Quickening change, in the American social scene, in public expectations, in technology, and in myriad other influences affecting the public's health, confronts state health departments with a host of challenges.
Government's Responsibility for Health
Government holds ultimate accountability for the nation's health.
State Responsibility in Public Health
The state's basic legal authority in matters of health derives from the sovereign powers reserved to the states under the United States Constitution.
APHA recommends that each state organize, finance, and staff its own health department to the end that state departments of health will possess not only the statutory authority they need, but will enjoy as well the authority of recognized competence for fulfilling their growing complex roles in securing the public health.
Organization of Health Services
The rising proliferation of health programs outside established health agencies poses a clear challenge.
APHA recommends that the state health department assume the leadership in a multiagency framework of health services that can offer guidance to colleague agencies in the administration of their health services and that will coordinate the efforts of all agencies.
Coordination of Health-Related Programs
The state health department can promote statewide plans, objectives, and programs that will provide maximum health benefit at both the state and local level.
In recent years, each state health department has found it necessary to expand its day-by-day working relationships at local, state, and national levels.
The state health department must develop close working relationships with the governor's office and with legislative bodies in order to obtain both the legal basis and the funds necessary for carrying out its responsibilities.
State Professional Associations and Voluntary Agencies
The continuing importance of voluntary health and welfare agencies to the whole public health movement points up the necessity for good communications between these groups and the state health department.
State and Local Health Relationships
The Association supports a division of responsibilities between state and local health agencies under which the state agency is responsible for setting statewide health policy and standards, while most of the actual health services are provided locally.
Federal government has made funds available to the states to stimulate new activities and help maintain existing programs.
Voluntary and Professional Organizations
National organizations offer special opportunities for professional development, especially in the field of public health.
The Consumers of Health Services
As state health departments move forward to meet the new health needs created by the increasingly complex structure of our society, it becomes evident that more direct participation of the public is essential in the shaping of programs and policies.
Partnership for Health and Comprehensive Health Planning
The "partnership for health" evisioned in P.L. 89-749 provides a sound basis for strengthening the capacity of the states to deal autonomously and constructively with their own health needs.
Functions of the State Health Department
The state health department's mission to advance community health is carried forward through four basic functions: (1) health surveillance, planning, and program development; (2) promotion of local health coverage; (3) setting and enforcement of standards; and (4) providing health services.
- Health Surveillance, Planning, and Program Development In developing and promoting health programs, the state health department must engage in a continuing agency program-planning process based upon its own continuing surveillance and appraisal of health problems, needs, and resources, and relate these to the comprehensive health plan of the state.(a) Areawide Planning by CommunitiesThe state health department has a basic responsibility to assist communities to initiate and conduct areawide, comprehensive health-planning programs.(b) Financial Aid and Consultation.The state health department provides leadership and encouragement to local communities in the allocation of state aid and federal grants-in-aid for health programs.
- Promotion of Local Health Coverage Local health programs receiving state aid should meet minimum criteria set by the state health agency.When it is developing its policies and programs, the state health department should be guided by the recognized need to assure all persons in all areas of the state ready access to organized health services. The state health department has a continuing responsibility to furnish local services or aid the local development of health services and otherwise assure their availability.
- Setting and Enforcement of Standards.A good public health structure rests on legally enforceable, basic health standards.
State Certification for Federal Programs
Increasingly, state health departments are called on to certify services and facilities for participation in federal medical care programs.
Major State Health Department Services
The functions described above pertain to six major health program areas:
- Personal health services
- Control of the environment
- Professional education
- Public health education
- Administration, while not a health program area in itself, is essential to the effectiveness of a health agency, and is best considered under this heading.
- Providing Health Services: The state health department's responsibility for personal health services is to insure that standards of care and completeness of service are adequate to the personal health needs of the citizens in every part of the state.
- Control of the Environment: The state's obligation to maintain a wholesome living environment devolves largely upon the state health department.
- Research: Another tangible expression of state leadership is the encouragement and support of research on methods of quality control and improvement.
- Education of the Public: A vigorous state health information and education program is essential both because state government is closer to the people than is federal government and because it has more resources than local government.
- Education of the Health Professions: Education of state health department personnel takes two essential directions—formal professional education and inservice training.
- Administrative Services: The successful execution of health programs demands the highest standards of administrative and management performance. Health department staff should be appointed from among well-qualified candidates.
The major organizational units of a state health agency might be determined on the basis of such characteristics as program responsibility, technical competence or discipline, geographic responsibility, client group characteristics, or a combination of these factors.
State and Local AdministrationThe director of community health services must be a deputy state health officer of a higher echelon than program directors, since many of his functions involve supervision and coordination of program activities.
No single statement can provide a detailed blueprint for the structure and operation of state health departments in 50 states. The forces pressuring for diversity from state to state are manyfold and infinitely complex.
A common cycle occurs in all human efforts made to solve social problems; identifying a problem, determining resources available, developing solutions, evaluating results, and returning again to problem identification. It is the hope of the Association that this document will assist the state health departments as they traverse this continuing cycle in the field of public health.
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