officer. The Commissioner, under the supervision of the
State Board of Health, administers and enforces the health laws
of the state. Along with the staff, the Commissioner oversees
the day-to-day administration of the Department's policies and
programs. The Commissioner is selected by the Texas Board of
Health and serves at the will of the board. By law, the
Commissioner must be licensed to practice medicine in the state.
C. State Board of Health/Council
Policy-making
The 18 members of the State Board of Health are appointed by the
Governor with the advice and consent of the senate. Except for
the public members, each must be licensed under the laws of the
state and must have at least 5 years' experience in Texas in the
area of specialization. Board composition includes:
Six physicians, one of whom specializes in the treatment of
disabled children
Two hospital administrators
One dentist
One registered nurse
One veterinarian
One pharmacist
One nursing home administrator
One optometrist
One professional civil engineer who has specialized in the
practice of sanitary engineering
One chiropractor
Two public members
Board members serve staggered 6-year terms, with the terms of six
members expiring February 1 of each odd-numbered year. No later
than September 1 of each odd-numbered year, the Governor
designates one board member as chairman and one member as
vice-chairman. The board may appoint advisory committees to
assist in performing its duties. The board has general
supervision and control over all matters relating to the health
and well-being of Texas residents.
D. Regional/District Health Offices
The state of Texas is divided into eight public health regions.
These regions follow county and council of government boundaries
and are functionally representative of the distinct geographical
areas and demographic population groups within the state. A
physician director and staff for each state health department
program are assigned to each public health region. Within the
eight regions are 18 regional offices. The primary purpose of
the public health regional offices is to provide public health
services in the areas of the state not covered by local health
departments. These services include direct clinical services and
regulatory services. In addition, the public health regions
serve as reference and resource centers for the local health
departments in the respective regions.
The staff for regions usually range from 200 to 400 employees.
The following positions are typical of those found in regional
offices:
Regional Medical Director
Assistant Regional Director for Administration
Regional Nursing Director
Chief Regional Engineer
Program Managers
Immunization
Tuberculosis
Sexually Transmitted Diseases
WIC
Clinical Nurses
Clerical Staff
Health Education/Promotion
Volunteer Coordinator
The public health regional offices are supported by state and
Federal funds and are accountable to the SHA.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Formal Liaison Function
The Associateship for Community and Rural Health at the THD
serves as the state-local liaison. All correspondence from the
SHA to the local health departments is coordinated through the
Associateship. All grants, contracts, budget and activity
reporting as well as policies and procedures are coordinated
through the Associateship. This Associateship also provides
orientation and continuing education for local public health
professionals.
The interaction between state and local public health agencies in
Texas may be characterized as mixed centralized and decentralized
organizational control. Under this arrangement local health
services may be provided by the SHA in some jurisdictions and by
local governmental units, boards of health, or health departments
in other jurisdictions.
F. Budget
Total FY 1988 Texas SHA expenditures were $362,715,000. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $182,388,000
State Funds $163,058,000
Local Funds 0
Fees and Reimbursements $9,667,000
Other $7,601,000
3III. Local Public Health Agencies (LPHAs)
A. General
Texas has 71 state-participating local health departments
including 33 county, 27 city-county, 8 city, and 3 multicounty
health departments. The total count varies from this because
counties with multiple cities that have merged their health
departments are called districts. The local units receive state
funds in the form of contracts for services provided and
generally provide a broad range of public health services.
There is also a category of local health entities that provide
public health services and are classified as Non-participating
Units. These units are small and usually provide only a limited
range of services, such as environmental health. They do not
receive any state funds. The exact number and location of these
units are not available.
The state provides public health services to local areas that do
not have a local health department. These services are provided
through the regional offices.
B. Services Provided
The following information on services provided by local health
departments in Texas is derived from a survey conducted by NACHO
during 1989. Sixty-eight of the 71 local health departments in
Texas responded to the survey. Services provided by 70 percent
of health departments in the state responding to the survey are
underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 22 ( 32.4%)
2. Morbidity Data 25 ( 36.8%)
3. Reportable Diseases 59 ( 86.8%)
4. Vital Records and Statistics 23 ( 33.8%)
B. Epidemiology/Surveillance
1. Chronic Diseases 31 ( 45.6%)
2. Communicable Diseases 61 ( 89.7%)
II. Policy Development
A. Health Code Dev. and Enforcement 48 ( 70.6%)
B. Health Planning 37 ( 54.4%)
C. Priority Setting 35 ( 51.5%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 48 ( 70.6%)
2. Health Facility Safety/Quality 40 ( 58.8%)
3. Rec. Facility Safety/Quality 32 ( 47.1%)
4. Other Facility Safety/Quality 23 ( 33.8%)
B. Licensing
1. Health Facilities 19 ( 27.9%)
2. Other Facilities 51 ( 75.0%)
C. Health Education 45 ( 66.2%)
D. Environmental
1. Air Quality 22 ( 32.4%)
2. Hazardous Waste Management 31 ( 45.6%)
3. Individual Water Supply Safety 55 ( 80.9%)
4. Noise Pollution 8 ( 11.8%)
5. Occupational Health and Safety 13 ( 19.1%)
6. Public Water Supply Safety 44 ( 64.7%)
7. Radiation Control 7 ( 10.3%)
8. Sewage Disposal Systems 57 ( 83.8%)
9. Solid Waste Management 31 ( 45.6%)
10. Vector and Animal Control 49 ( 72.1%)
11. Water Pollution 40 ( 58.8%)
E. Personal Health Services
1. AIDS Testing and Counseling 47 ( 69.1%)
2. Alcohol Abuse 6 ( 8.8%)
3. Child Health 58 ( 85.3%)
4. Chronic Diseases 41 ( 60.3%)
5. Dental Health 31 ( 45.6%)
6. Drug Abuse 4 ( 5.9%)
7. Emergency Medical Service 7 ( 10.3%)
8. Family Planning 36 ( 52.9%)
9. Handicapped Children 23 ( 33.8%)
10. Home Health Care 8 ( 11.8%)
11. Hospitals 3 ( 4.4%)
12. Immunizations 65 ( 95.6%)
13. Laboratory Services 40 ( 58.8%)
14. Long-term Care Facilities 4 ( 5.9%)
15. Mental Health -
16. Obstetrical Care 15 ( 22.1%)
17. Prenatal Care 45 ( 66.2%)
18. Primary Care 19 ( 27.9%)
19. Sexually Transmitted Diseases 56 ( 82.4%)
20. Tuberculosis 61 ( 89.7%)
21. WIC 42 ( 61.8%)
C. Local Health Officer
M.D. Requirement, Local Governing Body Appointment
The local health authority is a physician licensed to practice
medicine in Texas and is appointed by the official executive body
of a county, city, or combination of cities and counties to
provide necessary health-related advice and to enforce laws which
protect the health of the people of that jurisdiction. Such
duties include but are not limited to assisting the Texas Board
of Health in the enforcement of proper rules, regulations,
requirements, and ordinances of local quarantine, inspection,
disease prevention and suppression, birth and death statistics,
general sanitation, contagious infections and dangerous epidemic
diseases, and disaster planning in the health authority's
jurisdiction.
The Local Public Health Reorganization Act, however, is
permissive; if the respective governing body chooses not to
appoint a health authority, the Texas Board of Health or its
designee may appoint a public health regional director to perform
the duties of a health authority. In a county or a city served
by a local health department, if the director of the local health
department is a physician licensed to practice medicine in Texas,
the director must be formally appointed the health authority for
that jurisdiction. In counties not served by local health
departments or those with non-physician directors, the physician
serving as health authority is usually engaged full-time in the
private practice of medicine and may or may not be remunerated
for performing the health authority duties.
The physician appointed to serve as health authority of a city,
county or district must serve the executive body of the local
jurisdiction and also the Texas Board of Health. The health
authority may consult with the Regional Director for guidance or
technical assistance in performing the duties set forth in the
Act.
D. Local Board of Health
Advisory
The Local Public Health Reorganization Act allows for creation of
a local advisory or administrative public health board. An
"advisory public health board" shall advise members and the
directors on matters of public health. An "administrative public
health board" shall have the authority to adopt substantive and
procedural rules which are necessary and appropriate to promote
and preserve the health and safety of the public within its
jurisdiction, provided that no rule adopted shall be in conflict
with the laws of the state or the ordinances of any member
municipality or county. Again, the law is permissive and gives
the respective executive body discretion in appointing a local
public health board. Current data on which local health
departments have local public health boards are not available.
E. Staff
The staffs of local health departments consist of local, state,
and contract employees. These individuals are supervised by the
local jurisdiction. The number of employees for a local health
department ranges from 1 to 1,033.
F. Budget
Total FY 1988 LPHA expenditures were $197,417,000*. In Fy 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $18,814,000*
State Funds $20,903,000
Local Funds $124,844,000*
Fees and Reimbursements $51,000
Other Sources $698,000*
Source Unknown $32,107,000*
* The SHA reported that these figures were estimated.
2Texas Department of Health, 1990
Governor
Board of Health
Commissioner of Health
Office of General Counsel
Office of the Board of Health
Internal Audit
Deputy Commissioner
Public Health Promotion Division
Bureau of State Health Data and Policy Analysis
Assistant Deputy Commissioner for Administration
Bureau of Personnel Management
Bureau of Automated Data Services
Bureau of Support Services
Associate Commissioner for Special Health Services
Bureau of Long-Term Care
Bureau of Vital Statistics
Bureau of Licensing and Certification
Associate Commissioner for Family Health Services
Bureau of Maternal and Child Health
Bureau of Women, Infants and Children's Nutrition
Bureau of Chronically Ill and Disabled Children's Services
Associate Commissioner for Disease Prevention
Bureau of Disease Control and Epidemiology
Bureau of HIV and STD Control Protection
Bureau of Dental and Chronic Disease Prevention
Bureau of Laboratories
Associate Commissioner for Environmental and Consumer Health
Protection
Bureau of Radiation Control
Bureau of Consumer Health Protection
Bureau of Environmental Health
Bureau of Solid Waste Management
Bureau of Veterinary Public Health
Associate Commissioner for Community and Rural Health
Bureau of Community Health Services and Administration
Bureau of Emergency Management
Public Health Regions
2Types of Local Health Departments by Jurisdiction
Texas, 1990
Jurisdiction Co C C/Co M/Co N/Co
Abilene-Taylor X
Anderson X
Andrews City Co X
Angelina City C X
Aransas X
Archer X
Armstrong X
Atascosa X X
Austin-Travis C X
Baily X
Bandera X
Bastrop X
Baylor X
Beaumont X
Bee X
Bell Dist X
Big Spring-Howa X
Blanco X
Borden X
Bosque X
Brazoria X
Brazos X
Brewster X
Briscoe X
Brooks X
Brownwood-Brown X
Burleson X
Burnett X
Caldwell X
Calhoun X
Callahan X
Cameron X
Camp X
Carson X
Cass X
Castro X
Cherokee X
Childress X
Clay X
Cochran X
Coke X
Coleman X
Collin X
Collingsworth X
Colorado X
Comal X
Comanche X
Concho X
Cooke X
Corpus Christi- X
Corsicana-Navar X
Coryell X
Cottle X
Crane X
Crockett X
Crosby X
Cuero-Dewitt X
Culberson X
Dallam X
Dallas X
Dallas X
Dawson X
Deaf Smith X
Del Rio-Val Ver X
Delta X
Denton X
Dickens X
Dimmit X
Donley X
Duval X
Eastland X
Ector X
Edwards X
El Paso City Co X
Ellis X
Erath X
Falls X
Fannin X
Fayette X
Fisher X
Floyd X
Foard X
Fort Bend X
Fort Worth X
Franklin X
Freestone X
Frio X
Gaines X
Galveston X
Garza X
Gillespie X
Glasscock X
Gollad X
Gonzales X
Gray X
Grayson X
Greenville-Hunt X
Gregg X
Grimes X
Guadalupe X
Hall X
Hamilton X
Hansford X
Hardeman X
Hardin X
Harris X
Hartley X
Haskell X
Hemphill X
Henderson X
Hidalgo X
Hill X
Hockley X
Hood X
Hopkins X
Houston X
Houston X
Hudspeth X
Hutchinson X
Irion X
Jack X
Jackson X
Jasper X
Jeff Davis X
Jefferson X
Jim Hogg X
Jim Wells X
Johnson X
Jones X
Karnes X
Kaufman X
Kendall X
Kenedy X
Kent X
Kerr X
Kimble X
King X
Kinney X
Kleberg X
Knox X
LaSalle X
Lamb X
Lampasas X
Lavaca X
Lee X
Leon X
Liberty X
Limestone X
Lipscomb X
Live Oak X
Llano X
Loredo X
Loving X
Lubbock X
Lubbock X
Lynn X
Madison X
Marion X
Marshall-Harris X
Martin X
Mason X
Matagorda X
Maverick X
McCulloch X
McMullen X
Medina X
Menard X
Midland X
Midland X
Milam X
Mills X
Mitchell X
Montague X
Montgomery X
Moore X
Morris X
Motley X
Nacogdoches X
Navarro X
Newton X
Ochiltree X
Oldham X
Orange X
Palo Pinto X
Panola X
Paris- Lamar Co X
Parker X
Parmer X
Pecos X
Plainview-Hale X
Polk X
Port Arthur X
Potter X
Presidio X
Rains X
Randall X
Reagan X
Real X
Red River X
Reeves X
Refugio X
Roberts X
Robertson X
Rockwall X
Runnels X
Rusk X
Sabine X
San Angelo-Tom X
San Angustine X
San Antonio-Bex X
San Jacinto X
San Marcos-Hays X
San Patricio X
San Saba X
Schleicher X
Scurry X
Shelby X
Sherman X
Skackelford X
Somervell X
Starr X
Stephens X
Sterling X
Stonewall X
Sutton X
Sweetwater-Nola X
Swisher X
Tarrant X
Terrell X
Terry X
Texarkana-Bowie X
Throckmorton X
Titus X
Trinity X
Tyler X
Tyler-Smith Co X
Upshur X
Upton X
Uvalde City Co X
Van Zandt X
Victoria X
Waco McLennan C X
Walker X
Waller X
Ward X
Washington X
Webb X
Wharton X
Wheeler X
Wichita Falls C X
Wilbarger X
Willacy X
Williamson Dist X
Wilson X
Winkler X
Wise X
Wood X
Yoakum X
Young X
Zapata X
Zavala X
1UTAH
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,690,000 245,803,000
Population Density (1988) 20.9 69.4
(per/sq.mi.)
Number of Counties 29 3,139
Median Age (1987) 25.5 31.7
Percent Below Poverty Level (1985) 11.1 14.0
(persons)
Percent of Population Rural (1980) 16.0 26.0
Percent of Population White (1980) 94.6 83.1
Percent of Population Non-white (1980) 5.4 16.9
Median Years of Education (1980) 12.8 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for county governments are
established by the Utah Constitution and Code.
Commission Form - (28) - At the present time, all counties except
Cache use this form of government. With the Commission Form,
counties use three-member boards of commissioners who are elected
from single-member districts, at large, or a combination. They
serve as the administrative and legislative bodies for the
county.
General County Plan - (1) - Cache County functions under the
General County Plan which provides for a county council that is
the governing body. An elected executive is mandated under this
plan.
Many other options as to the form of county government and their
management plans are available to Utah counties, but none has
been adopted at the present time.
Data for this state were updated November 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Utah Department of Health (UDH), the SHA, is a free-standing,
independent agency. Its mission is (1) to protect the public's
health through preventing illness, injury, disability, and
premature death; assuring access to affordable, quality health
care; and promoting healthy lifestyles; and (2) to protect the
environment through preventing or reducing pollution to
environmentally safe levels.
The following are some areas of responsibility for the SHA:
State Public Health Agency
Medicaid Single State Agency
Lead Environmental Agency in the State*
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The chief administrative officer of the UDH, the Executive
Director, is appointed by the Governor with the advice and
consent of the Senate. The Executive Director serves at the
pleasure of the Governor. The Executive Director is required to
be a physician who is licensed to practice medicine and surgery
in the state. In addition, the candidate is required to have 1
year's graduate work in a recognized school of public health or
its equivalent and have at least 5 years' professional full-time
experience, of which at least 3 must have been in public health
administration.
The Executive Director has the following powers and
responsibilities: to enforce state laws and rules established by
the Department; to amend, modify, or rescind committee rules; to
order abatement of public health hazards; to organize the
Department; to accept Federal aid; to accept funds and gifts; and
to prescribe rules for administration and government of the
Department.
* The Governor has proposed a new Department of Environmental
Quality.
C. State Board of Health/Council
Advisory
Utah has a seven-member Health Advisory Council which is
appointed by the Governor with the advice and consent of the
Senate. The membership must be broadly representative of the
public interest and will be selected with due regard to their
interest in or knowledge of public health, environmental health,
health planning, health care financing or health care delivery
systems. The Council must include health professionals, but the
majority of the membership must be non-health professionals. No
more than four persons can be from the same political party, and
consideration for membership must take into account balance in
terms of geography, sex, and ethnicity. Council members are
appointed to 4-year staggered terms.
The Council is responsible for advising the Department on any
subject deemed to be appropriate by the Council except that the
Council cannot become involved in administrative matters. The
Council is directed to advise the Department as requested by the
executive director. Quarterly Council meetings are required, and
additional meetings may be held if considered necessary by the
chairman.
D. Regional/District Health Offices
The UDH has not divided the state into administrative regions or
districts.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The UDH has designated the Office of Local and Rural Health
Systems as its liaison unit for general, non-programmatic
communications with local health departments. The Office
provides a variety of technical assistance ranging from needs
assessment to facilitating the purchase of liability insurance to
quality assurance. It administers $1,416,674 in Federal and
state funds as block grant contracts to local health
departments. It advocates for local health departments within
the UDH, and among policy makers such as state legislators. The
Office arranges two UDH meetings with local health departments
each year, in addition to providing considerable support for
quarterly meetings of the Utah Association of Local Health
Officers, the Local Community Health Nursing Directors
Association, and the Conference of Local Environmental Health
Administrators. It also maintains a limited amount of data on
each local health department, such as financial expenditures and
services provided.
The interaction of state and local public health agencies in Utah
may be characterized as decentralized organizational control.
Under this arrangement, local governments are responsible for
creating health departments with appointed local boards of
health.
F. Budget
Total FY 1988 SHA expenditures were $58,012,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $37,315,000
State Funds $15,194,000
Local Funds 0
Fees and Reimbursements $5,481,000
Other $23,000
3III. Local Public Health Agencies (LPHAs)
A. General
Utah has 12 local health departments, 6 of which are city/county
(single county) and 6 multicounty (district). Local health
departments are legally separate and autonomous from the UDH.
The UDH has over 200 contracts each year with the local health
departments to support their provision of public health
services. Some of the contracts are categorical for specific
programs while others are block grants. Matching local funds
(currently at 40 percent rate) are required for eligibility for
these funds. The local health departments must also meet minimum
standards of performance that are promulgated by the UDH.
B. Services Provided
The following information on services provided by local health
departments in Utah is derived from a survey conducted by NACHO
during 1989. Eleven of the 12 local health departments in Utah
responded to the survey. Services provided by 70 percent of
health departments in the state responding to the survey are
underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 6 ( 54.5%)
2. Morbidity Data 5 ( 45.5%)
3. Reportable Diseases 6 ( 54.5%)
4. Vital Records and Statistics 7 ( 63.6%)
B. Epidemiology/Surveillance
1. Chronic Diseases 8 ( 72.7%)
2. Communicable Diseases 9 ( 81.8%)
II. Policy Development
A. Health Code Dev. and Enforcement 8 ( 72.7%)
B. Health Planning 10 ( 90.9%)
C. Priority Setting 11 (100.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 10 ( 90.9%)
2. Health Facility Safety/Quality 7 ( 63.6%)
3. Rec. Facility Safety/Quality 11 (100.0%)
4. Other Facility Safety/Quality 5 ( 45.5%)
B. Licensing
1. Health Facilities 1 ( 9.1%)
2. Other Facilities 9 ( 81.8%)
C. Health Education 11 (100.0%)
D. Environmental
1. Air Quality 9 ( 81.8%)
2. Hazardous Waste Management 6 ( 54.5%)
3. Individual Water Supply Safety 11 (100.0%)
4. Noise Pollution 2 ( 18.2%)
5. Occupational Health and Safety 2 ( 18.2%)
6. Public Water Supply Safety 11 (100.0%)
7. Radiation Control 5 ( 45.5%)
8. Sewage Disposal Systems 10 ( 90.9%)
9. Solid Waste Management 9 ( 81.8%)
10. Vector and Animal Control 10 ( 90.9%)
11. Water Pollution 11 (100.0%)
E. Personal Health Services
1. AIDS Testing and Counseling 8 ( 72.7%)
2. Alcohol Abuse 1 ( 9.1%)
3. Child Health 11 (100.0%)
4. Chronic Diseases 11 (100.0%)
5. Dental Health 10 ( 90.9%)
6. Drug Abuse 2 ( 18.2%)
7. Emergency Medical Service 5 ( 45.5%)
8. Family Planning 9 ( 81.8%)
9. Handicapped Children 8 ( 72.7%)
10. Home Health Care 2 ( 18.2%)
11. Hospitals -
12. Immunizations 11 (100.0%)
13. Laboratory Services 6 ( 54.5%)
14. Long-term Care Facilities -
15. Mental Health 1 ( 9.1%)
16. Obstetrical Care 2 ( 18.2%)
17. Prenatal Care 11 (100.0%)
18. Primary Care 5 ( 45.5%)
19. Sexually Transmitted Diseases 11 (100.0%)
20. Tuberculosis 9 ( 81.8%)
21. WIC 11 (100.0%)
C. Local Health Officer
M.D. Requirement When Population over 100,000, Local Board of
Health Appointment
The local health officer is appointed by the local board of
health. Local health officers are required to be medical doctors
unless the population of the jurisdiction is under 100,000. The
role of the local health officer for each of the 12 local health
departments is to provide overall direction for the local public
health programs. Supervision of the local health officer is
performed by the local board of health.
