Skip to main content
Medicine LibreTexts

2.2: How Public Health Is Organized

  1. Last updated
  2. Save as PDF
  • Page ID
    116086

    • \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)

    \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)

    \( \newcommand{\dsum}{\displaystyle\sum\limits} \)

    \( \newcommand{\dint}{\displaystyle\int\limits} \)

    \( \newcommand{\dlim}{\displaystyle\lim\limits} \)

    \( \newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\)

    ( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\)

    \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)

    \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\)

    \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)

    \( \newcommand{\Span}{\mathrm{span}}\)

    \( \newcommand{\id}{\mathrm{id}}\)

    \( \newcommand{\Span}{\mathrm{span}}\)

    \( \newcommand{\kernel}{\mathrm{null}\,}\)

    \( \newcommand{\range}{\mathrm{range}\,}\)

    \( \newcommand{\RealPart}{\mathrm{Re}}\)

    \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\)

    \( \newcommand{\Argument}{\mathrm{Arg}}\)

    \( \newcommand{\norm}[1]{\| #1 \|}\)

    \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\)

    \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\AA}{\unicode[.8,0]{x212B}}\)

    \( \newcommand{\vectorA}[1]{\vec{#1}}      % arrow\)

    \( \newcommand{\vectorAt}[1]{\vec{\text{#1}}}      % arrow\)

    \( \newcommand{\vectorB}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)

    \( \newcommand{\vectorC}[1]{\textbf{#1}} \)

    \( \newcommand{\vectorD}[1]{\overrightarrow{#1}} \)

    \( \newcommand{\vectorDt}[1]{\overrightarrow{\text{#1}}} \)

    \( \newcommand{\vectE}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{\mathbf {#1}}}} \)

    \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \)

    \(\newcommand{\longvect}{\overrightarrow}\)

    \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)

    \(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)

    Public health is a part of our government at all levels in the US. In addition, large nongovernmental agencies and smaller nonprofit organizations also play a significant role in public health.

    Public health in the US is a highly decentralized system. While federal agencies offer guidelines, research, and funding that empowers public health efforts at the states, and some key processes (like the approval of new pharmaceuticals by the FDA) are centralized within specific agencies, for the most part, public health mandates and rules are issued at the state level. Therefore, different states may have different mandates or standards, regarding public health, and they may promote quite distinct approaches to public health challenges.

    There are both pros and cons to having a decentralized public health system.

    • On one hand, the variety of approaches across states can lead to innovations and can respond to local needs and conditions. Where decentralized public health units (for example, state health departments in the Northeast of the US, or provincial health departments in Canada) have a long tradition of collaboration, they may be able to mount a response to a health threat more quickly than a centralized power, especially if that central government is hesitant to act for political reasons. Also, having a strong, decentralized network of local providers can provide a nimble response in a crisis, for example, quickly distributing vaccines to those who need them.
    • On the other hand, a more unified response would sometimes be more effective. Decentralized units may have difficulty working together or may compete for resources (as various states competed for access to ventilators early in the covid pandemic). Their collaboration and data sharing may be purely voluntary. There can be repetition of efforts -- for example, translating health information or developing tests for a certain disease -- that would be more efficient if done in a centralized way. Where a central health agency takes an evidence-based approach to public health, uniform guidelines or programs can benefit the public more quickly.

    Given the decentralized nature of public health in the US and internationally, it is helpful to understand the roles played by major public health organizations. Public health organizations are often grouped into five major buckets:

    • International -- intergovernmental organizations like the World Health Organization (WHO)
    • Federal -- national organizations like the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC)
    • State -- state health departments (in all 50 states plus similar organizations in US territories like Puerto Rico and Guam)
    • Local (city, county, or region within a state) -- local health departments
    • Nongovernmental agencies -- large quasi-governmental organizations like the Red Cross, in particular, but also small local nonprofits

    At each level, a variety of different professions work together in public health -- epidemiologists, doctors, nurses, health educators, lab scientists, outreach workers, and more.

    This page offers a general overview of key agencies at these different levels. More specific information is contained in pages below.

    International

    At the international level, the World Health Organization or WHO is the world's public health agency. WHO tracks health data, develops policies and programs, and assists national public health organizations in responding to epidemics and other health crises. WHO membership includes 194 nation-states plus two associated semi-states, Puerto Rico and Tokelau. The WHO (like UNICEF and UNDP) is part of the UN structure. WHO works with world governments and also builds partnership agreements to work with non-governmental organizations (NGO's).

    UNICEF (focused on children), UNFPA (focused on family planning), UNDP (focused on development) and other agencies that operate under the UN or regional entities (like the Pan American Health Organization, PAHO) also do a great deal for public health.

