Health Department Governance

State and Local Health Department Governance Classification Map

Governance Health Structures

Public health governance structures vary from state to state. The relationship between state health agencies and regional/local public health departments also differs across states. These structural differences have important implications for the delivery of essential public health services. Identifying these differences is integral to understanding the roles, responsibilities, and authorities across levels of government for services provided within the community.

Types of governance health structures:

• Centralized or largely centralized structure: Local health units are primarily led by employees of the state
• Decentralized or largely decentralized structure: Local health units are primarily led by employees of local governments.
• Mixed structure: Some local health units are led by employees of the state and some are led by employees of local government. No single structure predominates.
• Shared or largely shared structure: Local health units might be led by employees of the state or by employees of local government. If they are led by state employees, then local government has the authority to make fiscal decisions and/or issue public health orders; if they are led by local employees, then the state has authority.

Source: The ASTHO Profile of State Public Health, Volume Three

State and Local Health Department Sites and Governance

Alabama-Florida

Georgia–Louisiana

Maine–Montana

Nebraska–Pennsylvania

Rhode Island–Wyoming