D. Local Board of Health
Policy-making
The local board of health is appointed by the county
commissioners and sometimes municipal officials. One or more of
the county commissioners usually serve on these boards. The
health officer may serve as secretary to the board. The number
of members must be at least five, but the maximum number is not
specified in the law. The function of the local board of health
is to provide policy direction to the local health department.
E. Staff
The staffs of local health departments are employed by the local
health officer. The number of staff for individual local health
departments ranges from 4 to 220.
F. Budget
Total FY 1988 LPHA expenditures were $33,447,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $14,204,000
State Funds $1,800,000
Local Funds $8,500,000
Fees and Reimbursements $8,430,000
Other Sources 0
Source Unknown 0
The SHA reported that these figures include the total amount of
additional local health department monies expended by all local
health departments.
2Utah Department of Health, 1990
Governor
Executive Director
Health Advisory Council
Ethnic Minority Health Commission
Public Information
Governmental and Community Allocations
Local and Rural Health Systems
Rural/Health Advisory Commission
Division of Health Care Financing
Facility Manager
Policy and Planning
Financial Services
Medicaid and Mgmt. Info. System Operations
Utah Medical Assistance Program Planning
Manager Health Care
Division of Environmental Health
Solid and Hazardous Waste
Solid and Hazardous Waste Comm.
Drinking & Water Sanitation
Safe Drinking Water Comm.
Radiation Control
Radiation Technical Advisory Comm.
Water Pollution Control
Water Pollution Control Comm.
Air Quality
Air Quality Comm.
Office of the Medical Examiner
Medical Examiner Advisory Comm.
Deputy Director
Assistant Director Financial Services
Finance
Financial Audit
General Services
Assistant Director Administrative Services
Organizational Development and Evaluation
Vital Records and Health Statistics
Budget
Human Resource Management
EDP and Systems
State Health Laboratory
Environmental Chemistry and Toxicology
Laboratory Improvement
Microbiology
Division of Community Health Services
Epidemiology
AIDS Advisory Comm.
Health Facility Licensure
Health Facility Comm.
Chronic Disease
Health Promotion and Risk Reduction
Emergency Medical Services
Emergency Medical Services Comm.
Division of Family Health Service
Child Health
Dental Health
Children's Special Health Services
Interagency Coordinating Council for Infants and Toddlers
Communicative Disorders
Maternal and Infant Health
WIC Services
WIC Advisory Council
2Types of Local Health Departments by Jurisdiction
Utah, 1990
Jurisdiction C/Co M/Co
Beaver X
Bountiful-Davis Co X
Box Elder X
Cache X
Carbon X
Daggett X
Duchesne X
Emory X
Garfield X
Grand X
Heber-Wasatch Co X
Iron X
Juab X
Kane X
Millard X
Morgan X
Park City-Summit Co X
Piute X
Provo-Utah Co X
Rich X
Salt Lake C/Co X
San Juan X
Sanpete X
Sevier X
Tooele C/Co X
Uintah X
Washington X
Wayne X
Weber X
C/Co = City/County HD
M/Co = Multicounty HD
1VERMONT
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 557,000 245,803,000
Population Density (1988) 60.1 69.4
(per/sq.mi.)
Number of Counties 14 3,139
Median Age (1987) 31.1 31.7
Percent Below Poverty Level (1985) 9.2 14.0
(persons)
Percent of Population Rural (1980) 66.0 26.0
Percent of Population White (1980) 99.1 83.1
Percent of Population Non-white (1980) .9 16.9
Median Years of Education (1980) 12.6 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The Vermont Constitution and Statutes empower and establish the
legal framework for counties. Counties operate under a County
Court System. The officers of this form of government consist of
a Superior Judge who is appointed by the Governor and assistant
judges of the Superior Court who are elected at large. The
assistant judges provide the principal management function for
the county.
State statutes require counties to provide and own a courthouse
to be used only as chambers for a justice of the Supreme Court
and for the Superior Judge and Superior Court. It is also
available to the probate court and district court.
Counties are granted authority to acquire and own land, condemn
land, assess taxes to support legitimate functions, and collect
rent on leased property.
There are no provisions in Vermont for home rule authority,
county administrators, or optional forms of government.
Data for this state were updated January 1991.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The SHA is the Vermont Department of Health (VDH), which is a
component of a superagency called the Agency of Human Services.
The purpose of the agency is to provide services to citizens and
communities throughout the state to prevent illness and control
or eliminate hazards to the public.
The following are some specific program areas for which the SHA
has responsibility:
Title V (Maternal and Child Health) - all of it
WIC
Title X
Nutrition (surveillance, nutrition education/training, and
grant consultation)
Early Periodic Screening, Diagnosis and Testing (outreach,
education, and case management only)
Refugee Health
Emergency Medical Services
Epidemiology (communicable disease, immunizations, chronic
disease, and health promotion)
Environmental Health
Dental Health
Chief Medical Examiner
Public Health Statistics and Vital Records (includes
hospital discharge data) - policy, planning, and
evaluation
Laboratory
Occupational and Radiological Health
The following are broad areas of responsibility for the SHA:
State Public Health Authority
Title V including Children With Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Commissioner of Health, the head of the SHA, is appointed by
the Secretary of the Agency for Human Services and by statutory
requirement must be a physician.
The responsibilities of the Commissioner include the delegation
of power and assignment of duties as appropriate. The
Commissioner is also responsible for conducting investigations
when information indicates possible public health hazards and may
determine when a public health risk or hazard is a state or local
problem.
C. State Board of Health/Council
Advisory
Vermont has a seven-member State Board of Health appointed by the
Governor. The board is composed of three physicians, one
dentist, and three lay persons. The members are appointed for a
term of 6 years. The board functions in an advisory capacity to
the Commissioner.
D. Regional/District Health Offices
Vermont has not divided the state into solely administrative
districts or regions. The 12 districts that exist are both
administrative and service delivery units for the VDH.
E. State-local Liaison
Centralized Organizational Control, Formal Liaison Function
The Director of the Division of Local Health is the focus of
communications between the SHA and the district offices. The
Director is also in the chain of command with line authority over
the district offices.
The interaction between state and local health agencies in
Vermont may be characterized as centralized organizational
control. Under this arrangement local health departments
function directly under the state's authority and are operated by
the SHA or a state board of health.
F. Budget
Total FY 1988 SHA expenditures were $21,655,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $12,378,000
State Funds $8,785,000
Local Funds 0
Fees and Reimbursements $304,000
Other $197,000
3III. Local Public Health Agencies (LPHAs)
A. General
Vermont has no autonomous local health departments. The local
units are part of the SHA. The 12 district offices provide
services to local areas and perform many of the same basic
functions as local health departments in other states. The
districts are composed of several towns (multitown areas) units
and have no relationship to county governments.
B. Services Provided
The following are services provided by all 12 of the districts
(information provided by VDH). Services provided by at least 70
percent of the health departments in the state are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 12 (100.0%)
2. Morbidity Data 12 (100.0%)
3. Reportable Diseases 12 (100.0%)
4. Vital Records and Statistics -
B. Epidemiology/Surveillance
1. Chronic Diseases -
2. Communicable Diseases 12 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement -
B. Health Planning -
C. Priority Setting -
III. Assurance Activities
A. Inspection
1. Food and Milk Control 12 (100.0%)
2. Health Facility Safety/Quality -
3. Rec. Facility Safety/Quality -
4. Other Facility Safety/Quality 12 (100.0%)
B. Licensing
1. Health Facilities -
2. Other Facilities 12 (100.0%)
C. Health Education 12 (100.0%)
D. Environmental
1. Air Quality -
2. Hazardous Waste Management -
3. Individual Water Supply Safety -
4. Noise Pollution -
5. Occupational Health and Safety -
6. Public Water Supply Safety 12 (100.0%)
7. Radiation Control -
8. Sewage Disposal Systems -
9. Solid Waste Management -
10. Vector and Animal Control -
11. Water Pollution -
E. Personal Health Services
1. AIDS Testing and Counseling -
2. Alcohol Abuse -
3. Child Health 12 (100.0%)
4. Chronic Diseases 12 (100.0%)
5. Dental Health -
6. Drug Abuse -
7. Emergency Medical Service -
8. Family Planning 12 (100.0%)
9. Handicapped Children 12 (100.0%)
10. Home Health Care -
11. Hospitals -
12. Immunizations 12 (100.0%)
13. Laboratory Services -
14. Long-term Care Facilities -
15. Mental Health -
16. Obstetrical Care -
17. Prenatal Care * 12 (100.0%)
18. Primary Care -
19. Sexually Transmitted Diseases -
20. Tuberculosis -
21. WIC 12 (100.0)
C. Local Health Officer
No M.D. Requirement, Board of Health Appointment
State law in Vermont designates the health officer as the town
official who is responsible for public health problems in their
town. Health officers have the power of the Vermont Commissioner
of Health in their town(s) of jurisdiction. A health officer is
an agent of the VDH and has authority to enforce any state health
regulations in his/her town. The health officer relates to the
VDH district office for technical assistance, support, and
training. The health officer will also relate to the VDH central
office consultants, depending on the issue.
* Public health nursing and nutritional counseling
D. Local Board of Health
Policy-making
Each of the 251 towns in Vermont has it own local board of health
which is usually the town Board of Selectpersons. The board of
health is responsible for appointing the town health officer.
E. Staff
All personnel are either employed or contracted by the state.
The district units have on average 12 employees in each unit. A
typical region would have a District Manager, four nurses, a
nutritionist, two health educators, two to three clerks, one
dental hygienist, and one sanitarian.
F. Budget
There are no local sources of funding.
2Vermont Department of Health, 1990
Commissioner
Emergency Medical Services Division
Epidemiology Health Promotion and Chronic Disease Division
Administration Division
Public Health Policy and Analysis Division
Dental Division
Occupational and Radiological Health Division
Chief Medical Examiner Division
Environmental Health Division
Programs for Children with Special Health Needs Division
Public Health Laboratory Division
Local Health
Chief of Operations
District Manager (12)
Local Health District Staff
2Types of Local Health Departments by Jurisdiction
Vermont, 1990
Jurisdiction N/Co M/T
Addison X
Barre X
Bennington X
Bennington X
Brattleboro X
Burlington X
Caledonia X
Chittenden X
Essex X
Franklin X
Grand Isle X
Lamoille X
Middlebury X
Morrisville X
Newport X
Orange X
Orleans X
Rutland X
Rutland X
Springfield X
St. Albans X
St. Johnsbury X
Washington X
White River Junctio X
Windham X
Windsor X
N/Co = No County HD
M/T = Multitownship HD
1VIRGINIA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 6,015,000 245,803,000
Population Density (1988) 151.5 69.4
(per/sq.mi.)
Number of Counties * 95 3,139
Median Age (1987) 31.8 31.7
Percent Below Poverty Level (1985) 10.0 14.0
(persons)
Percent of Population Rural (1980) 34.0 26.0
Percent of Population White (1980) 79.1 83.1
Percent of Population Non-White (1980) 20.9 16.9
Median Years of Education (1980) 12.4 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and authority for county governments in Virginia
are established by the state constitution and code. Counties may
choose one of six different forms of government: Traditional,
County Board, County Executive, County Manager, Urban County
Manager, and Urban County Executive.
Traditional Form - (85) - This form has a board made up of 3 to
11 supervisors who are elected from single-member districts, at
large, or by a combination of methods. Eighty-two of these
counties have a board-appointed administrator. In the other two
counties the board serves as the legislative and administrative
body.
County Administrator Form - (3) - This form is used in Carroll,
Russell, and Scott Counties where the board appoints a county
administrator who also serves as the county purchasing agent.
County Executive Plan - (2) - In Albemarle and Prince William
Counties which use this plan, the county executive is appointed
* Virginia has 95 counties and 41 independent cities, which total
136 separate areas.
Data for this state were updated January 1991. by the board and
responsible for administering all affairs under the board's control.
County Manager Form - (1) - Henrico County operates with this
plan and uses a board that appoints a county manager.
Urban County Executive Form - (1) - The Urban County Executive
Form is patterned after the County Executive but expands the
board's authority in certain areas and permits the board to
appoint an executive officer.
Urban County Manager Form - (1) - This form operates with a
board-appointed county manager who is quite similar to the County
Executive, except that the position has more authority to appoint
employees in administrative services.
Charter Form - (2) - Chesterfield and Roanoke counties operate
under the Traditional Form of government and also have a county
charter. Although they have a charter, there is no home rule
authority, and most local decisions require approval by the
General Assembly. These counties operate with boards of
supervisors and appointed administrators.
City-county Consolidation - (5) - The following city-county
consolidations are known as cities: Hampton-Elizabeth
City-County is known as the City of Hampton; Virginia
Beach-Princess Anne County is known as the City of Virginia
Beach; South Norfolk-Norfolk County is known as the City of
Chesapeake; Warwick City-Newport News County is known as the City
of Newport News; and Suffolk-Nansemond County is known as the
City of Suffolk. In addition to these consolidations, all cities
of the first class make up a type of government known as
independent cities, of which Virginia has 41.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The State Health Agency is the Virginia Department of Health
(VDH). It is a free-standing, independent agency (see attached
table of organization). The Code of Virginia states, "the State
Board of Health and the State Health Commissioner, assisted by
the State Department of Health, shall administer and provide a
comprehensive program of preventive, curative, restorative and
environmental health services, educate the citizens in health and
environmental matters, develop and implement health resource
plans, collect and preserve vital records and health statistics,
assist in research, and abate hazards and nuisances to the health
and to the environment, both emergency and otherwise, and thereby
improve the quality of life in the commonwealth."
The following are some areas of responsibility for the SHA:
State Public Health Authority
State Agency for Children with Special Health Care Needs
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Health Planning and Development Agency
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Commissioner of Health, the head of the SHA, is appointed by
the Governor and confirmed by each house of the General
Assembly. The Commissioner must be a physician licensed to
practice medicine in this state, be certified by the American
Board of Preventive Medicine, experienced in public health
duties, sanitary science and environmental health, and otherwise
qualified to execute the duties incumbent on him/her by law.
C. State Board of Health/Council
Policy-making
The State Board of Health consists of 11 residents of Virginia
appointed by the Governor for terms of 4 years each. Two members
of the Board are members of the Medical Society of Virginia, one
member is a member of the Virginia Pharmaceutical Association,
one member is a member of the State Dental Association, one
member is a member of the Virginia Nurses' Association, one
member is a member of the Virginia Veterinary Association, one
member is a representative of local government, one member is a
representative of the hospital industry, one member is a
representative of the nursing home industry, and two members are
consumers with expertise in health care policy, analysis, and
financing. A vacancy, other than expiration of term, is filled
by the Governor for the unexpired term. The responsibility of
the board includes: making policy, promulgating regulations for
operation of the department's program; licensing of certain
health professions and facilities; protecting environmental
health standards.
D. Regional/District Health Offices
The state is divided into four regions each directed by a
physician (see attached map). The regions are further divided
into 36 districts, each directed by a physician. Each locality,
cities and counties, is served by a local health department.
The following positions are common to regional offices:
Director
Administrator
Sanitarian
Nurse Manager
Nutritionist
Program Representatives
STD
AIDS
Immunization
TB
WIC
Secretary
Several Clerks
The regional staff usually function as consultants, providing
support to the health departments in the region. They may be
involved in program evaluation but not usually in evaluating or
supervising the performance of staff. The Regional Director is
responsible for supervising and evaluating the performance of the
district medical directors in the region.
E. State-local Liaison
Centralized Organizational Control, Formal Liaison Function
The Deputy Commissioner for Community Health Services functions
as the state-local liaison. He is responsible for the day-to-day
operations of the regional, district and local health
departments. Information flows up and down this chain of
command.
The state and LPHA interaction in Virginia may be characterized
as centralized organizational control. Under this system, local
health departments function directly under the state's authority
and are operated by the SHA or a state board of health.
F. Budget
Total FY 1988 SHA expenditures were $206,196,000. Total FY 1988
United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $55,085,000
State Funds $88,562,000
Local Funds $40,847,000
Fees and Reimbursements $21,702,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Virginia has 119 local health departments. These local health
departments consist of 13 city/county departments, 24 city health
departments, and 82 county health departments. Within these
local departments are 56 satellite clinic offices for a total of
175 clinic sites. The governing body of any city/county enters
into a contractual agreement with the Board of Health for
operating the local health department. Each local health
department is funded cooperatively by the state and local
funding, with shares determined by the revenue capacity of the
locality. The contract specifies the services to be provided, in
addition to the services required by law, and also other
provisions as the board and governing body of the city/county may
agree upon. Local health departments are supported by a
cooperative budget, which, including local match dollars and fee
revenue, totals $104,665,622 ($17.82 per capita).
B. Services Provided
The following information on services provided by local health
departments in Virginia is derived from a survey conducted by
NACHO during 1989. Fifty-seven of the 119 local health
departments in Virginia responded to the survey. Services
provided by 70 percent of health departments in the state are
underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 22 ( 38.6%)
2. Morbidity Data 26 ( 45.6%)
3. Reportable Diseases 56 ( 98.2%)
4. Vital Records and Statistics 56 ( 98.2%)
B. Epidemiology/Surveillance
1. Chronic Diseases 41 ( 71.9%)
2. Communicable Diseases 56 ( 98.2%)
II. Policy Development
A. Health Code Dev. and Enforcement 32 ( 56.1%)
B. Health Planning 29 ( 50.9%)
C. Priority Setting 27 ( 47.4%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 54 ( 94.7%)
2. Health Facility Safety/Quality 24 ( 42.1%)
3. Rec. Facility Safety/Quality 28 ( 49.1%)
4. Other Facility Safety/Quality 21 ( 36.8%)
B. Licensing
1. Health Facilities 5 ( 8.8%)
2. Other Facilities 47 ( 82.5%)
C. Health Education 45 ( 78.9%)
D. Environmental
1. Air Quality 6 ( 10.5%)
2. Hazardous Waste Management 13 ( 22.8%)
3. Individual Water Supply Safety 52 ( 91.2%)
4. Noise Pollution 7 ( 12.3%)
5. Occupational Health and Safety 10 ( 17.5%)
6. Public Water Supply Safety 35 ( 61.4%)
7. Radiation Control 4 ( 7.0%)
8. Sewage Disposal Systems 54 ( 94.7%)
9. Solid Waste Management 17 ( 29.8%)
10. Vector and Animal Control 44 ( 77.2%)
11. Water Pollution 32 ( 56.1%)
E. Personal Health Services
1. AIDS Testing and Counseling 56 ( 98.2%)
2. Alcohol Abuse 2 ( 3.5%)
3. Child Health 55 ( 96.5%)
4. Chronic Diseases 53 ( 93.0%)
5. Dental Health 44 ( 77.2%)
6. Drug Abuse 2 ( 3.5%)
7. Emergency Medical Service 1 ( 1.8%)
8. Family Planning 55 ( 96.5%)
9. Handicapped Children 45 ( 78.9%)
10. Home Health Care 52 ( 91.2%)
11. Hospitals 2 ( 3.5%)
12. Immunizations 57 (100.0%)
13. Laboratory Services 27 ( 47.4%)
14. Long-term Care Facilities 4 ( 7.0%)
15. Mental Health 1 ( 1.8%)
16. Obstetrical Care 23 ( 40.4%)
17. Prenatal Care 57 (100.0%)
18. Primary Care 16 ( 28.1%)
19. Sexually Transmitted Diseases 56 ( 98.2%)
20. Tuberculosis 57 (100.0%)
21. WIC 57 (100.0%)
C. Local Health Officer
M.D. Requirement, Commonwealth Appointment
All districts are headed by a local health director. Each
director is a physician licensed to practice medicine in
Virginia. The Virginia recruitment and hiring process is used to
fill these local health director positions. Interviewing and
hiring are done at the regional level and are subject to approval
of the local governing body. The director is responsible for
carrying out services which are required by law and other
provisions mandated by the State Board of Health or by the local
governing body.
D. Local Board of Health
Virginia does not mandate local boards of health. All local
health departments are units of the VDH and are governed by the
State Board of Health. Some localities have advisory boards.
