The governmental public health system has changed since the attacks of September 11, 2001. To better understand state health department roles and responsibilities in order to strengthen them, these researchers compared a survey of state public health agencies (SPHAs) done in 2001 (before September) to one done is 2007 by the Association of State and Territorial Health Officials. In the first survey, 94 percent of senior representatives responded, compared to 100 percent in the later survey.
- The structure of SPHAs—freestanding/independent or a component of an umbrella or super agency—did not change.
- Responsibilities of SPHAs increased 10 percent or more in the areas of minority health, correctional health, disability determination, health planning and mental health.
- More states performed services directly than contracted them out.
- Emerging areas of practice included bioterrorism preparedness, institutional review boards, perinatal epidemiology, toxicology, tobacco control and prevention, and violence prevention.
- Quality improvement processes were in place in more states (29 versus 42).
SPHAs continually adjust to changing needs and take on greater responsibilities despite the fact that federal funding has remained flat or down in inflation-adjusted dollars.