摘要：Objectives. We assessed the structure and functions of state health departments throughout the United States and compared our findings with those from a previous national assessment conducted in 1990. Methods. In 2001, we sent a survey to the state health officers of all 50 states. The survey asked about the structure and functions of the state health agency. Results. The survey was completed by state health officers from 47 states (a 94% response rate). More than half of the states responding had a freestanding state public health agency and a state board or council of health. Forty-four percent had a regional or district structure. Although some traditional public health functions have been curtailed, important new public health functions have emerged since 1990. Conclusions. Our current findings confirm core changes in the structure and functions of state public health systems over the past decade and emphasize the need for more research into these systems to maximize their organizational performance. After the terrorist attacks of September 11, 2001, the nation experienced a renewed recognition of its dependency on the public health system. Although dramatic investments in the form of Congressional appropriations have been made since 2001 to enhance the capacity of federal, state, and local public health agencies to respond to terrorist threats, relatively little was known about the baseline structure and functions of these same agencies. In addition to the threat of terrorism, state health departments face numerous public health challenges. A strong infrastructure is required to perform the 10 essential public health services identified by US public health officials in 1994 and described elsewhere 1 , 2 and to protect the public from environmental toxins, influenza, chronic diseases, and unacceptable rates of infant mortality. Moreover, if they are to be responsive, state health agencies must be able to provide the core functions of public health: assessment, policy development, and assurance across the domains of health protection and health promotion activities. 1 , 3 Although investigators have examined local health departments’ performance of critical public health activities 4 – 15 and various aspects of state-level public health agencies, 13 , 16 – 22 these studies have been limited in scope. None have assessed state health department structure or functions from a comprehensive vantage point. The most recent comprehensive, nationwide examination of state health department structure and functions, compiled by the Centers for Disease Control and Prevention (CDC), was conducted in 1990. 3 Because much has changed since 1990, we surveyed state health officials (SHOs) in 2001 to gain a better understanding of state health departments’ structure and functions.