E. Staff
All employees of local health departments are employees of VDH,
with the exception of Arlington County which is operating a
locally administered health department as a pilot project
authorized by the General Assembly. In some instances the
locality may be the employer, but the employee is under the
supervision of the local health department. The positions are
funded through the contractual agreement or Federal grants and
contracts. The number of full-time employees for an individual
local health department ranges from 2 to 500.
F. Budget
Total FY 1988 LPHA expenditures were $110,084,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $ 9,873,000
State Funds $48,498,000
Local Funds $36,364,000
Fees and Reimbursements $15,349,000
Other Sources 0
Source Unknown 0
The SHA reported that these figures include the total amount of
additional local health department monies expended by all local
health departments.
2Virginia Department of Health, 1990
Commissioner of Health
Deputy Commissioner for Health Care Services
Director Office of Family Health Services
Division of M.C.H.
Division of Family Planning
Division of Children's Special Services
Division of P.H. Nutrition
Division of Dental Health
Director Office of Epidemiology
Division of Communicable Disease Control
Division of Health Hazards Control
Division of Survey and Investigation
Director Office of Health Education and Information
Division of Health Education
Division of Information Services
Division of Chronic Disease Control
Deputy Commissioner for Community Health Services
Director Northern Region
Director Southwest Region
Director Central Region
Director Eastern Region
Nursing Director
Director Sanitation Services
Office of Water Programs
Division of Water Supply Engineering
Division of Wastewater Engineering
Division of Shellfish Sanitation
Deputy Commissioner for Administration
Director Office of Human Resource Management
Division of Compensation and Class.
Division of Policy, Benefits and Operations
Division of Employment Services
Division of E.E.O.
Division of Organizational Development and Training
Director Office of Finance and General Services
Division of Purchasing and General Services
Division of Budget Services
Division of Information Resources
Division of Home Health Services
Division of Vital Records
Division of Accounting
Director Office Planning and Reg. Services
Division of Resources Development
Division of Licensing and Certification
Division of E.M.S.
Division of Health Planning
2Types of Local Health Departments by Jurisdiction
Virginia, 1990
Jurisdiction Co C C/Co
Accomack X
Alexandria X
Amelia X
Amherst X
Appomattox X
Arlington X
Bath X
Bedford X
Bedford X
Bland X
Botetourt X
Bristol X
Brunswick X
Buchanan X
Buckingham X
Buena Vista X
Campbell X
Caroline X
Carroll X
Charles City X
Charlotte X
Charlottsville-Albe X
Chesapeake X
Chesterfield X
Clarke X
Clifton Forge X
Colonial Height X
Covington X
Covington-Alleghany X
Craig X
Culpeper X
Cumberland X
Danville X
Dickenson X
Dinwiddie X
Emproia-Greensville X
Essex X
Fairfax X
Fairfax X
Falls Church X
Fauquier X
Floyd X
Fluvanna X
Franklin X
Franklin X
Fredericksburg X
Front R.-Warren X
Galax X
Giles X
Gloucester X
Goochland X
Grayson X
Greene X
Hampton X
Hanover X
Harrisburg-Rockingh X
Henrico X
Highland X
Hopewell X
Isle of Wight X
James City X
King George X
King William X
King and Queen X
Lancaster X
Lee X
Lexington X
Lexington-Rockbridg X
Loudoun X
Louisia X
Lunenburg X
Lynchburg X
Madison X
Manassas X
Manassas Park X
Martinsville-Henry X
Mathews X
Mecklinburg X
Montgomery X
Nelson X
New Kent X
Newport News X
Norfolk X
Northampton X
Northumberland X
Norton-Wise Co X
Nottoway X
Orange X
Page X
Patrick X
Petersburg X
Pittsylvania X
Poquoson X
Poquoson-York Co X
Portsmouth X
Powhatan X
Prince Edward X
Prince William X
Pulaski X
Radford X
Rappahannock X
Richmond X
Richmond X
Roanoke X
Roanoke City/Co X
Rockingham X
Russell X
S. Boston-Halifax X
Salem X
Scott X
Shenandoah X
Smyth X
Southampton X
Spotsylvania X
Stafford X
Staunton X
Staunton-Augusta X
Suffolk X
Surry X
Sussex X
Tazewell X
Virginia Beach X
Washington X
Waynesboro X
Westmoreland X
Williamsburg X
Winchester X
Winnchester-Freder X
Wythe X
York X
Co = County HD
C/Co = City/County HD
C = City HD
1WASHINGTON
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 4,648,000 245,803,000
Population Density (1988) 69.9 69.4
(per/sq.mi.)
Number of Counties 39 3,139
Median Age (1987) 31.9 31.7
Percent Below Poverty Level (1985) 12.0 14.0
(persons)
Percent of Population Rural (1980) 27.0 26.0
Percent of Population White (1980) 91.5 83.1
Percent of Population Non-white (1980) 8.5 16.9
Median Years of Education (1980) 12.7 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The structure and function of the county government in Washington
are established by the state constitution and statutes. Counties
can choose between two structural options for their governments:
Commission and Home Rule Charter.
Commission Form - (34) - These counties have three-member
commissioner boards which are elected from single-member
districts. The boards serve as the legislative and executive
bodies for the counties. Within the group of counties that
employ the Commission Form of government, 13 use an appointed
administrator to carry out the polices established by the board.
Home Rule Charter - (5) - Four of these counties function with a
council and an elected executive. One Home Rule Charter county
(Clallam) has a commission and an appointed administrator.
Data for this state were updated March 1991.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Division of Health was a component of the superagency (the
Washington Department of Social and Health Services) from 1970
until 1989, when an independent Department of Health was
re-established. The Department of Health is the state agency
which helps Washingtonians live healthier lives by:
Empowering individuals and communities to make informed
health choices
Assuring access to quality prevention and illness care
Protecting people from environmental threats to health
Advocating sound, cost-effective health policies
The following are some areas of responsibility for the SHA:
State Public Health Authority
Institutional Licensing Agency (except nursing homes)
Institutional Certifying Authority for Federal Reimbursement
(except nursing homes)
Health Professions Licensing Agency
State Agency for Children with Special Health Care Needs
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Secretary of the Department of Health is the administrative
head of the SHA. Appointed by the Governor and confirmed by the
Senate, the Secretary is not required to have an M.D. degree.
The State Health Officer, who is appointed by the Secretary, does
require an M.D. degree. To fulfill the responsibilities and
duties of the office, the Secretary shall:
1. Exercise all the powers and perform all the duties
prescribed by law with respect to public health and
vital statistics.
2. Investigate and study factors relating to the
preservation, promotion, and improvement of the health
of the people, the causes of morbidity and mortality,
and effects of the environment and other conditions
upon the public health for such action as the board
determines is necessary.
3. Strictly enforce all laws for the protection of the
public health and the improvement of sanitary
conditions in the state, and all rules, regulations,
and orders of the State Board of Health.
4. Enforce the public health laws of the state and the
rules and regulations promulgated by the Department or
the board of health in local matters, when in its
opinion an emergency exists and the local board of
health has failed to act with sufficient promptness or
efficiency, or is unable, for reasons beyond its
control, to act, or when no local board has been
established.
5. Investigate outbreaks and epidemics of disease that may
occur and advise local health officers as to measures
to be taken to prevent and control the same.
6. Exercise general supervision over the work of local
health departments and establish uniform reporting
systems by local health officers to the State
Department of Health.
7. Have the same authority as local health officers,
except that the Secretary shall not exercise such
authority unless the local health officer fails or is
unable to do so, or when in an emergency the safety of
the public health demands it.
8. Cause to be made, from time to time, personal health
and sanitation inspections at state-owned or contracted
institutions and facilities to determine compliance
with sanitary and health care standards as adopted by
the department, and require the governing authorities
thereof to take such action as will conserve the health
of all persons connected therewith, and report the
findings to the Governor.
9. Take such measures as the Secretary deems necessary to
promote the public health, to establish or participate
in the establishment of health educational or training
activities, and to provide funds for and to authorize
the attendance and participation in such activities of
employees of the state or local health department and
other individuals engaged in programs related to or
part of the public health programs of the local health
departments or State Health Department. The Secretary
is also authorized to accept any funds from the Federal
government or any public or private agency made
available for health education training purposes and to
conform with such requirements as are necessary to
receive such funds.
10. Establish and maintain laboratory facilities and
services as necessary to carry out the responsibilities
of the Department.
C. State Board of Health/Council
Policy-making
The Washington Board of Health is a 10-member body, appointed by
the Governor, made up of the Secretary of the Department, 4
persons experienced in matters of health and sanitation, 1 person
who is an elected city official who is a member of a local health
board, 1 local health officer, and 2 persons representing the
consumers of health care.
D. Regional/District Health Offices
The SHA has not divided the state into geographical regions or
districts.
E. State-local Liaison
Decentralized Organizational Control, Formal Liaison Function
The Office of Local Health Support Services has responsibility
for the state-local liaison. In support of the Department's
mission, the Office of Local Health Support Services facilitates
the formal partnership link between the Washington Department of
Health and the public health community in Washington State. The
objectives of the Office are to facilitate communication and
coordination between the Department of Health and local
government, to increase capacity of local public health agencies
to develop and implement effective public health programs. The
Office has the following roles/functions:
1. Represent the Secretary/State Health Officer to outside
agencies and organization.
2. Act as liaison and resource to program managers and
local public health agency managers.
3. Provide management services and consultation to local
public health agencies.
4. Manage consolidated contract with local public health
agencies.
The interaction between state and local public health agencies in
Washington may be characterized as decentralized organizational
control. Under this arrangement local government directly
operates local health departments with a local board of health.
Responsibilities are defined by state statute and State Board of
Health regulations.
F. Budget
Total FY 1988 Washington SHA expenditures were $25,987,000*.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $4,674,000
State Funds $6,890,000
Local Funds $151,000
Fees and Reimbursements 0
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Washington has 32 local health departments, consisting of 25
county, 5 multicounty, and 2 city-county health departments.
B. Services Provided
The following information on services provided by local health
departments in Washington is derived from a survey conducted by
NACHO during 1989. All 32 local health departments in Washington
responded to the survey. Services provided by at least 70
percent of health departments in the state responding to the
survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 10 ( 31.3%)
2. Morbidity Data 15 ( 46.9%)
3. Reportable Diseases 30 ( 93.8%)
4. Vital Records and Statistics 32 (100.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases 10 ( 31.3%)
2. Communicable Diseases 32 (100.0%)
* These data exclude most funds expended on maternal and child
health because these programs were in another part of the
superagency.
II. Policy Development
A. Health Code Dev. and Enforcement 22 ( 68.8%)
B. Health Planning 23 ( 71.9%)
C. Priority Setting 23 ( 71.9%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 28 ( 87.5%)
2. Health Facility Safety/Quality 6 ( 18.8%)
3. Rec. Facility Safety/Quality 22 ( 68.8%)
4. Other Facility Safety/Quality 9 ( 28.1%)
B. Licensing
1. Health Facilities 2 ( 6.3%)
2. Other Facilities 28 ( 87.5%)
C. Health Education 25 ( 78.1%)
D. Environmental
1. Air Quality 6 ( 18.8%)
2. Hazardous Waste Management 25 ( 78.1%)
3. Individual Water Supply Safety 30 ( 93.8%)
4. Noise Pollution 6 ( 18.8%)
5. Occupational Health and Safety 5 ( 15.6%)
6. Public Water Supply Safety 30 ( 93.8%)
7. Radiation Control 3 ( 9.4%)
8. Sewage Disposal Systems 31 ( 96.9%)
9. Solid Waste Management 30 ( 93.8%)
10. Vector and Animal Control 28 ( 87.5%)
11. Water Pollution 26 ( 81.3%)
E. Personal Health Services
1. AIDS Testing and Counseling 31 ( 96.9%)
2. Alcohol Abuse 6 ( 18.8%)
3. Child Health 32 (100.0%)
4. Chronic Diseases 19 ( 59.4%)
5. Dental Health 20 ( 62.5%)
6. Drug Abuse 6 ( 18.8%)
7. Emergency Medical Service 4 ( 12.5%)
8. Family Planning 15 ( 46.9%)
9. Handicapped Children 29 ( 90.6%)
10. Home Health Care 5 ( 15.6%)
11. Hospitals -
12. Immunizations 32 (100.0%)
13. Laboratory Services 19 ( 59.4%)
14. Long-term Care Facilities -
15. Mental Health 3 ( 9.4%)
16. Obstetrical Care 3 ( 9.4%)
17. Prenatal Care 24 ( 75.0%)
18. Primary Care 8 ( 25.0%)
19. Sexually Transmitted Diseases 29 ( 90.6%)
20. Tuberculosis 32 (100.0%)
21. WIC 25 ( 78.1%)
C. Local Health Officer
M.D. Requirement, Local Board of Health Appointment
Local health officers are appointed by the local board of health
and are required to be an M.D. They have the power and duty to
enforce state statutes, state rules, and local rules passed by
the local board of health.
D. Local Board of Health
Policy-making
County commissioners constitute the local board of health for
county health departments. District (multicounty) boards are
composed of representatives from county commissioners, city, and
town governments within the jurisdiction. These boards enforce
state statutes, enact and enforce local rules, approve health
budget, and supervise the local health department.
E. Staff
All of the staffs of local health departments are county
employees, except for King County which has a mixture of county
and Seattle City employees. The number of individuals employed
by a local health department ranges from 1 to 960.
F. Budget
Total FY 1988 LPHA expenditures were $87,001,000**. Total FY
1988 United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $14,007,000
State Funds $10,126,000
Local Funds $42,852,000
Fees and Reimbursements $17,778,000
Other Sources $2,238,000
Source Unknown 0
The SHA reported that these figures include the total amount of
additional monies expended by all local health departments.
** These data were provided by the SHA.
2Wahington State Department of Health, 1990
Secretary
Deputy Secretary
Board of Health
Health Officer
Local Health Support Services
Attorney General Office Health Division
Legal and Constituency Affairs/Media Relations
Division of Health Information--Assistant Secretary
Epidemiology
Health Policy Support
Hospital Data System
Center for Health Statistics
Birth Defects
Division of Parent and Child Health--Assistant Secretary
Women, Infants and Children (WIC)
Maternal/Infant Health, Newborn Screening and Genetics
Operation Support
Family Planning
Children with Special Health Care Needs
Child and Adolescent Health
Division of Health Promotion and Disease Prevention--
Assistant Secretary
Primary Health Care Services
Injury Prevention Operations
Health Education and Promotion
Rural Health Systems Project
Heart Disease and Cancer
Kidney Disease and Diabetes
Parent and Child Health
Prevention/Education
Operations/Client Services
EPI-Surveillance
Sexually Transmitted Disease
Immunization/Tuberculosis Services
Division of Environmental Health--Assistant Secretary
Drinking Water
Radiation Protection
Shellfish
Local Environmental Health Support
Toxic Substances
Program Services
Division of Licensing and Certification--Assistant Secretary
Facility Licensing and Certification Division
Professional Licensing Services Division
Fac. Development and Accom. Licensing
Licensing Policy and Budget
EMS/Trauma
Division of Laboratories--Assistant Secretary
Virology and Serology
Radiation Chemistry
Laboratory Resource and Development
Public Health Microbiology Lab
Environmental Chemistry
Bacterial/Quality Assurance
Newborn Screening
Genetics Laboratory
Division of Management Services Assistant Secretary
Comptroller's Officer
Contracts/Rules
Information Services
Administrative Services
Personnel
2Types of Local Health Departments by Jurisdiction
Washington, 1990
Jurisdiction Co C/Co M/Co
Adams X
Asotin X
Benton X
Chelan X
Clallam X
Clark X
Columbia X
Cowlitz X
Douglas X
Ferry X
Franklin X
Garfield X
Grant X
Grays Harbor X
Island X
Jefferson X
Kitsap X
Kittitas X
Klickitat X
Lewis X
Lincoln X
Mason X
Okanogan X
Pacific X
Pend Oreille X
San Juan Island X
Seattle-King Co X
Skagit X
Skamania X
Snohomish X
Spokane X
Stevens X
Tacoma-Pierce C X
Thurston X
Wahkiakum X
Walla Walla X
Whatcom X
Whitman X
Yakima X
Co = County HD
C/Co = City/County HD
M/Co = Multicounty HD
1WEST VIRGINIA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 1,877,000 245,803,000
Population Density (1988) 77.8 69.4
(per/sq.mi.)
Number of Counties 55 3,139
Median Age (1987) 32.4 31.7
Percent Below Poverty Level (1985) 22.3 14.0
(persons)
Percent of Population Rural (1980) 64.0 26.0
Percent of Population White (1980) 96.2 83.1
Percent of Population Non-white (1980) 3.8 16.9
Median Years of Education (1980) 12.2 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule Authority
The West Virginia Constitution establishes the structure and
provides authority for operating county governments.
Commission Form - (55) - The commissions are made up of three
members, except one county which has a five-member board. The
commissioners are elected at large with staggered 6-year terms.
Twenty-three counties have the position for appointed
administrators.
Although counties do not have authority to adopt home rule or
charter provisions, they can apply to the legislature for
permission to alter the county commission. The form of county
government can also be changed with permission of the legislature
and approval by the voters.
Data for this state were updated January 1991.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Bureau of Public Health, the SHA, is a component of the
superagency known as the Department of Health and Human
Resources. The mission of the Department is to organize and
manage resources to develop and implement a continuum of
health services so that they are primarily dedicated to the
statewide support and enhancement of public health, environmental
health, and behavioral health services, which are community
responsive, therapeutically appropriate, and prevention oriented.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Lead Environmental Agency in the State
State Mental Health Authority
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
State Institutions/Hospitals
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The Director of the Bureau of Health is the State Health
Officer. This individual speaks for public health in the state.
Various statutes give the Director authority to approve the
appointment of county health officers, decide public health
goals, develop policies, direct the disbursement of funds, and is
otherwise the leader from whom all direction flows. This
position is appointed by the Secretary of Health and Human
Services.
C. State Board of Health/Council
Policy-making
The 16-member State Board of Health is appointed by the Governor,
with the advice and consent of the Senate. Three members of the
board shall be physicians or surgeons with a doctor of medicine
degree, one member shall be an osteopathic physician, one shall
be a dentist, one shall be a registered nurse, one shall be a
pharmacist, three shall be from mental health disciplines, one
shall be an administrator of a licensed hospital, one shall be an
optometrist, one shall be a chiropractor, and three shall be
representative citizens. All appointments are for 5-year terms.
The Board reviews actions brought before it when the law dictates
that it has final approval. Some such actions include final
approval of policies, rules, regulations, and fees before they
are implemented. The composition and functions of the Board of
Health are currently being reviewed, and changes are forthcoming.
D. Regional/District Health Offices
The state has no designated regional/district health offices, but
it is divided into eight public health management districts for
the more efficient delivery of community health services. The
geographic delineation of the districts was determined by various
factors including community interest and homogeneity, natural
boundaries, patterns of communication and transportation, and
uniformity of social and economic problems.
E. State-local Liaison
Shared Organizational Control, Formal Liaison Function
The Division of Local Health has been given responsibility for
formal liaison functions between the state and local health.
Although communications from the top down are usually transmitted
to the locals through this office, the locals may contact anyone
or any office at the state level. Field nurses currently have a
major role in state-local liaison, but future plans call for a
centrally located group of public health specialists to perform
this function.
The interaction between state and local public health agencies in
West Virginia may be characterized as shared organizational
control. Under this arrangement local health departments are
under the authority of the SHA as well as the local government
and board of health.
F. Budget
Total FY 1988 West Virginia SHA expenditures were $159,720,000.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $32,762,000
State Funds $99,724,000
Local Funds 0
Fees and Reimbursements $2,639,000
Other $24,595,000
3III. Local Public Health Agencies (LPHAs)
A. General
West Virginia has 49 local public health agencies, including 40
county health departments (one of which has contracted with a
private provider for certain mandated services), 7 city-county
health departments, and 2 multicounty health departments. One of
the multicounty units consists of two counties and the other has
six counties.
All of the local health departments relate to the state by having
the same personnel merit system for employees, reporting diseases
to the epidemiology section, working with regional health
advisory groups, and sending in monthly and yearly expenditure
reports. Annually all counties send to the Director, Bureau of
Public Health, through the Division of Local Health, their
projected budget and program plans for the next fiscal year for
approval. State aid funds are distributed by formula, and every
local agency depends on that distribution for financial support.
