Comparing public health systems in six states in the southeast region of the US to contribute to infrastructure development and systems change

In this study we compared state and local public health (PH) systems in six states in the southeast region of the US (AL, FL, GA, NC, SC, TN) to contribute to a better understanding of infrastructure development and systems change. Leadership structure of each state, PH responsibilities, population and demographics of each state/region, types of public health data collected, and health status indicators are some examples of the information used in the comparison. Many specific variables were examined such as whether the state has a board of health and/or local boards of health, funding mechanisms, if there are multi-county health departments, districts, or regions, and who is responsible for running them, if the public health leader of the state is a cabinet level position, and what state agency was responsible for environmental regulation and control. Information was gathered using multiple sources such as the statutes of each state, state public health websites, and repeat in-depth interviews with the communications department of each state to verify information collected and get further clarification as needed. We discovered that there are relationships and agreements among PH entities in some states that are not necessarily reflected in formal written policy. These relationships affect how public health is administered and how resources are shared. The different organizational structures of states were not linked to health outcomes. Local public health was primarily organized around county governance in these southeastern states. Many states did not appear to prioritize accreditation of public health departments with some notable exceptions such as NC. The legal structures that permit and encourage multiple county health departments (NC and GA) may be particularly important for small and/or rural counties to be able deliver all essential health services that will be assessed for accreditation.