Health Department Governance

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State and Local Health Department Governance Classification Map

This map shows the United States with each state color-coded to identify which Governance Health Structure they fall under. The Governance Health Structures are identified by seven colors. Gray represents states that have a Decentralized Governance Health Structure. The gray states are California, Oregon, Washington, Idaho, Montana, North Dakota, Minnesota, Wisconsin, Michigan, Ohio, West Virginia, Indiana, Illinois, Iowa, Missouri, Kansas, Nebraska, Colorado, Utah, Arizona, North Carolina, New Jersey, Connecticut, Massachusetts and New York. Dark blue represents states that have a Centralized Governance Health Structure. The dark blue states are New Mexico, Arkansas, Mississippi, South Carolina, District of Columbia, Delaware, Rhode Island and Vermont.Light blue represents states that have a Largely Centralized Governance Health Structure. The light blue states are Louisiana, Alabama, Virginia, New Hampshire and South Dakota. Green represents states that have a Largely Decentralized Governance Health Structure. The green states are Nevada and Texas. Purple represents states that have a Mixed Governance Health Structure. The purple states are Alaska, Wyoming, Oklahoma, Tennessee, Pennsylvania and Maine. Navy blue represents states that have a Shared Governance Health Structure. The navy blue states are Kentucky, Georgia and Florida. Orange represents a Largely Shared Governance Health Structure. The one orange state is Maryland.

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 5

State and Local Health Department Sites and Governance

Alabama-Florida

Georgia–Louisiana

Maine–Montana

Nebraska–Pennsylvania

Rhode Island–Wyoming

 

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