B. Services Provided
The following information on services provided by local health
departments in West Virginia is derived from a survey conducted
by NACHO during 1989. Thirty-six of the 49 local health
departments in West Virginia responded to the survey. Services
provided by at least 70 percent of health departments in the
state that responded to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 11 ( 30.6%)
2. Morbidity Data 9 ( 25.0%)
3. Reportable Diseases 22 ( 61.1%)
4. Vital Records and Statistics 8 ( 22.2%)
B. Epidemiology/Surveillance
1. Chronic Diseases 24 ( 66.7%)
2. Communicable Diseases 35 ( 97.2%)
II. Policy Development
A. Health Code Dev. and Enforcement 22 ( 61.1%)
B. Health Planning 20 ( 55.6%)
C. Priority Setting 14 ( 38.9%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 35 ( 97.2%)
2. Health Facility Safety/Quality 27 ( 75.0%)
3. Rec. Facility Safety/Quality 29 ( 80.6%)
4. Other Facility Safety/Quality 16 ( 44.4%)
B. Licensing
1. Health Facilities 14 ( 38.9%)
2. Other Facilities 30 ( 83.3%)
C. Health Education 29 ( 80.6%)
D. Environmental
1. Air Quality 18 ( 50.0%)
2. Hazardous Waste Management 17 ( 47.2%)
3. Individual Water Supply Safety 36 (100.0%)
4. Noise Pollution 4 ( 11.1%)
5. Occupational Health and Safety 8 ( 22.2%)
6. Public Water Supply Safety 34 ( 94.4%)
7. Radiation Control 7 ( 19.4%)
8. Sewage Disposal Systems 34 ( 94.4%)
9. Solid Waste Management 19 ( 52.8%)
10. Vector and Animal Control 29 ( 80.6%)
11. Water Pollution 25 ( 69.4%)
E. Personal Health Services
1. AIDS Testing and Counseling 19 ( 52.8%)
2. Alcohol Abuse 2 ( 5.6%)
3. Child Health 28 ( 77.8%)
4. Chronic Diseases 19 ( 52.8%)
5. Dental Health 14 ( 38.9%)
6. Drug Abuse 3 ( 8.3%)
7. Emergency Medical Service 3 ( 8.3%)
8. Family Planning 34 ( 94.4%)
9. Handicapped Children 8 ( 22.2%)
10. Home Health Care 12 ( 33.3%)
11. Hospitals -
12. Immunizations 36 (100.0%)
13. Laboratory Services 13 ( 36.1%)
14. Long-term Care Facilities 3 ( 8.3%)
15. Mental Health 2 ( 5.6%)
16. Obstetrical Care 7 ( 19.4%)
17. Prenatal Care 12 ( 33.3%)
18. Primary Care 7 ( 19.4%)
19. Sexually Transmitted Diseases 34 ( 94.4%)
20. Tuberculosis 34 ( 94.4%)
21. WIC 11 ( 30.6%)
C. Local Health Officer
M.D. Requirement, Local Board of Health Appointment
A county or municipal board of health has the authority to
appoint a health officer to serve for an indefinite term at the
pleasure of the appointing board of health. The health officer
must be a physician licensed or eligible for licensure in the
state. The salary will be determined by the appointing board and
will be paid from the county or municipal treasury.
Under the supervision of the appointing board, a local health
officer is responsible for administering all state public health
laws, rules, regulations, and orders that are applicable to the
county or municipality. The health officer serves as secretary
to the local board of health and attends all meetings but does
not vote. The health officer is responsible for supervising and
directing the activities of the county or municipal health
services, employees and facilities, except that the duties do not
include the rendering of medical or surgical services on an
individual basis to wards of the county or municipality or to
inmates of any public institution operated or maintained by the
county commission or municipality. The county health officer or
a designated representative determines when corrections have been
made sufficient to warrant removal of any restrictions or
limitations placed by a health department employee. The local
health officer has responsibility to report to the State Director
of Health a weekly report, in a manner specified by the Director,
those diseases or conditions for which a report is required.
D. Local Board of Health
Policy-making
Local boards of health are composed of five members appointed by
the county or municipal governing body. In any county or
municipality where the board of education contributes funds to
the county or municipality, the board of education may nominate
one member of the local board of health. All members of the
board of health must be citizens and residents of the county or
municipality they are appointed to represent. No more than three
of the members can belong to the same political party, nor more
than two of the members can be residents of the same magisterial
district or municipal ward, nor more than two members can be
personally and individually licensed in, engaged in, or actively
participating in the same business, profession, or occupation.
All members of the board are appointed for terms of 5 years, with
the terms staggered so that the term of one member expires each
year. The salary of members is established by the governing body
of the county or municipality but is not to exceed $10 per
meeting. Reimbursement is authorized for actual expenses for
necessary travel and other expenses incurred in the performance
of duties as a member of the board.
County or municipal boards of health are required to direct,
supervise, and control all matters relating to the general health
and sanitation of their respective counties or municipalities.
They are given the same power as the State Board of Health, or
Director, as far as the powers are applicable to the county or
municipality. The boards of health have the power and authority
to adopt, promulgate, and amend rules and regulations, consistent
with the laws of the state and the rules and regulations of the
State Board of Health, as may be necessary and proper for the
protection of the general health of the municipality or county
and the prevention of the introduction, propagation, and spread
of disease.
It is the duty of local boards of health to protect the general
health and supervise and control the sanitation of their
respective counties and municipalities, to enforce the laws of
the state pertaining to public health and the rules and
regulations of the State Board of Health, insofar as they are
applicable to the counties or municipalities. They are also
required to perform other duties in relation to public health as
may be prescribed by order of the county commission or ordinances
in municipalities as long as they are consistent with the laws,
rules, and regulations of the State Board of Health. All local
boards of health receiving state or Federal funds for health
purposes must first receive approval by the Director of the State
Bureau of Health for their general plans of operation for health
purposes.
E. Staff
The staffs of local health departments are employed and managed
by the local jurisdiction but are also part of the State Merit
System. The number of employees for a local health department
ranges from 2 to 80.
F. Budget
Total FY 1988 LPHA expenditures were $19,472,000. Total FY 1988
United States LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contract $98,000*
State Funds $6,528,000
Local Funds $4,124,000*
Fees and Reimbursements $5,824,000*
Other Sources $2,898,000*
Source Unknown 0
*The SHA reported that these figures were estimated. The SHA
reported that the expenditures shown include the total amount of
additional monies expended by all local health departments.
2West Virginia Department of Health and Human Resources, 1990
Secretary of Health and Human Resources
Regulatory Agencies
Legal Services
Public Information
Inspector General
Administration and Finance
Public Health
Community Health
Emergency Medical Services
Maternal and Child Health
Dental Services
Local Health
Primary Care
Nutritional Services
Environmental Health
Epidemiology and Health Promotion
Laboratory
Community Support
Behavioral Health
Social Services
Long-Term Care
Commission on Aging
Veterans' Affairs
Women's Commission
Income Assistance
Medical Services
Income Maintenance
Child Advocacy
Work and Training
Employment Security
Employment Services
Worker's Compensation
2Types of Local Health Departments by Jurisdiction
West Virginia, 1990
Jurisdiction Co C/Co M/Co
Barbour X
Berkeley X
Boone X
Braxton X
Brooke X
Buchannan-Upshur Co X
Calhoun X
Charleston-Kana Co X
Clarksburg-Harr Co X
Clay X
Doddridge X
Elkins-Randolph Co X
Fairmont-Marion Co X
Fayette X
Gilmer X
Grant X
Greenbrier X
Hampshire X
Hancock X
Hardy X
Huntington-Cabe Co X
Jackson X
Jefferson X
Lewis X
Lincoln X
Logan X
Marshall X
Mason X
McDowell X
Mercer X
Mineral X
Mingo X
Monongalia X
Monroe X
Morgan X
Nicholas X
Pendleton X
Pleasants X
Pocahontas X
Preston X
Putnam X
Raleigh X
Ritchie X
Roane X
Summers X
Taylor X
Tucker X
Tyler X
Wayne X
Webster X
Wetzel X
Wheeling-Ohio Co X
Wirt X
Wood X
Wyoming X
Co = County HD
C/Co = City/County HD
M/Co = Multicounty HD
1WISCONSIN
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 4,855,000 245,803,000
Population Density (1988) 89.2 69.4
(per/sq.mi.)
Number of Counties 72 3,139
Median Age (1987) 31.4 31.7
Percent Below Poverty Level (1985) 11.6 14.0
(persons)
Percent of Population Rural (1980) 36.0 26.0
Percent of Population White (1980) 94.4 83.1
Percent of Population Non-white (1980) 5.6 16.9
Median Years of Education (1980) 12.5 12.5
(25 years of age and over)
B. County Government Structure
Home Rule Authority
The state constitution and statutes establish and empower the
county governments of Wisconsin.
Commission Form - (72) - The counties function under a Commission
Form of government which is made up of three-member Boards of
Supervisors who are elected from single-member districts.
Districts are permitted to elect two Supervisors if their
population is twice that for other districts in the county.
Counties may choose from the following structural options:
County Executive - (8) - They may elect a strong county
executive with veto power over the Board of Supervisors.
Eight counties have chosen this option.
County Administrator - (9) - Counties may also choose to
have a County Administrator. This position is appointed by
the Board of Supervisors and serves as the chief
administrative officer of the county. Currently, nine
counties have appointed a County Administrator.
Data for this state were updated November 1990. Administrative
Coordinator - (55) - Fifty-five counties
operate with an Administrative Coordinator. The
Administrative Coordinator is an elected or appointed
official who is appointed to serve in this capacity. The
responsibility of this position includes coordinating all
administrative and management functions of the county that
are not under the authority of other boards or elected
officials.
Still another choice involves the utilization of a county
coordinator position. This position administers all management
functions of the county not vested in boards or other elected
officials. Currently no counties have chosen this option.
Counties have been granted authority for administrative and
organizational home rule. Even with this authority the power of
the counties is limited, but their flexibility in carrying out
functions is increased. No counties in Wisconsin have opted for
consolidation of city and county governments.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The SHA is the Wisconsin Division of Health. It is a component
of a superagency called the Department of Health and Social
Services. The mission of the Division of Health is to administer
programs to promote and protect public health, regulate the
quality of health care facilities and services, and assure that
state residents have access to health care.
Major responsibilities for the Department include:
1. Administer the Medical Assistance Program.
2. Survey hospitals, nursing homes, and other health care
facilities for compliance with state standards.
3. Maintain vital records plus compile data on health
status and utilization of health care facilities.
4. Conduct communicable disease surveillance and
epidemiology.
5. Conduct environmental health programs, including
facility sanitation, occupational safety and health
consultation, and radiological surveillance.
6. Administer the Maternal and Child Health and Preventive
bloc grants, WIC, and other Federally funded prevention
and intervention programs.
The following are some broad areas of responsibility for the SHA:
State Public Health Authority
Medicaid Single State Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The Administrator for the Division of Health serves as the State
Health Officer and administrative head of the unit. The
Administrator is appointed by the Secretary of the Department of
Health and Social Services. The statutes indicate that the
Secretary can assign the Administrator any duties related to the
Secretary or the Department of Health and Social Services. The
State Health Officer may appoint such advising and examining
bodies as provided by law.
C. State Board of Health/Council
Wisconsin does not have a state board of health or health
council.
D. Regional/District Health Offices
Wisconsin has five regional offices which provide consultations
and technical assistance to the local health units in their
jurisdiction. Regional staffs implement a number of programs
which are centrally administered, plus assist local health
agencies on issues related to public health that may go beyond
the programmatic scope of the division's central office. They do
not, however, provide direct patient services. They also serve a
liaison function between the central office and local agencies.
The number of staff in the regional offices ranges from 12 to
16. The following types of employees are typically found in
regional offices:
Regional Director
Nutritionists
Immunization Program Advisor
Public Health Educators
Public Health Sanitarians
Public Health Nurses
Clerical Personnel E. State-local Liaison
Decentralized Organizational Control, Informal Liaison Function
The regional offices might be considered the state-local liaisons
for many purposes, but this activity is not limited to one
individual or entity within the Division of Health. On occasion,
local and central office staffs deal with each other directly.
The central office recognizes that a special partnership exists
between the state and local health agencies because of the shared
mission. Due to this partnership the Division of Health staff is
strongly encouraged to engage in cooperative interaction with
local agency staff.
The interaction between state and local public health agencies in
Wisconsin may be characterized as decentralized organizational
control. Under this arrangement local government directly
operates health departments with or without a local board of
health.
F. Budget
Total FY 1988 Wisconsin SHA expenditures were $75,585,000*.
Total FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $46,562,000
State Funds $25,441,000
Local Funds 0
Fees and Reimbursements $3,582,000
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
Wisconsin has 107 local public health agencies, ranging in size
from those with a single nurse to full-service health
departments. They consist of 69 county, 37 city or village
health departments, and 1 city-county health department. For the
most part, they are locally administered, locally funded, and
responsible to local governmental authorities.
* These expenditure data exclude state and Federal
funding for Medical Assistance Program.
B. Services Provided
The following information on services provided by local health
departments in Wisconsin is derived from a survey conducted by
NACHO during 1989. Eighty-two of the 107 local health
departments in Wisconsin responded to the survey. Services
provided by 70 percent of health departments in the state
responding to the survey are underlined.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 33 ( 40.2%)
2. Morbidity Data 35 ( 42.7%)
3. Reportable Diseases ** 107 (100.0%)
4. Vital Records and Statistics 31 ( 37.8%)
B. Epidemiology/Surveillance
1. Chronic Diseases 43 ( 52.4%)
2. Communicable Diseases** 107 (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 53 ( 64.6%)
B. Health Planning 57 ( 69.5%)
C. Priority Setting 60 ( 73.2%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 30 ( 36.6%)
2. Health Facility Safety/Quality 17 ( 20.7%)
3. Rec. Facility Safety/Quality 28 ( 34.1%)
4. Other Facility Safety/Quality 21 ( 25.6%)
B. Licensing
1. Health Facilities 4 ( 4.9%)
2. Other Facilities 34 ( 41.5%)
C. Health Education 68 ( 82.9%)
D. Environmental
1. Air Quality 20 ( 24.4%)
** The SHA reported that all public health agencies are required
to collect and submit data on reportable disease, and to conduct
epidemiology and surveillance of selected communicable diseases.
Although the NACHO survey indicated less than 100 percent
involvement, all agencies do provide these services.
2. Hazardous Waste Management 23 ( 28.0%)
3. Individual Water Supply Safety 42 ( 51.2%)
4. Noise Pollution 20 ( 24.4%)
5. Occupational Health and Safety 16 ( 19.5%)
6. Public Water Supply Safety 25 ( 30.5%)
7. Radiation Control 18 ( 22.0%)
8. Sewage Disposal Systems 19 ( 23.2%)
9. Solid Waste Management 19 ( 23.2%)
10. Vector and Animal Control 53 ( 64.6%)
11. Water Pollution 27 ( 32.9%)
E. Personal Health Services
1. AIDS Testing and Counseling 37 ( 45.1%)
2. Alcohol Abuse 14 ( 17.1%)
3. Child Health 75 ( 91.5%)
4. Chronic Diseases 71 ( 86.6%)
5. Dental Health 24 ( 29.3%)
6. Drug Abuse 14 ( 17.1%)
7. Emergency Medical Service 8 ( 9.8%)
8. Family Planning 23 ( 28.0%)
9. Handicapped Children 42 ( 51.2%)
10. Home Health Care 44 ( 53.7%)
11. Hospitals -
12. Immunizations 80 ( 97.6%)
13. Laboratory Services 27 ( 32.9%)
14. Long-term Care Facilities 1 ( 1.2%)
15. Mental Health 11 ( 13.4%)
16. Obstetrical Care 5 ( 6.1%)
17. Prenatal Care 31 ( 37.8%)
18. Primary Care 10 ( 12.2%)
19. Sexually Transmitted Diseases 67 ( 81.7%)
20. Tuberculosis 67 ( 81.7%)
21. WIC 54 ( 65.9%)
C. Local Health Officer
No M.D. Required, Local Board of Health or Governing Body
Appointment
Local health officers are not required to be physicians. They
are appointed by the local board of health or the local governing
body. The responsibilities of the local health officer are to
provide rules and regulations as necessary to preserve health,
prevent spread of communicable diseases, cause removal of any
objects detrimental to health, enforce state public health laws
and regulations, and supervise the staff of the health
department. They are also required to enforce the rules and
regulations of the local board of health.
D. Local Board of Health
Policy-making
Counties in Wisconsin may have boards of health, county health
committees or county health commissions. These bodies consist of
five to eight members usually appointed by the chairperson of the
local governing body. The jurisdiction of the local board
depends on the size of the county and whether the county has a
single county board of health. If there is not a single county
board of health, there may be a county health commission or
committee appointed to have jurisdiction over areas of the county
that do not have city or village boards of health.
Local boards of health generally have responsibility for securing
the staffs of the local health department, overseeing the
operation of the local health department, and protecting the
health of the citizens within their jurisdiction.
E. Staff
The staffs of local health departments are employed and
supervised by the local governmental agency. The number of staff
for a local health department ranges from 1 to 365.
F. Budget
Total FY 1988 LPHA expenditures were $13,342,000***. Total FY
1988 LPHA expenditures were $3,978,948,000.
Source of Funds
Federal Grants and Contracts $10,788,000
State Funds $2,554,000
Local Funds 0
Fees and Reimbursements 0
Other Sources 0
Source Unknown 0
*** Local government funding, which constitutes approximately 69
percent of local agency budgets, is not included in this figure.
2Wisconsin Division of Health, 1990
Secretary Health and Social Services
Administrator Division of Health
Regions
Northeastern
Northern
Southeastern/Milwaukee
Southern
Western
Office of Health Care Information
Center for Health Statistics
Bureau of Health Care Financing
Bureau of Quality Compliance
Bureau of Community Health and Prevention
Bureau of Environmental Health
Office of Management and Policy
2Types of Local Health Departments by Jurisdiction
Wisconsin, 1990
Jurisdiction Co C C/Co N/Co T/T
Adams X
Appleton X
Ashland X
Barron X
Bayfield X
Beloit X
Brown X
Brown Deer X
Buffalo X
Burlington X
Burnett X
Caledonia X
Calumet X
Chippewa X
Clark X
Columbia X
Crawford X
Cuddahy X
Dane X
De Pere X
Dodge X
Door X
Douglas X
Dover X
Dunn X
Eau Claire C Co X
Elmwood Park X
Florence X
Fond Du Lac X
Forest X
Franklin X
Glendale X
Grant X
Green X
Green Bay X
Green Lake X
Greendale X
Greenfield X
Hales Corners X
Iowa X
Iron X
Jackson X
Jefferson X
Juneau X
Kenosa X
Kewaunee X
Konosha X
La Crosse X
Lafayette X
Langlade X
Lincoln X
Madison X
Manitowoc X
Manitowoc X
Marathon X
Marinette X
Marquette X
Menasha X
Milwaukee X
Milwaukee X
Monominee X
Monroe X
Mount Pleasant X
Neenah X
Nonway X
North Bay X
Oak Creek X
Oconto X
Oneida X
Oshkosh X
Outgamie X
Ozaukee X
Pepin X
Pierce X
Polk X
Portage X
Price X
Racine X
Racine X
Raymond X
Richland X
Rock X
Rusk X
Sauk X
Sawyer X
Shawano X
Sheboygan X
Shorewood X
South Milwaukee X
St. Croix X
St. Francis X
Sturtevant X
Taylor X
Trempealeau X
Union Grove X
Vernon X
Vilas X
Walworth X
Washburn X
Washington X
Waterford X
Watertown X
Waukesha X
Waupaca X
Waushara X
Wauwatosa X
West Allis X
Whitefish Bay X
Winnebago X
Wood X
Yorkville X
Co = County HD
C = City HD
C/Co = City/County HD
N/Co = No County HD
T/T = Town/Township HD
1WYOMING
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1988) 479,000 245,803,000
Population Density (1988) 4.9 69.4
(per/sq.mi.)
Number of Counties 23 3,139
Median Age 29.1 31.7
Percent Below Poverty Level (1985) 12.0 14.0
(persons)
Percent of Population Rural (1980) 37.0 26.0
Percent of Population White (1980) 95.1 83.1
Percent of Population Non-white (1980) 4.9 16.9
Median Years of Education (1980) 12.7 12.5
(25 years of age and over)
B. County Government Structure
No Home Rule
The structure and function of county governments in Wyoming are
established by the constitution and statutes. The counties in
Wyoming are generally extensions of the state and function to
provide mandated services at the local level. Recently, however,
counties have begun to provide many additional services that are
not required.
Commission Form - (23) - All Wyoming counties use the Commission
Form of government. Three to five commissioners are elected at
large. Their duties are to administer the functions of the
county and enact only those ordinances and regulations that are
permitted by statutes.
There is no provision for counties to adopt home rule, charters,
or any other alternate form of county government. In fact, only
the Commission Form of government is authorized by the
legislature.
Data for this state were updated November 1990.
3II. State Health Agency (SHA)
A. General
Component of Superagency *
The SHA, the Division of Health and Medical Services (DHMS), is a
component of a superagency called the Department of Health and
Social Services. The mission of the Division of Health and
Medical Services is to preserve and enhance the health of the
people of Wyoming and to assure conditions in which people can be
healthy. The Division is structured with an administrator and
six deputy administrators who manage programs in health
administration, preventive medicine, nursing services, family
health services, dental health and Title XIX medical assistance.
