摘要：We sought to document the structure and functions of state public health agencies throughout the United States in 2007 and compare findings with those from a similar 2001 assessment. In 2007 a survey of the structure and functions of state public health agencies was sent to and completed by senior deputies in all 50 states and the District of Columbia (a 100% response rate). The results of the survey showed that all emerging practice areas in 2001 had expanded by 2007. Also, state health departments generally had greater levels of responsibility in 2007 than they did in 2001, emphasizing the need for continued support of governmental public health systems and research on the operations of those systems. The need to understand our public health infrastructure is greater now than ever before. Since the events of September 11, 2001, and the subsequent anthrax attacks, national attention has been focused on governmental public health capacity and capability. An unrelenting series of sentinel events—Hurricane Katrina, the childhood obesity epidemic, H1N1 outbreaks, and the worst economic crisis since the Great Depression—has not allowed that scrutiny to diminish. Health transformation through health reform will move us closer to providing comprehensive and affordable health insurance coverage for all Americans. Even if universal health insurance coverage were achieved, the governmental public health system would still play a critical role in ensuring access to high-quality, reliable preventive services. Gaps in care will still remain, especially for the chronically ill and other vulnerable populations; these will add a greater burden to the already overburdened public health system. The role of public health in advocating for system improvements has expanded as a result of the current resource constraints and will increase as a consequence of health reform, with public health increasingly taking the community lead in efforts to ensure a coordinated health safety net. Emphasis on health department standards and performance is increasing. National performance standards have been developed for state and local health departments, and accreditation is in the final developmental stage. 1 , 2 In addition, widespread interest in performance improvement exists among health departments nationally, as evidenced by the 16 states participating in the Multistate Learning Collaborative, an accreditation initiative funded by the Robert Wood Johnson Foundation. 3 Quality improvement guidelines in the context of public health practice have been specifically defined. 4 Despite these advances, limited research has concentrated on descriptive elements of the entire public health enterprise, particularly at the state level. A more complete understanding of state health departments is a necessary precursor before full implementation of system-wide strengthening of governmental public health can be successfully undertaken. The American Public Health Association (APHA) Committee on Administrative Practices attempted to describe state public health practice in its early work before 1935. 5 In 1953, APHA put forward a policy statement regarding state health department services and responsibilities. 6 The statement noted how a state health department should be organized, defined major departmental units, and described 3 general categories of activities: personal health services, community health services, and administrative services. This description of the structure, organization, and services of a state health department was expressed by “the group judgment of a responsible committee whose members have been drawn from various areas of the continent.” 6 (p235) Although state-level public health agencies have been researched since that time, few of these studies have assessed state health department structure and functions comprehensively. 7 – 12 The most recent comprehensive examination of the functional roles and responsibilities of state public health agencies (SPHAs) was conducted in 2001, 13 before the terrorist attacks of September 11. Much has changed since that time, and these changes demonstrate the need for a strengthened public health infrastructure to perform essential public health services. 14 We surveyed SPHAs in 2007 and compared results with those from the 2001 study in an effort to provide an enhanced understanding of the structure and functions of these agencies.
