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Bioterror Focus Changing Public Health Systems

EVERY U.S. STATE has an agency that handles public health, but how the public health apparatus functions from state to state diverges widely. Some agencies are freestanding, others are part of a larger health and human services department. The way they deal with local health agencies varies as well: some states centralize control over local health agencies, others grant local agencies wide latitude in operations, and still other states fall somewhere in between. The services provided by these agencies are also all over the map.

Does the structure matter? Not really, say researchers at the RAND Corporation who recently examined “whether there is a link between how state and local public health departments are organized and the level of their emergency preparedness.”

Along the way toward answering that question the researchers discovered some other interesting facts related to agency organization, which they lay out in a “technical report” called Organizing State and Local Health Departments for Public Health Preparedness.

One finding is that the infusion of emergency response funds for bioterrorism has outpaced agencies’ ability to use these funds effectively, necessitating restructuring of health departments to accommodate this new priority.

Another finding is that the new attention on emergency response has increased tensions among health agencies, as some critics complain that the “focus on preparedness has diverted needed staff and other resources away from traditional public health activities.”

The paper documents findings and observations on other subjects, such as barriers to improving preparedness, facilitators of organizational change, and private sector approaches.