The following are some areas of responsibility for the SHA:
State Public Health Authority
Medicaid Single State Agency
State Agency for Children with Special Health Care Needs
(called Maternal and Child Health Services)
State Health Planning and Development Agency
Institutional Licensing Agency
Institutional Certifying Authority for Federal Reimbursement
B. Head of State Health Agency
M.D. Requirement, Department Director Appointment
The Administrator of the Division of Health and Medical Services
is the head of the SHA. The Administrator position requires an
M.D. or Ph.D. degree in a health field. The Administrator is
responsible for providing leadership and direction to the
Division of Health and Medical Services to promote and protect
public health and the safety of the citizens of Wyoming.
* Wyoming is undergoing a reorganization of all state agencies
toward a cabinet style of government. Scheduled to be operating
by July 1991, the superagency will be the Wyoming Department of
Health, and the Division will be the Division of Public Health.
Title XIX Medical Assistance will become a separate division.
Legislation will most likely be introduced in 1991 clarifying the
role, responsibilities and qualifications of the State Health
Officer.
C. State Board of Health/Council
Advisory
A 16-member advisory council is appointed by the Governor to
provide consultation to the Department, and a 9-member advisory
council assists the Division in establishing general policies
and setting priorities for budget requests. The council is
composed of health professionals, community leaders, and
legislative representatives.
D. Regional/District Health Offices
The counties in Wyoming have been divided into five regions for
more efficient planning and health delivery. However, there are
no regional offices in these areas. The units within the regions
are brought together from time to time at various geographic
locations within the region to discuss important issues. It is
also important to note that some regions have independent public
health nursing units or no public health nursing units, which
affects the dollar amounts allocated by DHMS to each region.
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
The state-local liaison function is handled by the State Nursing
Deputy Director. This is a natural flow for communications
between the state and local areas because nurses, most employed
by the state, are found in all areas but one county.
The interaction of state and local health agencies in Wyoming may
be characterized as mixed centralized and decentralized
organizational control. Under this arrangement local health
services may be provided by the SHA in some jurisdictions and by
local governmental units, boards of health, or health departments
in other jurisdictions.
F. Budget
Total FY 1988 Wyoming SHA expenditures were $13,895,000. Total
FY 1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $5,939,000
State Funds $7,956,000
Local Funds NA
Fees and Reimbursements NA
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
There are 22 local health units in Wyoming. Twenty of these are
county units and two are city-county departments. All except the
two largest (Natrona and Laramie counties) are solely Public
Health Nursing Offices. Although support for the local units is
generally a mix of state and local funds, three counties (Platte,
Converse, and Campbell) have only local funding, at their choice.
B. Services Provided
The following information on services provided by local health
departments in Wyoming is derived from a survey conducted by
NACHO during 1989. Ten of the 22 local health departments in
Wyoming responded to the survey. Services provided by 70 percent
of health departments in the state responding to the survey are
underlined. Some of the services, such as air quality, are
provided by departments other than Health and Social Services.
Services Provided by LPHAs Number and Percent
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment 2 ( 20.0%)
2. Morbidity Data 3 ( 30.0%)
3. Reportable Diseases 10 (100.0%)
4. Vital Records and Statistics 6 ( 60.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases 3 ( 30.0%)
2. Communicable Diseases 9 ( 90.0%)
II. Policy Development
A. Health Code Dev. and Enforcement 4 ( 40.0%)
B. Health Planning 5 ( 50.0%)
C. Priority Setting 4 ( 40.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control 4 ( 40.0%)
2. Health Facility Safety/Quality 1 ( 10.0%)
3. Rec. Facility Safety/Quality 2 ( 20.0%)
4. Other Facility Safety/Quality 3 ( 30.0%)
B. Licensing
1. Health Facilities -
2. Other Facilities 2 ( 20.0%)
C. Health Education 7 ( 70.0%)
D. Environmental
1. Air Quality 1 ( 10.0%)
2. Hazardous Waste Management 1 ( 10.0%)
3. Individual Water Supply Safety 3 ( 30.0%)
4. Noise Pollution -
5. Occupational Health and Safety 1 ( 10.0%)
6. Public Water Supply Safety 4 ( 40.0%)
7. Radiation Control -
8. Sewage Disposal Systems 4 ( 40.0%)
9. Solid Waste Management 1 ( 10.0%)
10. Vector and Animal Control 2 ( 20.0%)
11. Water Pollution 3 ( 30.0%)
E. Personal Health Services
1. AIDS Testing and Counseling 7 ( 70.0%)
2. Alcohol Abuse 2 ( 20.0%)
3. Child Health 8 ( 80.0%)
4. Chronic Diseases 5 ( 50.0%)
5. Dental Health 3 ( 30.0%)
6. Drug Abuse 1 ( 10.0%)
7. Emergency Medical Service 1 ( 10.0%)
8. Family Planning 6 ( 60.0%)
9. Handicapped Children 7 ( 70.0%)
10. Home Health Care 9 ( 90.0%)
11. Hospitals 1 ( 10.0%)
12. Immunizations 9 ( 90.0%)
13. Laboratory Services 3 ( 30.0%)
14. Long-term Care Facilities 2 ( 20.0%)
15. Mental Health 1 ( 10.0%)
16. Obstetrical Care -
17. Prenatal Care 5 ( 50.0%)
18. Primary Care 2 ( 20.0%)
19. Sexually Transmitted Diseases 8 ( 80.0%)
20. Tuberculosis 5 ( 50.0%)
21. WIC 6 ( 60.0%)
C. Local Health Officer
M.D. Required, Local Board of Health Appointment
The health officer is appointed by the local board of health or
county commission. This position requires a licensed M.D.
Responsibilities include assisting the administrative division of
the State Department of Public Health in carrying out the
provisions of all health and sanitary laws and regulations of the
state. County health officers of this state are by statute under
the supervision and direction of the State Health Officer
(Department of Health and Social Services).
D. Local Board of Health
Policy-making
Two types of local health boards may be formed in Wyoming:
district and county and/or city. According to the Wyoming
statutes, the word "district" shall mean and include any
combination of towns, villages, cities, and counties of the
state. County and/or city and district boards of health may
enact rules and regulations pertaining to the prevention of
disease and the promotion of public health in the areas over
which such perspective boards have jurisdiction. The number of
members on a district board will be at least equal to the number
of participating political subdivisions, with at least one of
each represented on the board. Members must also include one
physician and one dentist.
A county or city board of health consists of five members. These
members must be qualified electors of the county in which they
serve, one of which must be a physician and one a dentist. A
county may elect not to form a board of health, in which case the
county commission acts as a health advisory board.
E. Staff
The staffs of the local health departments are generally a
mixture of state and local employees. In these cases they are
supervised by the state through an agreement with the local
jurisdictions. In three counties (Platte, Converse, and
Campbell), the staff consists of all local employees and is
supervised locally. The number of staff for a local health
department ranges from 2 to 26.
F. Budget
Data on FY 1988 LPHA expenditures are not available.
2Wyoming Division of Health and Medical Services, 1990
Governor
Director DHMS
Administrator DHMS
Deputy Administrator Health Administration
Budget and Personnel
Vital Records
Data Authority
Tumor Registry
Medical Facilities
Public Information
Deputy Administrator Preventive Medicine
AIDS
STD
Immunization
Emergency and Injury Control
Health Promotion Risk Reduction
Radiological Health
Environmental Health
Public Health Laboratory
TB Screening
Rheumatic Fever
Deputy Administrator Public Health Nursing Services
Management Assistant Director
Preventive Medicine Nursing Consultant
Consultants' Supervisors
Adult Health Nursing Consultant
Maternal Child Health Consultant
Deputy Administrator Family Health Services
Children's Health
Adolescent Health
Renal Disease
Genetics Programs
WCH Special Programs
WIC
Deputy Administrator Medical Assistance
Title XIX
Deputy Administrator Dental Health
2Types of Local Health Departments by Jurisdiction
Wyoming, 1990
Jurisdiction Co C/Co N/Co
Albany X
Big Horn X
Campbell X
Carbon X
Casper-Natrona Co X
Cheyenne-Laramie Co X
Converse X
Crook X
Fremont X
Goshen X
Hot Springs X
Johnson X
Lincoln X
Niobrara X
Park X
Platte X
Sheridan X
Sublette X
Sweetwater X
Teton X
Unita X
Washakie X
Weston X
Co = County HD
C/Co = City/County HD
N/Co = No County HD
1AMERICAN SAMOA
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
Territory United States
Population (1990)* 46,329 (1988) 245,803,000
Population Density (1990)* 609.6 (1988) 69.4
(per/sq.mi.)
Number of Counties 14 3,139
Median Age (1980)* 20.0 (1985) 31.7
Percent Below Poverty Level (1980)* 60.6 14.0
(persons)
Percent of Population Rural (1980) 82.5 26.0
Percent of Population White (1980) * 00.3 83.1
Percent of Population Non-white (1980)* 98.2 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
American Samoa consists of the main Island of Tutuila and the
islands east and north of it: Aunu'u; the Manu'a Group of three
islands east of Tutuila; Swain's Island to the north; and the
uninhabited Rose Atoll. The islands lie in the southern central
Pacific Ocean about 2,300 miles southwest of Hawaii. The main
island, Tutuila, contains over half of the land mass (42 of 76
sq. mi.) of the territory and about 96 percent of the
population. Native Samoans are believed to have occupied these
islands for over 2,000 years. Both Samoan and English are
spoken.
C. Territorial Government Structure
American Samoa is an unincorporated territory of the United
States. The government for the territory has legislative,
judicial and executive branches. The legislative branch is made
up of a bicameral legislature (the Fono). The legislature has 18
Senators and 21 members of the House of Representatives. Members
of the Senate are elected from local chiefs or Matai for a term
of 4 years. One Senator representing Swain's Island is a
non-voting delegate who is selected in an open meeting by all
permanent adult residents. Representatives are elected for
*These data were provided by the SHA.
Data for this territory were updated December 1990. 2-year terms.
The executive branch includes the Governor, Lieutenant Governor and
departmental office heads. The Governor is elected to a 4-year term
by popular vote and exercises authority under the direction of the
U.S. Secretary of the Interior. Local government of the territory,
except for Swain's Island, has been divided into three administrative
districts, each with an appointed district Governor. The districts are
subdivided into a total of 14 counties. Chiefs, representing
each family, form village and district councils. The independent
village governments are linked through the three district
Governors who are appointed by the Governor of the territory.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
In American Samoa almost all medical care is provided by the
government through a single agency, the Department of Health. No
private medical care, no health insurance, nor third party
payment for medical care is available. Even most off-island care
is administered through the Department. The Department functions
as the SHA as well as the local public health agency for the
territory. LBJ Tropical Medical Center on the main Island of
Tutuila provides all inpatient medical care for the islands and
much of the outpatient care. LBJ is a 124-bed acute-care
hospital providing a fairly comprehensive array of primary and
secondary medical, promotive, and preventive services. Eight
health centers provide additional outpatient care. The main
island of Tutulia has three health centers, Aunu'u has one, and
the Manu'a Island group has four. The health centers vary
greatly in the size of the population served, size, condition,
and type of facility, staffing and utilization by the villages
within their service areas. Some of the more developed and
busier health centers are supervised by physician's assistants,
while others are headed by a registered nurse or licensed
practical nurse. Primary medical and emergency medical care and
various preventive services are delivered in these health
centers.
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Director of Health is the head of the Department of Health.
Administration of the health care system is quite centralized,
but the administrative relationships seem to vary greatly
depending on who is in the Office of Director.
C. State Board of Health/Council
No State Board of Health
D. Regional/District Health Offices
The Department of Health has not divided American Samoa into
geographical regions or districts.
E. State-local Liaison
The American Samoa Department of Health functions as both a state
and a local health agency, thus eliminating the need for
state-local liaison.
F. Budget
Total FY 1991 American Samoa SHA budget is $12,000,000 for
operations, not including capital improvement programs. Total FY
1988 United States SHA expenditures were $8,312,928,000.
3III. Local Public Health Agencies (LPHAs)
A. General
American Samoa has no local health departments. Local public
health services are provided by elements of the Department of
Health.
B. Services Provided
Services available to inpatients at LBJ include the following:
Pediatrics
General Medicine
General Surgery
Obstetrics and Gynecology
Dental Care
Clinical Laboratory
Radiological
Pharmacy
Dietetics Services
Intensive Care Unit
Neonatal Intensive Care
Eye
Ear, Nose, and Throat
Physical Therapy
Public health services provided by the Department of Health
through the outpatient clinics, health centers and public health
nurses include the following:
Environmental Health
Health Education
Public Health Nursing
Public Health Laboratory
Maternal and Child Health
Control and Staffing of Dispensaries
Chronic Disease (CDC Diabetes Control Grant)
Nutrition Services
Communicable Disease Control
AIDS Prevention
STD Prevention and Control
Immunization
Tuberculosis Control
C. Local Health Officer
Information about local health officers was not available at the
time of printing.
D. Local Board of Health
American Samoa has no local boards of Health.
E. Staff
The number of staff employed by the American Samoa Department of
Health is 520.
F. Budget
The budget for all local health services is included within the
budget for the SHA.
2American Samoa Department of Health, 1990
At the time of printing, organizational chart was not available.
2Types of Local Health Departments by Jurisdiction
America Samoa, 1990
American Samoa does not have local health departments
1COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
Commonwealth United States
Population (1989) 40,000 (1988) 245,803,000
Population Density (1989) 217.9 (1988) 69.4
(per/sq.mi.)
Number of Counties NA 3,139
Median Age (1987) NA 31.7
Percent Below Poverty Level (1985) NA 14.0
(persons)
Percent of Population Rural (1980) NA 26.0
Percent of Population White (1980) NA 83.1
Percent of Population Non-white (1980) NA 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
The Commonwealth of the Northern Mariana Islands (CNMI) consists
of 16 small islands with a total land mass of 183.6 square
miles. The islands are peaks of a massive volcanic mountain
range which rises from the floor of the Marianas Trench; they are
located 3,300 miles west of Hawaii and 120 miles from their
closest neighbor, Guam. The three main islands, Saipan, Rota,
and Tinian, support 90 percent of the population. Saipan is the
administrative center for the commonwealth. English is the
official language.
Chamorros constitute the native and majority population of the
Marianas. The traditional society, however, has been largely
destroyed by depopulation, forced resettlement, disease, and
colonial abuse. The Chamorros still retain their characteristic
strong extended family ties and individualism but are more a
blend of Spanish, Filipino, German, Japanese, and American.
Approximately 25 percent of the inhabitants are descendants of
people who migrated to Saipan from the atolls between Yap and
Chuuk after fierce typhoons devastated their islands. A small
but growing number of aliens and expatriates also reside on the
islands.
Data for this territory are based on the best available
information and were updated December 1990. C. Commonwealth
Government Structure
The Commonwealth of the Northern Mariana Islands is referred to
as a "Flag Territory" and holds territorial status with the
United States. This results from a 1975 referendum in which the
Northern Marianas voted for a separate status as a United States
commonwealth territory.
The government of the Commonwealth of the Northern Mariana
Islands consists of the Governor and a bicameral legislature.
The legislature is composed of a 9-member Senate and a 15-member
House of Representatives with all members elected to 2-year
terms.
3II. State Health Agency (SHA)
A. General
The Department of Health and Environmental Services is the
primary health agency for the Commonwealth of the Northern
Mariana Islands. The government uses the SHA to provide most of
the medical and health care available to residents. This agency
serves as both the SHA and the local provider of public health
care. The services are fairly centralized on the island of
Saipan. Public health services are provided through a central
clinic on Saipan, sub-hospitals on Rota and Tinian, and
dispensaries on Saipan and Pagan. Scheduled field medical
services are provided to Rota, Tinian, and the Northern Islands.
These facilities serve as entry points into the health care
systems and provide a limited range of basic medical services.
Patients who require more specialized medical care are referred
to the central public health clinic or to the hospital.
Acute medical care is provided by a 74-bed general acute
medical-surgical hospital that was recently completed on Saipan.
If specialized care beyond the capacity of the commonwealth
facilities is needed, the patients are referred to Guam, Hawaii,
Japan, the Philippines, or the United States mainland.
B. Head of State Health Agency
The Director of the Department of Health and Environmental
Services is the head of the SHA.
C. State Board of Health/Council
Information about the presence or function of a state board or
council of health was not available at the time of printing.
D. Regional/District Health Offices
CNMI does not have regional or district public health offices.
E. State-local Liaison
Because the CNMI Department of Health and Environmental Services
functions as both a state and a local health agency, a
state-local liaison function is not needed.
F. Budget
Budget information for the Department of Health and Environmental
Services was not available at the time of printing.
3III. Local Public Health Agencies (LPHAs)
A. General
There are no local health departments in the CNMI. Local public
health services are provided by elements of the CNMI Department
of Health and Environmental Services.
B. Services Provided
These services include, but are not limited to, communicable
disease control, hypertension control, immunizations, maternal
and child care, crippled children services, dental care,
environmental health services, and home medical care services.
Patients who require more specialized medical care are referred
to the central public health clinic or to the hospital.
C. Local Health Officer
Information about the presence and function of local health
officers was not available at the time of printing.
D. Local Board of Health
Information about the presence and function of local boards of
health was not available at the time of printing.
E. Staff
Staff are employed by the CNMI Department of Health and
Environmental Services.
F. Budget
The budget for local health services was not available at the
time of printing.
2Commonwealth of Northern Mariana Islands Department of
public Health and Environmental Services, 1990
Governor
Director
Division of Hospital Services
Inpatient
Outpatient
Division of Public Health Services
Division of Dental Health Services
Division of Vocational Rehabilitation Services
Division of Medicaid Services
Division of Environmental Quality Services
2Types of Local Health Departments by Jurisdiction
Commonwealth of the Northern Mariana Islands, 1990
The Commonwealth of the Northern Mariana Islands does not have
local health departments
1COMMONWEALTH OF PUERTO RICO
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
Commonwealth United States
Population (1990)* 3,293,050 (1988) 245,803,000
Population Density (1990)* 1,040 (1988) 69.4
(per/sq.mi.)
Number of Counties 00 3,139
Median Age 24.6 31.7
Percent Below Poverty Level (1980) 62.4 14.0
(persons)
Percent of Population Rural (1980) 33.2 26.0
Percent of Population White (1980) NA 83.1
Percent of Population Non-white (1980) NA 16.9
Median Years of Education (1980) NA 12.5
(25 Years of age and over)
B. Location, Geography, and People
The Commonwealth of Puerto Rico lies in the Caribbean Sea about
50 miles east of Hispaniola. The commonwealth consists of the
main island of Puerto Rico, the small offshore islands of Vieques
and Culebra, and numerous smaller islets. The total land mass is
3,459 square miles.
Puerto Rico was ruled by Spain from 1509 until 1898, when it
became an unincorporated territory of the United States as a
result of the Spanish American War. In 1952 Puerto Rico enacted
a new constitution which granted it the status of a
self-governing commonwealth in its relationship with the
United States. Spanish is the official language, but English is
widely spoken.
C. Commonwealth Government Structure
Neither a state nor a territory, Puerto Rico enjoys a unique
relationship with the United States under its current
commonwealth status. Puerto Ricans are citizens of the
United States and have most of the rights, privileges, and
* These data were provided by the SHA.
The data for this territory were revised January 1991. obligations of
other citizens. In practice, Puerto Rico functions much as a State of
the Union. It operates under a constitution adopted by the Puerto
Ricans and ratified by Congress. Puerto Rico's legislature controls
law-making in all matters that are normally under the authority of
individual state governments. The commonwealth, therefore, completely
controls the administration of its schools, police, and public works. The
island, however, is excluded from the Federal tax structure, but,
for purposes of Federal funds, is treated as a state except for
Medicaid, food stamps, Social Security taxes, and Aid to
Dependent Children.
The Puerto Rican Constitution, like that of the United States,
provides for checks and balances of the legislative, executive,
and judicial branches of the government. Broader than the United
States Constitution, however, the Puerto Rican Constitution
guarantees representation, even if the candidates fail to win a
majority of votes in particular contests.
In national elections, Puerto Ricans may vote in presidential
primaries, but not in the general election itself (unless they
become voters in one of the states). Puerto Rico does have a
voice (but not a vote) in the United States Congress through a
Resident Commissioner who is elected by the people to a 4-year
term. The Commissioner has all the privileges of a member of the
Congress without the right to vote, except in House committees to
which he/she belongs.
The commonwealth enjoys fiscal autonomy and a customs union that
allows free trade anywhere in the world, and duty-free trade with
all other parts of the United States. The Federal government
does retain control of customs, interstate trade, the Postal
Service, defense, Coast Guard, Lighthouse Service, licensing of
radio and television stations and so forth. Federal courts are
maintained to adjudicate civil and criminal matters that fall
under the jurisdiction of the United States Government.
Puerto Rico does not have county administrative or political
structure but is divided into 78 municipalities that include the
island municipalities of Vieques and Culebra. Puerto Rico has a
Governor, 27 Senators, 51 Representatives, the Resident
Commissioner, local mayors, and assemblies elected once every 4
years, coinciding with Federal presidential elections. The
Puerto Rican legislature is bicameral, with a Senate and a House
of Representatives.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Puerto Rico Department of Health (PRDH), the SHA, is a
free-standing, independent agency. Under its jurisdiction are
all the health-related affairs of Puerto Rico. The PRDH performs
the following functions:
Planning, evaluating, and regulating as well as
auditing the programmatic, administrative, and fiscal
aspects of health facilities and services. The PRDH
performs these duties in the public and private health
sectors of the commonwealth.