    Federal

    At the national level (federal), we have the U.S. Department of Health and Human Services (HHS) as the central coordinating body for health. Most of the centers traditionally housed under HHS relate to public and community health -- for example, consider the Indian Health Service, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Food & Drug Administration (FDA), the National Institute for Occupational Safety and Health (NIOSH), and the research-oriented National Institutes of Health (NIH). These big federal agencies support research and policy development, and they monitor health trends. A few also provide healthcare directly -- for example, the Indian Health Service and the Veterans Administration. Others administer the funding for healthcare, like the Centers for Medicare and Medicaid Services (CMMS) and the Health Resources & Services Administration (HRSA).

    Of all of these centers, the one most directly charged with protecting the public's health has been the Centers for Disease Control & Prevention or CDC, our nation's primary public health institution. The CDC monitors the health of the nation (as well as international health trends) and publishes health statistics. It is a great source for general health information, as well examples of public health campaigns and priorities. They develop and disseminate model programs and policies for local health departments to adapt. The mission of the CDC is to protect the public from public health threats, promote health and to respond to any health threats that arise, from a flu epidemic to bioterrorism.

    Mission of the CDC:

    • CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.
    • CDC increases the health security of our nation. As the nation’s health protection agency, CDC saves lives and protects people from health threats. To accomplish our mission, CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these arise.

    In 2025, the federal public health and healthcare systems are currently being reorganized. As this chapter is being written (April 2025), HHS is being overhauled, and some of the leading federal agencies in public health (including the CDC, SAMHSA, NIOSH, and others) are being eliminated or fundamentally changed. See 2.2.2: 2025 Reorganization of HHS for more discussion of the vision and impacts of this reorganization.

    State

    At the state level, each state has at least one agency that focuses on health. In California, we have the Health and Human Services Agency taking the lead on health policy and enforcement. Within that agency, there are many departments: Department of Public Health, Department of Health Services, Department of Aging, etc. Local public health agencies often receive funding and mandates from the state Department of Public Health, while public hospitals might work more closely with the Department of Health Services or in the case of state-run hospitals, the Department of State Hospitals.

    California's Department of Public Health supports local health departments by providing model programs, funding, data, research, and other services to support local health efforts.

    Local

    Each local area in the US also has a health department. A local area is usually defined as a city, a county, or a group of counties. The San Francisco Department of Public Health is our local agency.

    Each place in the US organizes their public health departments a little differently. In some states, mental health and physical health are under the same public health department. In other states, they are separate. In some counties, the same thing - some combine mental health with physical health, and some separate it out to a different agency. Some public health departments just focus on prevention and policy, while others also run the local hospital and clinic system. There is a lot of variety, place to place.

    Example:

    • The San Francisco Department of Public Health is responsible for running a network of clinics, the big General Hospital, and a big public skilled-nursing facility called Laguna Honda. It also runs prevention programs (everything from encouraging exercise to reducing violence) and develops public policies and guidelines. Community Behavioral Health Services - working on mental health and substance abuse issues - is part of the San Francisco Department of Public Health. SF DPH is one big department, working on many facets of health.
    • In contrast, the Alameda County Public Health Department across the Bay has a more limited mission. It does not run the clinics or the hospitals - a separate Health Services agency does that. It does not run the mental health or substance abuse services - the county Department of Mental Health does that. So the Alameda County Public Health Department focuses mainly on community education, mobilization, environmental health measures, monitoring health and other prevention efforts.

    References

    Alameda County Department of Public Health. (n.d.). About Alameda County Public Health Department. https://acphd.org/about/

    California Department of Public Health (n.d.). Abouut us. https://www.cdph.ca.gov/Pages/About.aspx

    Centers for Disease Control and Prevention. (n.d.). About CDC. https://www.cdc.gov/about/cdc/index.html

    Exemplar News. (2022, March 14). COVID fueled debate over centralized vs. decentralized health systems: The Director of the International Health Systems Program of the Harvard T. H. Chan School of Public Health, Thomas J. Bossert, reflects on the benefits of both systems during the pandemic. https://www.exemplars.health/stories...er-centralized

    San Francisco Public Health Department. (n.d.). About the Departmentt of Public Health. https://www.sf.gov/departments--depa...-health--about

    U.S. Department of Health and Human Services. (n.d.). About HHS. https://www.hhs.gov/about/index.html

    World Health Organization. (n.d.). About WHO. https://www.who.int/about

    This page titled 2.2: How Public Health Is Organized is shared under a CC BY-NC-SA 4.0 license and was authored, remixed, and/or curated by Janey Skinner.