Several affiliated organizations function under the SHA.
Included in this group are the General Health Council,
Administration of Health Facilities and Services, Administration
of Medical Services of Puerto Rico, and Central Areawide
Comprehensive Health Services Corporation (CACHSC). The CACHSC
is a private non-profit organization which serves as fiscal agent
to the SHA for Federal grants earmarked to provide high-quality
primary and migrant health care to medically underserved and low
income residents of the mountainous municipalities of
Barranquitas, Comerio, Corozal, Naranjito and Orocovis.
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The Secretary of Health is the State Health Officer and the Chief
Executive Officer of the PRDH. Responsibilities of the position
include overseeing the health of the people and carrying out all
other functions assigned by the Puerto Rico Legislature. Part of
the function as Health Commissioner is to serve as an ex officio
member of the following boards, commissions, and councils:
1. Puerto Rico Food and Nutrition Commission
2. Puerto Rico Family Protection and Strengthening
Commission
3. Transit Security Commission
4. University of Puerto Rico Medical Sciences Campus Loans
and Scholarships Committee
5. Advisory Council For Youth Affairs
6. State Council For Developmental Deficiencies
7. State Board for Vocational, Technical, and High Skills
Education
8. Advisory Board for Sports and Recreation
9. Consultive Board for the Children Medical Treatment
Fund
10. Examining Board for Surgery Assistant Technicians
11. Examining Board for Physical Therapy
12. Consulting Board of the Administration of Youth
Institutions
13. Consultive Council of Old Age Affairs
14. Board of Directors of the Puerto Rico Institute of
Forensic Sciences
15. Board of Directors of the Puerto Rico and the Caribbean
Cardiovascular Center Corporation
16. Radiation Control Commission
17. Chairman of the Board of Participating Entities of the
Puerto Rico Medical Center
18. Council for the Improvement of the Quality of Life in
Urban Areas
19. Board to Determine Dangerous Occupations for Minors
20. Board for Nursing Home Affairs
21. Consultive Council of Environmental Protection
22. State Board to Supervise Medical/Surgical and
Hospitalization Service Plans for Municipal Employees
23. Commission for Drug Addiction Control
24. Board for the Disposal of Human Bodies, Organs,
and Tissue
25. Commission for the Responses to Environmental
Emergencies of the Commonwealth of Puerto Rico
26. Examining Board of Embalmers
The Secretary of Health will create, reorganize, consolidate or
suppress all those health department divisions, bureaus, offices,
services, etc., for the better functioning of the Department, as
long as it does not conflict with legislative dispositions. The
Secretary has authority to appoint all necessary personnel
following the procedures of the Public Service Personnel Law of
Puerto Rico.
C. State Board of Health/Council
Advisory
The General Council of Health serves as the Puerto Rico State
Board of Health. The Council was created to advise the public
and private sectors in planning, coordinating, revising, and
evaluating the health systems of Puerto Rico. As the advisory
body for the Secretary of Health, the Council also develops
criteria and guidelines for establishing Health Department Policy
related to health services.
The Council has 25 members representing the diverse geographical
areas of Puerto Rico. Among its members are health providers
such as physicians, dentists, nurses, occupational therapists,
pharmacists, health service administrators, and health
educators. Members from the consumer sector, including women,
civic groups, medical plans, and medically indigent patients are
represented, as are those from the financial and legal
professions. Ex officio members are included from several of the
health-related agencies such as the Department of Education,
Social Services, Anti-addiction Services, the Administrator of
the State Insurance Fund, the Director of the Administration of
Medical Services, and the Chancellor of the Medical Sciences
Campus of the University of Puerto Rico.
D. Regional/District Health Offices
Geographically, Puerto Rico is divided into six regions and three
sub-regions. The regional administrative level called the
Administration of Health Services and Facilities (AHSF) is
responsible for providing health services. At the regional level
the directions of the PRDH and AHSF are implemented. The
regional offices administer public health programs, but the
offices themselves do not provide direct patient care. The
regional managing structure utilizes the following staff
positions:
Regional Director
Regional Administrator
Administrative Support Staff
E. State-local Liaison
Mixed Centralized and Decentralized Organizational Control,
Informal Liaison Function
Since the SHA also serves as the local health agency, there is no
particular need for a liaison between the levels. This function
is accomplished through the normal chain of command. The Office
of Federal Affairs does have responsibility for coordination and
liaison between the SHA and community health centers.
The interaction between state and local public health agencies in
Puerto Rico may be characterized as mixed centralized and
decentralized organizational control. Under this arrangement,
local health services may be provided by the SHA in some
jurisdictions and by local governmental units, boards of health,
or health departments in other jurisdictions.
F. Budget
Total FY 1991 SHA budget is $719,822,665. Total FY 1988 United
States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $248,897,396
State Funds $470,925,269
Local Funds 0
Fees and Reimbursements 0
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
The municipality of San Juan has the only autonomous local health
department in Puerto Rico. The San Juan Health Department (SJHD)
employs approximately 3,500 people with an annual budget of over
$71 million, which represents almost 33 percent of the total
budget of the government of San Juan. SJHD offers preventive as
well as curative health services to anyone requesting them. Many
people from surrounding municipalities receive health care from
the facilities of the SJHD.
Several other municipalities have health centers serving their
communities. The city of Bayamon has a municipal hospital and
several diagnostic and treatment centers. Several of the smaller
municipalities have small health units and share the expenses of
the community health centers. The municipal health facilities
report to the mayors of the towns where they are located, but
must abide by all of the rules and regulations of the PRHD in
terms of accreditation of health facilities, quality of care, and
all other procedures of the SHA.
At several municipalities, especially those that have been
identified as having an underserved population and where there is
a health care personnel shortage, community health centers
operate with Federal, state, and municipal funds. Such centers
are located in the towns of Florida, Camuy, Barceloneta, Ciales,
Lares, Rincon, Patillas, Hatillo, Santurce (Belaval), Loiza,
Ponce (Playa de Ponce), and Castaner.
The Central Areawide Health Services Corporation is the umbrella
non-profit organization that manages the community health centers
in the town of Barranquitas, Comerio, Corozal, Naranjita y
Orocovis. These centers also provide health care to migrant
workers in the towns of Cidra, Mayaguez Migrant Health
Center-Western Region, and San Sabastian.
B. Services Provided
The three levels of health care delivery in the Puerto Rico
Public Health System are primary, secondary, and tertiary. At
the primary level the main services offered are preventive and
ambulatory care. This level is formed by Diagnostic and
Treatment Centers, Family Health Centers, Health Centers, and
Public Health Units. At the Family Health Centers, services are
given through family health teams which consist of physicians,
nurses, health technicians, nutritionists, and social workers.
The teams are organized to render health services to the family
as a unit.
The secondary level is provided by the area hospitals,
subregional hospitals, and area health centers. At the secondary
level, hospitalization services and specialized clinics are
offered in sub-regions as well as in the areas that form each
region. Ambulatory clinics are of a specialized nature and
provide services to no less than two municipalities and no more
than six. Four essential services must be offered: internal
medicine, surgery, pediatrics, and obstetrics and gynecology.
Services are available to those patients referred from the
primary level.
Services in the tertiary level are offered at the regional
hospitals. These hospitals are specialized in the ambulatory
area as well as in hospitalization. Patients are referred from
the secondary level. At the medical centers of Mayaguez, Ponce,
and Rio Piedras, very specialized services are offered. At the
medical center in Rio Piedras two supra-tertiary hospitals
(pediatric and adult hospitals affiliated with the University of
Puerto Rico Medical Sciences Campus) serve referrals from all of
Puerto Rico.
SJHD operates nine diagnostic and treatment centers, an acute
general hospital, a community mental health center, a day care
center for AIDS patients, an emergency shelter for the homeless,
a rehabilitation and extended care center, a nursing home, an
animal control and adoption center, an AIDS Institute, and a
system for emergency medical service. Primary care services are
delivered through the diagnostic and treatment centers which are
strategically located throughout San Juan. Services include
clinics for general medicine, pediatrics, well babies,
immunizations, obstetrics and gynecology, internal medicine,
emergency room, dentistry, radiology, nutrition, social work,
health education, and pharmacy.
C. Local Health Officer
M.D. Requirement, Secretary of Health Appointment
The position of local health officer is filled by regional health
officers in Puerto Rico. They are appointed by and serve at the
pleasure of the Secretary of Health.
D. Local Board of Health
There are no local boards of health in Puerto Rico.
E. Staff
The San Juan Health Department employs a staff of 3,500 who are
employed and supervised by the local jurisdiction.
F. Budget
Total FY 1988 LPHA expenditures were not available.
2Puerto Rico Department of Health and Adminstration
of Health Facilities Services, 1990
Office of the Secretary
Board of General Health
Administration of Medical Services of Puerto Rico
Deputy Secretary
Assistant Secretariat of Administration
Office of Planning, Operations and Statistics
Office of Inspector General
Office of Internal Audits
Office of Legal Services
Office of Federal Affairs
Office of Communications
Assistant Secretariat of Regulations and Accreditations of Health
Facilities
Assistant Secretariat of Medical Emergencies
Assistant Secretariat of Health Education
Assistant Secretariat of Preventive Medicine and Family Health
Assistant Secretariat of Environmental Health
Assistant Secretariat of Nursing
Assistant Secretariat of Mental Health
Puerto Rico Forensic Institute of Psychiatry
Office of Women, Infants and Children
Office of Economic Assistance and Medically Indigent
Demographic Registry
Office of Regulations and Certifications of Health Professionals
Health Services for Correctional Facilities
Sexually Transmitted Diseases
Laboratory Services
Administration of Health Facilities and Services
Health Regions
2Types of Local Health Departments by Jurisdiction
Puerto Rico, 1990
Jurisdiction C
San Juan X
C = City HD
1FEDERATED STATES OF MICRONESIA -- CHUUK STATE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1987)* 49,365 243,416,000
Population Density (1987)* 1,004.0 68.8
(per/sq.mi.)
Number of counties 00 3,139
Median Age (1987)* 16.0 31.7
Percent Below Poverty Level (1985) NA 14.0
(persons)
Percent of Population Rural (1980)* 90.0 26.0
Percent of Population White (1980)* 1.0 83.1
Percent of Population Non-white (1980)* 99.0 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
The Federated States of Micronesia (FSM) is part of the
archipelago of the Caroline Islands. Chuuk (formerly Truk) is
located about 600 miles southeast of Guam. The state of Chuuk is
made up of volcanic islands which are centrally located in the
lagoon of Chuuk atoll and the outer island atolls which are
divided into the Hall Islands, the Mortlocks and the southwestern
atolls. The entire land mass of the state is about 45 square
miles.
C. National and State Government Structure
In 1982 the United States signed a Compact of Free Association
with the FSM. Since that time FSM has been referred to as a
freely associated state. FSM is made up of four states: Yap,
Chuuk, Pohnpei, and Kosrae. The national government is located
on Pohnpei and consists of executive, legislative, and judicial
branches. A President and Vice-president make up the executive
branch. The legislative branch consists of a bicameral
legislature.
* These data are provided by the SHA.
Data for this territory were revised December 1990. The state of
Chuuk has a bicameral legislature made up of a Senate (10 members)
and a House of Representatives (28 members), with all members
elected for 4-year staggered terms. Chuuk also has an elected Governor.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Chuuk Department of Health Services (CDHS) is the primary
health agency for the state. Health services are centralized to
the Chuuk State Hospital which is located on the Island of Moen
and a "super-dispensary" in the Mortlock Islands. There are 62
dispensaries scattered throughout the state. They range from one
dispensary on the smaller islands to five on the bigger island in
the Chuuk Lagoon. Most of the inhabited islands have
dispensaries which provide the population with basic health care.
Field trip services are provided to the outer islands
approximately every 6 weeks or on an emergency basis.
Information about the structure of the FSM National Health Agency
and its relationship to the SHA was not available at the time of
printing.
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Secretary of the Department of Human Resources is the head of
the health agency for FSM, and the Director of Health Services is
the head of the health agency for the state of Chuuk.
C. State Board of Health/Council
Chuuk State does not have a state board of health.
D. Regional/District Health Offices
Dispensaries are scattered throughout the state, but no offices
are designated as regional or district offices.
E. State-local Liaison
The CDHS functions as both the state and local health agency, so
there is no need for a state-local liaison.
F. Budget
The CDHS is operated on an annual budget appropriated through the
Chuuk State Legislature. The exact amount was not available at
the time of printing.
3III. Local Public Health Agencies (LPHAs)
A. General
Chuuk State has no local health departments. Local public health
services are provided by elements of the CDHS.
B. Services Provided
Services provided by the CDHS include environmental health,
health education, communicable disease control, family planning,
and child health.
C. Local Health Officer
Information on the presence and function of local health officers
was not available at the time of printing.
D. Local Board of Health
Chuuk State does not have local boards of health.
E. Staff
The number of staff employed by the CDHS was not available at the
time of printing.
F. Budget
The budget for local health services was not available at the
time of printing.
2Chuuk State Department of Health Services, 1990
Governor
Director
MHCC Chuuk
EPAB Chuuk
Assistant Director
Hospital Services
*Nursing Services
Clinical Nursing
Public Health Nursing
Public Health Clinics
Field/Dispensaries
Field Teams
Health Assistants
Midwives
Hospital Support
Dietary/Food Services
Maintenance/Housekeeping
Medical Supplies
Business Office
Medical Support Services
X-ray
Pharmacy
Laboratory
Medical Records
Dental Health Services
Environmental Health
Public Health Services
Health Education
Federal Programs
Mental Health
Cervical Cancer Detection
Family Planning
Hypertension
Geriatric
*Nursing Services (same as Hospital Services)
Medical Staff
Medical Doctors Medical Officers
Medex, Physician Assistants/Extenders
2Types of Local Health Departments by Jurisdiction
Chuuk State, 1990
Chuuk State does not have local health departments
1FEDERATED STATES OF MICRONESIA -- KOSRAE STATE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1987) 6,000 243,416,000
Population Density (1987) 150.0 68.8
(per/sq.mi.)
Number of Counties NA 3,139
Median Age (1987) NA 31.7
Percent Below Poverty Level (1985) NA 14.0
(persons)
Percent of Population Rural (1980) NA 26.0
Percent of Population White (1980) NA 83.1
Percent of Population Non-white (1980) NA 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
The Federated States of Micronesia (FSM) is part of the
archipelago of the Caroline Islands. Kosrae is located about 350
miles southeast of Pohnpei. The state of Kosrae consists of a
single island about 40 square miles in size. The population has
primarily a single language and culture, Kosrean. The
governmental center, the hospital, the post office, the high
school, and the courthouse are located in Tofol of the Lelu
municipality.
C. National and State Government Structure
In 1982 the United States signed a Compact of Free Association
with the FSM. Since that time FSM has been referred to as a
"freely associated state." FSM is made up of four states: Yap,
Chuuk, Pohnpei, and Kosrae. The national government is located
on Pohnpei and consists of executive, legislative, and judicial
branches. A President and Vice-president make up the executive
branch. The legislative branch consists of a bicameral
legislature.
The state of Kosrae has a unicameral legislature made up of 14
members. The members serve 4-year staggered terms. Two
popularly elected Senators represent Kosrae in the FSM Congress.
Kosrae also has a popularly elected Governor.
Data for this territory are based on the best available
information and were updated December 1990.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Department of Health Services is the primary health agency
for the state of Kosrae. Other than some services provided by
traditional birth attendants, all medical and health care are
provided by the government through the Department of Health
Services. At the center of this system lies the Kosrae State
Hospital, a 35-bed general medical facility. Patients are
charged a nominal fee for in-patient and out-patient services.
All services (except some basic services provided by public
health nurses and the school health program) are provided through
the hospital.
Information about the structure of the FSM National Health Agency
and its relationship to the SHA was not available at the time of
printing.
B. Head of State Health Agency
The Secretary of the Department of Human Resources is the head of
the health agency for FSM, and the Director of Health is the head
of the health agency for the state of Kosrae.
C. State Board of Health/Council
Information about the presence and function of a State Board or
Council of Health was not available at the time of printing.
D. Regional/District Health Offices
Kosrae does not have regional or district health offices.
E. State-local Liaison
Because the State Department of Health functions as both a state
and a local health agency, there is no need for a state-local
liaison function.
F. Budget
Budget information for the SHA was not available at the time of
printing.
3III. Local Public Health Agencies (LPHAs)
A. General
Kosrae State has no local health departments. Local public
health services are provided by elements of the Kosrae Department
of Health Services.
B. Services Provided
Primary and secondary medical care are available through the
state hospital. All clinical services, except for a few basic
services provided by nurses through the School Health Program,
are provided through the hospital. Patients with complications
or those requiring tertiary care are referred to Pohnpei, then to
Guam or Honolulu. The following are some of the services
provided by the outpatient clinics:
General Medical Clinics
Communicable Disease Control
Health Education Services
Laboratory Services
Well-child Clinics
Prenatal Clinics
Postnatal Clinics
Family Planning
Diabetes Clinics
Hypertension Services
Pediatric and Obstetrical Supervision
Dental Services
Dental Health Education
Immunizations
Services to Elderly
Teams of public health nurses conduct weekly visits to
communities and provide well-baby clinics, immunizations,
postnatal follow-ups, basic clinical services, and services to
the elderly.
C. Local Health Officer
Kosrae does not have local health officers.
D. Local Board of Health
Information about the presence or function of local boards or
councils of health was not available at the time of printing.
E. Staff
The number of staff employed by the Kosrae State Department of
Health Services was not available at the time of printing.
F. Budget
The budget for local health services was not available at the
time of printing.
2Kosrae State Department of Health Services, 1990
Director
Hospital Division
Nursing Services
Medical Services
Support Services
Sanitation Division
Food/Water Sanitation
Public Facility
Coastal Area Monitoring
Plane/Ship Inspections
Village Inspections
Dental Division
Preventive Dental
Clinical Services
Public Health Division
Preventive Programs
Clinical Programs
2Types of Local Health Departments by Jurisdiction
Kosrae State, 1990
Kosrae State does not have local health departments
1FEDERATED STATES OF MICRONESIA -- POHNPEI STATE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1985)* 28,671 (1987) 243,416,000
Population Density (1985) 197.7 68.8
(per/sq.mi.)
Number of Counties NA 3,139
Median Age (1985)* 15.9 (1987) 31.7
Percent Below Poverty Level (1985) NA 14.0
(persons)
Percent of Population Rural (1985)* 79.0 (1980) 26.0
Percent of Population White (1980)* 00.9 83.1
Percent of Population Non-white (1980)* 95.0 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
The Federated States of Micronesia (FSM) is part of the
archipelago of the Caroline Islands. The state of Pohnpei is
located about 450 miles east of Chuuk (formerly known as Truk)
and 2,600 miles west of Hawaii. Pohnpei is made up of a high
volcanic island and eight atolls. The land mass is 145 square
miles. Pohnpei has three distinct Micronesian cultural groups
which include Ponapeans, Mokilese, and Pingelapese. Pohnpei
State serves as the administrative center for the state
government and for the national government of FSM.
C. National and State Government Structure
In 1982 the United States signed a Compact of Free Association
with FSM. Since that time FSM has been referred to as a freely
associated state. FSM is made up of four states: Yap, Chuuk,
Pohnpei, and Kosrae. The national government is located on
Pohnpei and consists of executive, legislative and judicial
branches. The President and Vice-president make up the executive
branch. The legislative branch consists of a bicameral
legislature.
* These data were provided by the SHA.
Data for this territory were updated January 1991. The state of
Pohnpei has a uicameral legislature made up of 27
members. The members are elected for 4-year staggered terms.
Pohnpei also has a Governor.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Pohnpei Department of Health Services (PDHS) is the primary
health agency. Health services are centralized to the 116-bed
Pohnpei State Hospital. In addition to the hospital 22
dispensaries, staffed by mobile health teams, provide public
health services. Private medicine is not available in Pohnpei.
Information about the structure of the FSM National Health Agency
and its relationship to the SHA was unavailable at the time of
printing.
B. Head of State Health Agency
The Secretary of the Department of Human Resources is the head of
the health agency for FSM and the State Director of Health
Services is the head of the health agency for the state of
Pohnpei. Information about the requirements of the position and
means of appointment were not available at the time of printing.
C. State Board of Health/Council
Information about the presence and function of a State Board or
Council of Health was not available at the time of printing.
D. Regional/District Health Offices
Twenty-two dispensaries are distributed throughout the state, but
these are service units.
E. State-local Liaison
Because the Department of Health Services functions as both a
state and a local health agency, there is no need for a
state-local liaison function.
F. Budget
Budget information on the Department of Health Services was not
available at the time of printing.
3III. Local Public Health Agencies (LPHAs)
A. General
Pohnpei has no local health departments. Local public health
services are provided by elements of the PDHS.
B. Services Provided
Services provided by Pohnpei State Hospital include obstetrics
and gynecology, internal medicine, orthopedics, pediatrics,
surgery, eye problems, dental care, and maternal and child
health. Patients pay a small fee for both in-patient and
out-patient services. This source of income accounts for
approximately one-fourth of the annual health budget.
C. Local Health Officer
Information about local health officers was not available at the
time of printing.
D. Local Board of Health
Information about the presence and function of local boards of
health was not available at the time of printing.
E. Staff
The number of staff employed by the PDHS was not available at the
time of printing.
F. Budget
The budget for all local health services was not available at the
time of printing.
2Pohnpei State Department of Health Sevices, 1990
Director
Chief, Administration Division
Management and Admin. Services
Medical Record/Vital Statistics
Fiscal Services
Dietary and Food Services
Personnel Services
Laundry Services
Budget and Finance
Housekeeping and Janitorial
Procurement and Supply
Training and Employee Development
Security Services
Health Planning
Ambulance Services
Chief, Medical Services
Professional Services
X-ray Services
Pharmacy Services
Laboratory Services
Anesthesia
Hemodialysis
Special Clinics
Nursing Services
In-patient
Operation and Recovery
Labor and Delivery
Physio-therapy
Emergency Services
Medical Referrals
CRS Services
Chief, Public Health Division
Maternal and Child Health
Communicable Diseases
Health Education and Nutrition
Special Clinics
Drug/Alcohol and Mental Health
Sanitation and EPA
Public Health Nursing Services
Personnel and Admin. Services
Primary Health Care (CHC) Disp.
Chief, Dental Division
Dental Preventive Services
Elementary School Program
Dental Health Education
Dental Dispensary Services
Dental Clinics
Dental Laboratory Services
Dental Headstart Services
Dental Old-age Services
CDC Services
Dental Nursing Services
Dental X-ray Services
Personnel and Admin. Services
Types of Local Health Departments by Jurisdiction
Phonpei State, 1990
Pohnpei State does not have local health departments
1FEDERATED STATES OF MICRONESIA -- YAP STATE
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
State United States
Population (1987) 10,200 243,416,000
Population Density (1987) 85.7 68.8
(per/sq.mi.)
Number of Counties NA 3,139
Median Age (1987) NA 31.7
Percent Below Poverty Level (1985) NA 14.0
(persons)
Percent of Population Rural (1980) NA 26.0
Percent of Population White (1980) NA 83.1
Percent of Population Non-white (1980) NA 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
The Federated States of Micronesia (FSM) is part of the
archipelago of the Caroline Islands. Yap proper is located about
550 miles southwest of Guam. The state of Yap is made up of the
Island of Yap and several inhabited atolls which extend as far as
600 miles to the east. The population of Yap and the outer
islands is culturally and linguistically different. Two-thirds
of the population of the state resides on the Island of Yap.
C. National and State Government Structure
In 1982 the United States signed a Compact of Free Association
with FSM. Since that time FSM has been referred to as a freely
associated state. FSM is made up of four states: Yap, Chuuk,
Pohnpei, and Kosrae. The national government is located on
Pohnpei and consists of executive, legislative, and judicial
branches. A President and Vice-president make up the executive
branch. The legislative branch consists of a bicameral
legislature.
The state of Yap has a unicameral legislature made up of 10
members who serve 4-year terms. Six members are elected from the
Yap Islands proper and four are elected from the outer islands.
Yap also has a Governor.
Data for this territory were updated January 1991.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The Department of Health Services is the primary health agency
for the state of Yap. Health services are centralized to the Yap
State Hospital which is located on the Island of Yap.
Dispensaries are located on most of the outer islands, manned by
health assistants and physician assistants. Traveling medical
services called "field trip services" provide care and supplies
to these islands every 4 to 6 weeks. Patients with needs beyond
the capacity of the dispensaries are evacuated to the hospital on
Yap.
Information about the structure of the FSM National Health Agency
and its relationship with the SHA was not available at the time
of printing.
B. Head of State Health Agency
No M.D. Requirement, Cabinet-level Appointment
The Secretary of the Department of Human Resources is the head of
the health agency for FSM and the Director of Health is the head
of the health agency for the state of Yap. The Director is
appointed by the Governor and approved by the State Legislature.
C. State Board of Health/Council
Information about the presence and function of a state board or
council of health was not available at the time of printing.
D. Regional/District Health Offices
Dispensaries are located on many of the outer islands, but these
are strictly service units.
E. State-local Liaison
The State Department of Health functions as both the state and
local health agency, so there is no need for a state-local
liaison.
F. Budget
Total FY 1991 Yap SHA budget is $1,900,000*. Total FY 1988
United States SHA expenditures were $8,312,928,000. The Yap
budget data were provided by the SHA.
*These data were provided by the SHA.
3III. Local Public Health Agencies (LPHAs)
A. General
Yap State has no local health departments. Local public health
services are provided by elements of the Yap State Department of
Health.
B. Services Provided
Services provided by the Department include environmental health,
health education, communicable disease control, family planning,
maternal and child health, and prenatal care.
C. Local Health Officer
Information about the presence and function of local health
officers was not available at the time of printing.
D. Local Board of Health
Yap does not have local boards of health.
E. Staff
The number of staff employed by the Yap State Department of
Health was not available at the time of printing.
F. Budget
The budget for all local health services is included within the
budget for the SHA.
2Yap State Department of Health Services, 1990
Director
Board of Health
Assistant Director
Administrative Support
Division of Public Health
Primary Health Care Programs
Mental Health Care Programs
Dispensary Programs
Special Programs
Regular Clinics
Division of Clinical Care
Out-patient Services
In-patient Services
Continuing Education
Emergency Services
Physical Therapy
Labor and Delivery
Surgical Unit
Security
Division of Dental Health
Clinical Services
Community Services
Sub-Dental Clinics
Field Programs
Division of Ancillary Services
Medical Records
Medical Supply
Maintenance
Laboratory
Laundry
Kitchen
X-ray
2Types of Local Health Departments by Jurisdiction
Yap State, 1990
Yap State does not have local health departments
1GUAM
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
Territory United States
Population (1990)* 132,726 (1988) 245,803,000
Population Density (1990)* 635.1 (1988) 69.4
(per/sq.mi.)
Number of Counties NA 3,139
Median Age (1980)* 22.3 31.7
Percent Below Poverty Level (1990)* 8.0 (1985) 14.0
(persons)
Percent of Population Rural (1980) 60.5 26.0
Percent of Population White (1980)* 25.4 83.1
Percent of Population Non-white (1980)* 74.6 16.9
Median Years of Education (1980)* 12.5 12.5
(25 years of age and over)
B. Location, Geography, and People
The southernmost of the Mariana Islands and located in the west
central Pacific, Guam is about 1,500 miles east of the
Philippines, 1,350 miles south of Tokyo, and 3,300 miles west of
Honolulu. The territory consists of a single island that is 30
miles long and 4 to 8 miles wide totaling 209 square miles. The
native and predominant population of the island is Chamorros.
C. Territorial Government Structure
Guam is an unincorporated territory of the United States. The
government consists of executive, legislative, and judicial
branches. The legislative branch is made up of a 21-member
unicameral legislature. The legislature is elected to 2-year
terms and is responsible primarily for internal affairs. Guam
has a non-voting delegate to the U.S. House of Representatives
who is elected by popular vote every 2 years. The executive
branch is made up of the Governor, Lieutenant Governor, and
executive department. The Governor and Lieutenant Governor are
elected by popular vote and serve 4-year terms.
* These data and total FY 1990 Guam expenditures were provided by
the SHA.
Data for this territory were updated January 1991.
3II. State Health Agency (SHA)
A. General
Component of Superagency
The Guam Department of Public Health and Social Services (GDPHSS)
is the primary health agency for the territory. It serves as the
State Health Agency as well as the provider of local health
services. The GDPHSS has four divisions which perform its major
functions: Environmental Health, Senior Citizens, Public Health,
and Public Welfare Division. The Department is authorized and
funded by both Federal and local jurisdictions. GDPHSS provides
basic public health and medical services to approximately 10,000
residents per month through three regional health centers.
Several other governmental agencies are providing services
related to health care. The recently reactivated Guam Health
Planning and Development Agency is a distinct and separate
department which will serve as the government's primary planning
unit for health services. The Environmental Protection Agency
shares many surveillance and monitoring activities with the
Division of Public Health and the Division of Environmental
Health. The Guam Fire Department operates the emergency medical
services system, but central planning and administration are
vested in the GDPHSS.
B. Head of State Health Agency
No M.D. Requirement, Not Cabinet-level Appointment
The Director of GDPHSS is the head of the territorial health
agency.
C. State Board of Health/Council
Guam does not have a state board of health.
D. Regional/District Health Offices
Health services are provided through three regional health
centers: in Inaranjan village in the southern area of the
island; in Mangilao in the central area; and in Dededo in the
northern area.
E. State-local Liaison
Because the GDPHSS functions as both a state and a local health
agency, there is no need for a state-local liaison.
F. Budget
Total FY 1990 Guam SHA expenditures were $8,252,300. Total FY
1988 United States SHA expenditures were $8,312,928,000.
Source of Funds
Federal Grants and Contracts $3,138,875
State Funds $5,113,425
Local Funds 0
Fees and Reimbursements $363,699
Other 0
3III. Local Public Health Agencies (LPHAs)
A. General
GDPHSS serves as both the territorial and local public health
department.
B. Services Provided
All of the regional health centers provide maternal and child
health, family planning, chronic disease prevention and control,
generalized community health nursing, dental, pharmacy,
nutrition, and health education. In addition, the central and
southern centers provide x-ray and laboratory services. Services
to children with special health care needs and for communicable
disease control are available only at the central center. The
Southern Regional Community Health Center in Inarajan is the only
facility funded as a community health center under Section 330 of
the Public Health Service Act. This center provides
comprehensive primary care on a fee-for-service basis adjusted
for patient's ability to pay.
C. Local Health Officer
Information about the presence and function of local health
officers was not available at the time of printing.
D. Local Board of Health
Information about the presence and function of local boards of
health was not available at the time of printing.
E. Staff
Staff of GDPHSS are employed and supervised by the central
agency.
F. Budget
The budget for all local health services is included within the
budget for the SHA.
2Guam Department of Public Health and Social Services, 1990
Director
Physician Services
Office of Planning and Evaluation
Office of Vital Statistics
Health Info. Systems
Office of Epidemiology and Research
Bureau of Community Health Services
Chronic Disease Prevention and Control
Dental Health Services
Nutrition Health Services
Speech and Hearing
Bureau of Communicable Disease Control
Enteric Disease and Foreign Quarantine
Immunization
Sexually Transmitted Diseases and AIDS
Tuberculosis
Bureau of Family Health and Nursing Services
Home Care Services
Maternal Child Health Services
Central Region Housing Services
Northern Region Housing Services
Southern Region Housing Services
Bureau of Professional Support Services
Emergency Medical Services
Health Education
Laboratory
Medical Support Services
Pharmacy
Medical Records
X-rays
Medical Social Services
Biomedical Equipment Maintenance
Southern Region Community Health Center
Community Outreach Program
Medical Services
2Types of Local Health Departments by Jurisdiction
Guam, 1990
Guam does not have local health departments
1REPUBLIC OF THE MARSHALL ISLANDS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
Republic United States
Population (1988) 43,355 245,803,000
Population Density (1988) 656.9 69.4
(per/sq.mi.)
Number of Counties NA 3,139
Median Age (1987) NA 31.7
Percent Below Poverty Level (1985) NA 14.0
Percent of Population Rural (1980) NA 26.0
Percent of Population White (1980) NA 83.1
Percent of Population Non-white (1980) NA 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
The Republic of the Marshall Islands is located in an area of the
Pacific Ocean known as Micronesia. The islands are about 2,000
miles southwest of Hawaii and about 1,300 miles southeast of
Guam. The Marshall "Islands" are made up of two chains of
atolls. These chains have 29 low-lying coral atolls and 5
low-lying coral islands. Atolls consist of loosely connected
coral masses which ring a central lagoon. The lagoons may be
only a few miles across or massive in their breadth. Although
the islands which comprise the atoll chain are usually
considerable distances apart, some are sufficiently close to walk
between them at low tide. The republic consists of 66 square
miles of land mass.
The population is distributed unevenly over 24 populated atolls
and 2 small islands. The islands are only a few feet above sea
level and most are less than 15 miles in length and 400 yards in
width. None of the islands have sufficient space for more than
two parallel roads on the atoll. On most islands the population
lives on either side of a single road or street.
C. Republic Government Structure
The Republic of the Marshall Islands and the United States signed
a Compact of Free Association in 1982. Since that time the
Data for this territory are based on the best available
information and were updated December 1990.
political relationship of the Republic of the Marshall Islands
with the United States has been as a freely associated state.
The Republic has a President who is elected by the Legislature
from among its own members. The legislative branch of government
is a unicameral legislature (the Nitijela) that has 33 members.
3II. State Health Agency (SHA)
A. General
The Republic of the Marshall Islands Department of Health
Services (RMIDHS) is the SHA. Almost all medical and health care
is provided by the government through this agency. The principal
facility is an 81-bed acute care hospital in Majuro. A second
22-bed hospital is located on Ebeye in the Kwajalein Atoll.
Management staff for all medical, dental, and public health
services are located at these facilities. In addition, most
out-patient clinics, emergency medical services, and public
health clinics are at these two locations. There are, however,
60 dispensaries located on 25 outer islands. Health assistants
staff the clinic, often living in the facility. These
individuals are trained to provide basic medical care for common
illnesses, diseases, and minor injuries. Patients who need more
sophisticated care than that available at the dispensaries must
be transferred to one of the hospitals.
B. Head of State Health Agency
The Minister of Health is a cabinet-level officer responsible for
public health. The Secretary of Health Services is the chief
executive for operating health services. The only other
administrative officer is a health services administrator who
reports directly to these officials.
C. State Board of Health/Council
Information on the presence and function of a territorial board
or council of health was not available at the time of printing.
D. Regional/District Health Offices
The Republic of the Marshall Islands does not have regional or
district health offices.
E. State-local Liaison
The RMIDHS functions as both a state and a local health agency,
thereby eliminating need for a state-local liaison function.
F. Budget
No budget information for the SHA was available at the time of
printing.
3III. Local Public Health Agencies (LPHAs)
A. General
The Republic of the Marshall Islands does not have local health
departments but provides public health services through the SHA.
B. Services Provided
Hospitals provide general medical and surgical care, pediatric
and obstetrical care. General clinical laboratory, radiological
and pharmacy services support both in- and out-patient care.
Rehabilitative services are available at the Majuro Hospital.
Public health services include prenatal, well-baby, and child
health services including immunizations. Environmental health
services, which include surveillance over water quality and food
sanitation, are also provided. Public health dentistry is
limited to clinical dentistry, with much of the care provided by
dental nurses. Health education activities are limited to those
that can be supported by one individual. Rudimentary vital
statistics are kept. Communicable disease investigations,
screening, and casefinding for some chronic diseases are
performed on a limited basis by public health nurses.
C. Local Health Officer
Information about the presence or function of local health
officers was not available at the time of printing.
D. Local Board of Health
The Republic of the Marshall Islands does not have local boards
of health.
E. Staff
Public health staff are employed and supervised by the Department
of Health Services.
F. Budget
The budget for local health services was not available at the
time of printing.
2Marshall Islands Department of health Services, 1990
At time of printing, organizational chart was not available.
Figure 120
Types of Local Health Departments by Jurisdiction
Republic of the Marshall Islands, 1990
Republic of the Marshall Islands does not have local health
departments
1REPUBLIC OF PALAU
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
Republic United States
Population (1987) 14,000 243,416,000
Population Density (1987) 81.4 68.8
(per/sq.mi.)
Number of Counties NA 3,139
Median Age (1987) NA 31.7
Percent Below Poverty Level (1988)* 88.0 (1985) 14.0
(persons)
Percent of Population Rural (1988)* 21.0 (1980) 26.0
Percent of Population White (1986)* 1.5 (1980) 83.1
Percent of Population Non-white (1986)* 98.5 (1980) 16.9
Median Years of Education (1980) NA 12.5
(25 years of age and over)
B. Location, Geography, and People
The Republic of Palau is made up of approximately 200 small
volcanic and limestone islands which are part of the Caroline
Island Chain. The total land mass is 172 square miles. Palau
lies about 7 degrees, 30 minutes north of the equator. The
Philippines are about 600 miles to the west and Guam is 900 miles
to the northeast. Only about eight of the islands are inhabited.
Although most of the native population is of Western Carolinian
extraction, a small but growing group of aliens and individuals
from the United States reside in Palau. Some blending of
ethnicities and cultures has occurred, but the islanders have
retained many of their traditional characteristics such as strong
matrilineal clan kinship ties and hierarchial rank system.
C. Republic Government Structure
The Republic of Palau is functioning as a "Freely Associated
State" in its relationship with the United States. Several
referenda on a Compact of Free Association were approved by the
electorate, but not by the 75-percent vote required by the
constitution. Therefore, technically Palau is the last remaining
* These data were provided by the SHA.
Data for this territory were revised January 1991.
part of the Trust Territory of the Pacific Islands which is a
United Nations Trusteeship, administered by the United States.
Under the trusteeship, executive and administrative authority are
given to a High Commissioner. The Commissioner is appointed by
the President of the United States with consent and approval of
the United States Senate. Palau drafted and approved a local
constitution in 1981 which formed the Republic of Palau. Under
this constitution, the role of the High Commissioner was amended
to provide for local self-government. The Republic has a
President and Vice-president who are elected by popular vote for
4-year terms. The Palau National Congress is the legislative
body, consisting of a Senate and House of Delegates. The
Republic is divided into 16 states, each with an elected Governor
and legislature.
3II. State Health Agency (SHA)
A. General
The Ministry of Health is the primary health agency for the
Republic of Palau. Most medical and health care in the Republic
of Palau is provided by the government and administered through
the Ministry of Health. The principal acute-care facility in
Palau is the 65-bed MacDonald Memorial Hospital, limited to
primary and secondary care. The hospital also houses all
administrative and public health offices.
Government-sponsored dispensaries are located in 13 outlying
areas. Eleven dispensaries are located in the intermediate
islands. Only nine are staffed, either full-time or part-time.
Three dispensaries are located on the outer islands, but only two
are staffed full-time. The facilities offer a limited range of
basic medical services. Public health services are also provided
to other areas through scheduled medical field trips. Patients
requiring more specialized care are referred to the hospital at
Koror. Patients who require treatment beyond the capabilities of
the local facilities are referred to hospitals on Guam, Hawaii,
the Philippines or United States mainland.
B. Head of State Health Agency
New legislation has established a Ministry of Health, with the
Minister as head of the SHA.
C. State Board of Health/Council
Formerly, a Health Planning Council existed but is now defunct.
Many of the responsibilities are now carried out by the Board of
Directors of the Palau Community Health Center, a component of
the Bureau of Health Services. This body is responsible for
health policy-making with a preventive approach.
D. Regional/District Health Offices
Palau has no regional health offices. The Ministry of Health is
responsible for providing of all health services through regional
dispensaries.
E. State-local Liaison
National-state liaison is not a problem because all health
services are provided by the national government.
F. Budget
Public health activities are predominately supported by U.S.
Federal grants with minor grants, coming from the Palauan
Government Budget. These average $1.2 million annually, although
support for facilities and some personnel is also included in the
$2.3 million annual budget for MacDonald Memorial Hospital*.
3III. Local Public Health Agencies (LPHAs)
A. General
The Republic of Palau has no local health departments. Local
public health services are provided by elements of the Palau
Ministry of Health.
B. Services Provided
The Division of Primary Health (preventive services) provides a
range of still-evolving services at out-patient clinics held at
the hospital, and to a lesser extent, at the various outlying
dispensaries. These services include, but are not limited to,
maternal and child care, crippled children services, hypertension
screening and protection, communicable disease control, cancer
detection, vector control, consumer protection, and community
hygiene.
C. Local Health Officer
Information about the presence and function of local health
officers was not available at the time of printing.
* These data were provided by the SHA.
D. Local Board of Health
Information about the presence and function of local boards of
health was not available at the time of printing.
E. Staff
The number of staff employed by the Ministry of Health Services
was not available at the time of printing.
F. Budget
The budget for all local health services is included within the
budget for the SHA.
2Republic of Palau Bureau of Health Services, 1990
At time of printing, State Health Agency undergoing
reorganization.
2Types of Local Health Departments by Jurisdiction
Republic of Palau, 1990
Republic of Palau does not have local health departments
1UNITED STATES VIRGIN ISLANDS
2Public Health System Profile
3I. General State Information
A. Selected Sociodemographic Indicators
Territory United States
Population (1988)* 106,000 245,803,000
Population Density (1988)* 779.4 69.4
(per/sq.mi.)
Number of Counties 00 3139
Median Age (1989)* 27.0 (1987) 31.7
Percent Below Poverty Level (1989)* 23.0 (1985) 14.0
(persons)
Percent of Population Rural (1980)* 100.0 26.0
Percent of Population White (1980)* 15.6 83.1
Percent of Population Non-white (1980)* 84.2 16.9
Median Years of Education (1980)* 12.0 12.5
(25 years of age and over)
B. Location, Geography, and People
The territory of the U.S. Virgin Islands is made up of three main
inhabited (St. Croix, St. Thomas, and St. John) islands and about
50 small mostly uninhabited islands. The location of the
territory is the Caribbean Sea about 40 miles east of Puerto Rico
and at the eastern end of the Greater Antilles. The territory
has a combined land mass of approximately 137 square miles.
The Virgin Islands were originally inhabited by Carib and Arawak
Indians. After discovery by Europeans in 1493 the islands were
controlled by the English, French, Dutch, and the western islands
colonized by Denmark. The people of the U.S. Virgin Islands,
however, are predominately of African descent. English is the
official language but Spanish and Creole have wide usage.
C. Territorial Government Structure
The U.S. Virgin Islands is an unincorporated territory of the
United States. The Capitol is Charlotte Amalie, on the Island of
St. Thomas. The islands have been associated with the United
States since they were purchased from Denmark in 1917.
* These data were provided by the SHA.
The data for this territory were updated February 1991.
The government of the U.S. Virgin Islands consists of a Governor,
a Lieutenant Governor, and a unicameral legislature. The
legislature is made up of 15 Senators who are elected by popular
vote. Since 1973 the territory has sent a non-voting delegate to
the U.S. House of Representatives.
3II. State Health Agency (SHA)
A. General
Free-standing, Independent
The U.S. Virgin Island Department of Health is a free-standing
independent agency that serves as the SHA. It is the second
largest government department, owning nearly all of the health
facilities and providing most of the health care services. It
serves as the SHA and local health agency. The U.S. Virgin
Island Department of Health is responsible for providing
comprehensive quality care, including health education, to all
residents of the U.S. Virgin Islands, especially the
under-insured, uninsured, and poor.
B. Head of State Health Agency
M.D. Requirement, Cabinet-level Appointment
The U.S. Virgin Islands Department of Health is directed by the
Commissioner of Health who is appointed by the Governor of the
U.S. Virgin Islands and approved by the U.S. Virgin Islands
Legislature.
C. State Board of Health/Council
Presently, no boards are assigned to the Department of Health.
The rural health centers on two islands, however, do have boards
with members appointed by the Governor.
D. Regional/District Health Offices
St. Croix and St. Thomas have three districts on each island
(East District, Mid-Island, and West Districts). St. John has
two districts (Cruz Bay and Coral Bay).
E. State-Local Liaison
The U.S. Virgin Islands Department of Health functions as the
territorial and local health department, so there is no need for
a liaison function.
F. Budget
Total FY 1989 U.S. Virgin Islands SHA expenditures were
$91,888,542. Total FY 1988 United States SHA expenditures were
$8,312,928,000.
Source of Funds
Federal Grants and Contracts $897,684
State Funds $90,990,858
Local Funds 0
Fees and Reimbursements $0,000,000
Other $000,000
3III. Local Public Health Agencies (LPHAs)
A. General
The U.S. Virgin Islands has no local health departments. Local
public health services are provided by elements of the Virgin
Islands Department of Health.
B. Services Provided
The following information on local health services was provided
by the U.S. Virgin Islands Department of Health. Since the U.S.
Virgin Islands has no local health departments, the SHA is
responsible for all local health services. Responsibility for
some of the services listed below, however, are shared by the
Department of Health and other departments. The percentage
indicates the portion of responsibility for the service residing
with the Department of Health.
Services Provided Percent of Service
I. Assessment Activities
A. Data Collection/Analysis
1. Behavioral Risk Assessment (100.0%)
2. Morbidity Data (100.0%)
3. Reportable Diseases (100.0%)
4. Vital Records and Statistics (100.0%)
B. Epidemiology/Surveillance
1. Chronic Diseases (100.0%)
2. Communicable Diseases (100.0%)
II. Policy Development
A. Health Code Dev. and Enforcement (100.0%)
B. Health Planning (100.0%)
C. Priority Setting (100.0%)
III. Assurance Activities
A. Inspection
1. Food and Milk Control (100.0%)
2. Health Facility Safety/Quality (100.0%)
3. Rec. Facility Safety/Quality (100.0%)
4. Other Facility Safety/Quality (100.0%)
B. Licensing
1. Health Facilities (100.0%)
2. Other Facilities (100.0%)
C. Health Education (100.0%)
D. Environmental
1. Air Quality ( 0.0%)
2. Hazardous Waste Management ( 50.0%)
3. Individual Water Supply Safety (100.0%)
4. Noise Pollution ( 0.0%)
5. Occupational Health and Safety ( 0.0%)
6. Public Water Supply Safety ( 0.0%)
7. Radiation Control ( 0.0%)
8. Sewage Disposal Systems (100.0%)
9. Solid Waste Management ( 50.0%)
10. Vector and Animal Control (100.0%)
11. Water Pollution ( 50.0%)
E. Personal Health Services
1. AIDS Testing and Counseling (100.0%)
2. Alcohol Abuse (100.0%)
3. Child Health (100.0%)
4. Chronic Diseases (100.0%)
5. Dental Health (100.0%)
6. Drug Abuse (100.0%)
7. Emergency Medical Service (100.0%)
8. Family Planning (100.0%)
9. Handicapped Children (100.0%)
10. Home Health Care (100.0%)
11. Hospitals ( 0.0%)
12. Immunizations (100.0%)
13. Laboratory Services ( 0.0%)
14. Long-term Care Facilities ( 0.0%)
15. Mental Health (100.0%)
16. Obstetrical Care (100.0%)
17. Prenatal Care (100.0%)
18. Primary Care (100.0%)
19. Sexually Transmitted Diseases (100.0%)
20. Tuberculosis (100.0%)
21. WIC (100.0%)
C. Local Health Officer
M.D. Requirement, Gubernatorial Appointment
Two District Health Officers are appointed to the Division of
Prevention Health Promotion and Protection, one of which is
responsible for St. Thomas and St. John Islands and the other is
responsible for St. Croix. They report to the Assistant
Commissioner of Prevention, Health Promotion and Protection
(PHPP). They assist the Assistant Commissioner of PHPP in
investigating possible outbreaks of diseases and in preventing
epidemics at high-risk times. They are recommended by the
Assistant Commissioner of PHPP, approved by the Commissioner of
Health and appointed by the Governor.
D. Local Board of Health
The United States Virgin Islands does not have local boards of
health.
E. Staff
The number of staff employed by the U.S. Virgin Islands
Department of Health is 794.
F. Budget
The budget for all local health services is included within the
budget for the SHA.
2United States Virgin Islands Department of Health, 1990
Commissioner of Health
Territorial Assistant Commissioner
Marketing Services
Computer and Communications
Risk Management
Health Professions Institute
Emergency Medical Services
Deputy Commissioner Planning
Assistant Commissioner Operations
Renovations Project
Deputy Commissioner Financial Services
Deputy Commissioner Administrative Services
Administrator Health Services St. John, U.S.V.I.
Assistant Commissioner PHPP
WIC/Nutrition Services
Mental Health Services
Alcohol/Drug Dependency
Medical Assistance
Health Education
Environmental Health
Dental Health Services
Assistant Commissioner PHPP
Community Health
MCH and CSHCN Program
Family Planning Program
East End Family Health Center
Frederiksted Health Center
Public Health Nursing
Bureau of Rehabilitation
Social Services
St. John Health Services
2Types of Local Health Departments by Jurisdiction
United States Virgin Islands, 1990
The United States Virgin Islands do not have local health
departments
1LIST OF TABLES
Table S-1 Responsibilities of State Health Agencies ... 10
(SHAs) in 50 states and the District of
Columbia, 1990.
Table S-2 Assessment and policy development: .......... 11
activities reported by 2,269 local
public health agencies (LPHAs), 1990.
Table S-3 Assurance: inspection, licensing, health .... 12
education, and environmental activities
reported by 2,269 local public health
agencies (LPHAs), 1990.
Table S-4 Assurance of personal health services: ...... 13
activities reported by 2,269 local
public health agencies (LPHAs), 1990.
Table S-5 Ten organizational practices or processes ... 14
that must be carried out by a component of
the public health system in each locality.
1ACKNOWLEDGMENTS
Completion of these profiles is due in a large part to the
information and assistance provided by state and territorial
public health officials. The following public health officials
provided information and assistance:
Alabama Michael Mann, Director, Planning and
Evaluation Branch, Office of Management
Services, Alabama Department of Health
Alaska Alfred G. Zangri, Acting Director, Division
of Public Health, Alaska Department of Health
and Social Services
Arizona Vanessa Nelson Hill, Chief, Office of Local
Health Services, Arizona Department of Health
Services
Arkansas James L. Mills, Director, Bureau of Community
Health Services, Arkansas Department of
Health
California Alan Oppenheim, Research Program Specialist,
Office of County Health Services and Local
Public Health Assistance, California
Department of Health Services
Colorado Roger Donahue, Director, Local Health
Services, Colorado Department of Health
Connecticut Judy Sartucci, Director, Office of Local
Health Administration, Connecticut Department
of Health Services
Delaware Lyman T. Olsen, M.D., Medical Director,
Division of Public Health, Delaware
Department of Health and Social Services
District of Carlessia A. Hussein, D.P.H., Deputy
Columbia Commissioner, District of Columbia Commission
of Public Health
John Heath, Chief, Sexually Transmitted
Disease Epidemiology Service, District of
Columbia Commission of Public Health
Florida Phillip Street, Analyst, State Health Office,
Department of Health and Rehabilitative
Services
Georgia Sarah Price, Budget Officer, Administrative
Services, Division of Public Health, Georgia
Department of Human Resources
Carol E. Harris, Grant-in-Aid Budget Officer,
Division of Public Health, Georgia Department
of Human Resources
Hawaii Fay Nakamoto, Assistant to Director, Hawaii
Department of Health
Idaho Jane S. Smith, R.N., Chief, Bureau of
Preventive Medicine, Division of Public
Health, Idaho Department of Health and
Welfare
Diane Bowen, Supervisor, Office of Health
Policy and Resource Development, Division of
Health, Idaho Department of Health and
Welfare
Illinois George S. Rudis, Chief, Division of Local
Health Administration, Office of
Administrative Services, Illinois Department
of Public Health
Indiana James L. Rice, Director, Division of Local
Support Services, Indiana State Board of
Health
Iowa Ronald Eckoff, M.D., M.P.H., Acting Director,
Iowa Department of Public Health
Kansas Connie Hanson, R.N., M.S., Director, Special
Services Section, Bureau of Local Health
Services, Kansas Department of Health and
Environment
Garth Hulse, B.A., Management Analyst, Office
of Local and Rural Health Systems, Kansas
Department of Health and Environment
Kentucky James T. Corum, D.M.D., Director, Division of
Local Health, Department of Health Services,
Kentucky Cabinet for Human Resources
Lynn Owens, Public Health Administrator,
Division of Local Health, Department of
Health Services, Kentucky Cabinet for Human
Resources
Louisiana Miguel Zuniga, M.D., Health Services
Planner/Resident, Louisiana Department of
Health and Hospitals
Joel L. Nitzkin, M.D., D.P.A., Director,
Office of Public Health, Louisiana Department
of Health and Hospitals
Maine Lani Graham, M.D., M.P.H., Director, Bureau
of Health, Maine Department of Human Services
Eleanor Bruce, Director of Public Health
Nursing, Bureau of Health, Maine Department
of Human Services
N. Warren Bartlett, M.Div., Assistant
Director, Bureau of Health, Maine Department
of Human Services
Maryland C. Devadason, M.D., D.P.H., Director, Local
and Family Health Administration, Maryland
Department of Health and Mental Hygiene
Massachusetts Gerry E. Desilets, Associate Commissioner,
Office of Policy Development and Planning,
Massachusetts Department of Public Health
Hillel Liebert, Policy Development
Coordinator, Office of Planning and Policy
Development, Massachusetts Department of
Public Health
Michigan Carol Ogan, Administrative Assistant, Bureau
of Community Services, Michigan Department of
Public Health
Minnesota Jim Parker, Director, Division of Community
Health Services, Minnesota Department of
Health
Ryan Church, Division of Community Health,
Section of Community Development, Minnesota
Department of Health
Bill Brand, Division of Community Health,
Section of Community Development, Minnesota
Department of Health
Mississippi Randy Caperton, Director, Field Services,
Office of the State Health Officer,
Mississippi State Department of Health
Missouri Mary Lou Gillilan, R.N., Assistant Director,
Division of Local Health and Institutional
Services, Missouri Department of Health
Montana Mike Craig, Health Planning Bureau, Montana
Department of Health and Environmental
Sciences
Nebraska Franklin Harris, Director, Bureau of
Community Health Services, Nebraska
Department of Health
Nevada Ron Lang, Administrative Services Officer,
Health Division, Nevada Department of Human
Resources
New Hampshire John D. Bonds, Assistant Director for
Planning, Division of Public Health Services,
New Hampshire Department of Health and Human
Services
New Jersey Andrew D. Miller, M.D., M.P.H., Director
Local Health Development Services, New Jersey
State Department of Health
Anthony Kobylarz, M.P.H., Health Systems
Specialist I, Health Aid Services, New Jersey
Department of Health
New Mexico Alice Boss, Planner, Public Health Division,
New Mexico Health Department
New York Donald Davidoff, Director of Field
Operations, Office of Public Health, New York
Department of Health
North Carolina Phyllis A. Gray, Special Assistant, State
Health Director's Office, North Carolina
Department of Environment, Health, and
Natural Resources
North Dakota LaVerne Lee, Director, Division of Local
Health Services and Public Health Nursing,
North Dakota State Department of Health
Ohio Paul Dalton, Administrative Assistant,
Division of Local Services, Bureau of
Supportive Services, Ohio Department of
Health
Oklahoma Jerry R. Nida, M.D., Senior Medical
Consultant, Oklahoma State Department of
Health
Oregon Donna Clark, Assistant Administrator Health
Services, MCH Program Director, Oregon
Department of Human Resources
Pennsylvania William Kcenich, Acting Deputy Secretary for
Community Health, Pennsylvania Department of
Health and Welfare
Rhode Island William Waters Jr., Ph.D., Associate Director
of Health, Rhode Island Department of Health
South Carolina Jerry Dell Gimarc, Director, Officer of
External Affairs, South Carolina Department
of Health and Environmental Control
South Dakota Jan Smith, Director, Center for Health Policy
and Statistics, South Dakota State Department
of Health
Tennessee Richard Light, M.D., Director, Bureau of
Health Services, Tennessee Department of
Health and Environment
Texas Albert G. Randall, M.D., M.P.H., Associate
Commissioner, Community and Rural Health,
Texas Department of Health
Ann Henry, Health Planner, State Health Data
and Policy Analysis, Texas Department of
Health
Susan R. Griffin, Director, Special Projects
for Local Health Services, Community and
Rural Health, Texas Department of Health
Utah Robert W. Sherwood, Jr., Director, Bureau of
Local and Rural Health Services, Division of
Community Health Services, Utah Department of
Health
Vermont Patricia Berry, Director, Local Health
Services, Vermont Department of Health
Virginia Robert B. Stroube, M.D., M.P.H., Deputy
Commissioner for Community Health Services,
Virginia Department of Health
Washington Eileen Keith, Acting Supervisor, Office of
Local Health Support Services, Washington
Department of Health
John Church, Local Fiscal Consultant,
Washington Department of Health
Linda Chapman, Public Health Advisor, Office
of Local Health Support Services, Washington
Department of Health
Jim Harris, Public Health Advisor, Office of
Local Health Support Services, Washington
Department of Health
Dan Rubin, Chief, Office of Health Policy
Support, Washington Department of Health
West Virginia Joan R. Kenny, R.N., M.S., Director, Division
of Local Health, West Virginia Department of
Health
Jim Doria, Administrative Assistant, West
Virginia Department of Health and Human
Resources
Wisconsin George F. MacKenzie, Administrator, Wisconsin
Division of Health
Mary Erikson, Regional Office Coordinator,
Wisconsin Division of Health
Wyoming Donna Griffin, R.N., M.S., Management
Assistant, Division of Health and Medical
Services, Wyoming Department of Health and
Social Services
American Samoa Charles R. McCuddin, M.P.H., Deputy Director
for Planning and Development, American Samoa
Department of Health
Commonwealth of Northern Mariana Islands
Roylinne F. Wada, M.S., M.P.H., Assistant
Professor of Public Health and Executive
Director, Pacific Island Health Officers
Association (PIHOA)
Federated States of Micronesia (FSM)
FSM, Chuuk State Sanphy William, Acting Director of Health
Services, Chuuk State Department of Health
Roylinne F. Wada, M.S., M.P.H., Assistant
Professor of Public Health and Executive
Director, PIHOA
FSM, Korsae State Roylinne F. Wada, M.S., M.P.H., Assistant
Professor of Public Health and Executive
Director, PIHOA
FSM, Pohnpei Aminis David, M.O., Director of Health
State Services, Pohnpei State Department of Health
Services
FSM, Yap State Mary Figir, Director, Department of Health
Services, Yap State Department of Health
Services
Roylinne F. Wada, M.S., M.P.H., Assistant
Professor of Public Health and Executive
Director, PIHOA
Guam Leticia V. Espaldon, M.D., Director, Public
Health and Social Services, Guam Department
of Public Health and Social Services
Roylinne F. Wada, M.S., M.P.H., Assistant
Professor of Public Health and Executive
Director, PIHOA
Marshall Islands Roylinne F. Wada, M.S., M.P.H., Assistant
Professor of Public Health and Executive
Director, PIHOA
Republic of Palau Nobuo Swei, M.O., Director, Bureau of Health
Services, Republic of Palau
Roylinne F. Wada, M.S., M.P.H., Assistant
Professor of Public Health and Executive
Director, PHIOA
Puerto Rico Antonio R. Silva, M.D., Director of the
Office of Federal Affairs, Puerto Rico
Department of Health
Virgin Islands Cora L. E. Christian, M.D., M.P.H., Assistant
Commissioner of Health, United States Virgin
Islands
Overall responsibility for developing the concept, collecting the
information, and preparing this document belongs to Edward H.
Vaughn of the Division of Public Health Systems, Public Health
Practice Program Office, Centers for Disease Control. Special
thanks are due to Public Health Practice Program Office staff who
participated in this project and made this report possible.
Pomeroy Sinnock, the branch chief when the project began,
supported the idea of developing profiles of state and
territorial public health systems and provided encouragement and
guidance during the crucial early phase of the project. Computer
graphics for the tables of organization and maps were created
primarily by Barbara Rice with some assistance from Tami Laplante
and Willie Richardson. Angela Cooper carefully proofread
documents and made many useful suggestions for improvements.
Philip Thompson, the PHPPO editor, edited the document and
provided assistance and suggestions on all aspects of the
project. This project is also indebted to Deborah Wachtel, an
Association for Schools of Public Health intern during the summer
of 1990, for her work in collating information, preparing draft
profiles of state public health systems, and providing
suggestions which improved the quality of the profiles.
1SELECTED BIBLIOGRAPHY OF SOURCES
1. U.S. Department of Health and Human Services, Public
Health Service. Healthy People 2000: National Health
Promotion and Disease Prevention Objectives.
Washington, D.C.: Public Health Service, 1990.
2. Public Health Foundation, Public Health Agencies 1990:
An Inventory of Programs and Block Grant Expenditures.
Washington, D.C.: Public Health Foundation, 1990.
3. Miller, C.A., Brooks E, DeFriese G, Gilbert B, Jain S,
and Kavaler F. A Survey of Local Health Departments and
Their Directors. Am J Public Health, 1977;67:931-939.
4. National Association of County Health Officials.
National Profile of Local Health Departments: An
Overview of the Nation's Local Public Health System.
Washington, D.C.: National Association of County Health
Officials, 1990.
5. Institute of Medicine. The Future of Public Health.
Washington, D.C.: National Academy Press, 1989.
6. Emerson, H. Local Health Units for the Nation. New
York, New York: Commonwealth Fund, 1945.
7. Mullan, F. and Smith, J. Characteristics of State and
Local Health Agencies. Baltimore, Maryland: Johns
Hopkins School of Hygiene and Public Health, 1988.
8. U.S. Department of Commerce, Bureau of the Census.
Current Population Reports, County Population
Estimates: July 1, 1988, 1987, 1986. Washington, D.C.:
U.S. Department of Commerce, 1989.
9. State Policy Research, Inc. The State Policy Data Book
'88. Alexandria, Virginia: State Policy Research, Inc.,
1988.
10. U.S. Department of Commerce, Bureau of the Census.
State and Metropolitan Area Data Book 1986. Washington,
D.C.: U.S. Department of Commerce, 1986.
11. U.S. Department of Commerce, Bureau of the Census.
Census of Population. Vol. 1. Chapter C. General Social
and Economic Characteristics. Washington, D.C.: U.S.
Department of Commerce, 1983.
12. U.S. Department of Commerce, Bureau of the Census.
Census of Population. Vol. 1. Chapter A. Number of
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