Chapter 19

If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 19
State or Provincial Health Organizations,
Resources and Services

Table of Contents



REFERENCES - since publication of 8th edition


Midway between global or national health agencies with their highly generalized and centralized plans, and local health agencies with their unique and decentralized plans, lies the state or provincial health agency. In countries like Australia, Canada and the United States with considerable emphasis on states' rights, most policy affecting community and population health is set at the state level. The overall objective of this chapter is to develop an appreciation and understanding of the functions and resources of state or provincial government in supporting community health. 


Chapter 19 focuses on the role of state (or provincial) health agencies in health promotion and disease prevention. State health agencies are described in terms of their legal authority, the nature of their responsibilities and their role in facilitating the implementation of national health policy. Particularly useful to review are the functions of the units of a typical state health department in the United States (or province in Canada).


System in New York for Early Warning of Disease Patterns.  (The New York Times, April 4, 2003) - A statistical program used at the New York City Department of Health and Mental Hygiene has been shown to detect and indicate future increases in health events.  The Syndromic Surveillance System is an early warning system for possible disease outbreaks in the United States.

Massachusetts legislature considers fire-safe cigarette law.  From 1990 to 2000, fires caused by cigarettes have accounted for 195 deaths, 844 civilian injuries, 738 firefighter injuries, and more than $84 million in direct property damage in Massachusetts.  Cigarettes are the leading cause of fire related deaths in the United States. 

E.P.A. Plan to Stern Flow of Smog to East Coast is Upheld by Court. WASHINGTON (New York Times, June 2000). A federal appeals curt has upheld a new air-pollution program meant to drastically reduce smog that flows from the Middle West to East. Although still subject to further appeals, the ruling by the United States Court of Appeals for the District of Columbia Circuit would affect 19 states. It upholds a decision by a three-judge panel of the same tribunal, which held in March, that rules set down by the Environmental Protection Agency in 1998, but stayed a lawsuit, were proper.

State Initiatives Seek Overhaul of Health Care. BOSTON (The New York Times, June 2000). With one final petition drive, a coalition of doctors, nurses, senior citizen groups, labor unions and others is expected to collect the last several thousand signatures they need to place before Massachusetts voters what experts call the most sweeping health-care referendum on any state ballot fall 2000. The referendum would require the Legislature to find a way to provide health insurance coverage for all by mid-2002 in a state where more than 600,000 people lack it.

 Oklahoma Report Details State's Health Status. (The Nation's  Health, May 2000). Oklahoma's overall health status is poor and needs to be improved now so that the state's younger generation has a chance for a healthier future, according to a panel of the state's public health and medical leaders. Oklahoma's State Board of Health released its fourth annual "The State of the State's Health" report in February, determining there are number of critical factors that contribute to Oklahoma's poor health outcomes.

Funding Available for Statewide "Buckle Up America" Campaigns. (The Nations' Health, May, 1999). In cooperation with the National Highway Traffic Safety Administration, APHA is accepting proposals for grants of up to$10,000 each for the state level efforts supporting the "Buckle Up America' campaign. A total of $150,000 will be distributed through APHA to partnership of the state public health associations, medical societies and state highway safety offices, which will work together to advance the goals of the campaign.

Albany Chiefs Want To Spend More To Fight Tobacco Use. NY (NY Times, June 3, 1999, p. A21) Richard Perez-Pena. Legislative leaders in New York called for a major increase in funding for the state's tobacco control programs yesterday, and Governor George Pataki said he would be open to a substantial increase in tobacco control funding. Assembly Speaker Sheldon Silver (D) proposed a $90 million a year program, financed in part by a five-cent cigarette price increase, and 10 percent of the state's tobacco settlement money. Senator Joseph Bruno (R), the majority leader, said that he, too, wanted to see a major increase in the state's tobacco control programs and that a portion of the settlement should be used for "anything having to do with education on the pitfalls of smoking." The state currently spends $8.2 million a year, including Federal grants -- significantly less per capita than a number of other states.

Florida Anti-Smoking Program Forced To Cut Staff. (Julie Hauserman, "Anti-Smoking Program Takes Hit," St. Petersburg Times, June 3, 1999, p. B1) The Florida anti-smoking campaign was forced to eliminate 11 of its 31 staff positions and cut back hours for teens who worked part-time on the program. The 11 employees will be offered other jobs within the Department of Health. The budget for the program was recently cut by the Legislature from $70 million to $32 million. "It's troubling to see a tobacco prevention program that is more effective than any program in the country struggle for its life," said Ralph DeVitto, lobbyist for the American Cancer Society. State officials said the "Truth" ads would still be produced, but they will have less money to work with. The marketing staff was cut from four to two, and the marketing director was let go.

California Assembly Approves Stronger Cigar Warning Labels. (Jennifer Kerr, "Assembly Passes Bill Requiring Cancer Warnings On Boxes," ASSOCIATED PRESS, June 2, 1999). The California State Assembly approved a bill requiring cigar manufacturers and importers to carry new warnings on retail cigar packaging beginning January 1, 2000. One of the three new warnings states: "Warning: Cigars contain many of the same carcinogens found in cigarettes and cigars are not a safe substitute for smoking cigarettes. Quitting smoking now greatly reduces serious risks to your health. This product contains chemicals known to the State of California to cause cancer." Opponents of the bill said it was not needed, because the state already requires warnings indicating that cigars contain carcinogens. The author of the bill, Assemblywoman Carole Migden (D), said, "What we are trying to do is discourage young people from smoking, but what we do (now) is vilify cigarettes and reward cigars." Failure to comply with the new label law would result in a civil fine not to exceed $2,500 a day. The bill will now go to the Senate.

The State Tobacco Settlements Last November, 46 states settled the cases they had filed against the tobacco companies. When the states filed suit against the tobacco companies, elected officials from each of the states said that they were doing so to prevent another generation of children from becoming addicted to tobacco and to reduce the amount of money their citizens were spending to treat tobacco-caused disease.  When the states settled their cases, they promised that the settlement was just the first step in their efforts to reduce tobacco use, particularly among children. Through their Attorneys General, the states pledged that the funds from the settlement created an historic opportunity to use the tobacco companies own money to reduce tobacco use, even though the agreement they had just signed did not dictate how to spend the money.  If current trends continue, the vast majority of the states will spend little or none of the tobacco settlement money on programs intended to prevent children from starting to smoke or on helping current tobacco users to quit. Without the extraordinary efforts of tobacco control advocates and key public officials, the results would be even worse.  To find out more about how your state plans to use the settlement money or for more general information visit:

Overlooked Side Effect in the Sale of Hospitals. (New York Times April 27, 1997). Special foundations that are removed from hospital due to sale leaves many wondering if the foundations are serving the public or themselves.

Auditor Takes Swipe at Health Department. (Globe and Mail October 8, 1997). The Federal health Department is contributing to drug abuse among native Canadians through its fraud-ridden aboriginal health benefits program.

B.C.'s Civic Politicians Back Ban on Public Smoking. (Vancouver Sun October 24, 1997). Civic politicians want province-wide anti-smoking law.

Tight Budgets Force States to Abandon Health Plans.  (New York Times National July 2, 1995.) Some states delay implementing employee health plans due to budget restrictions.



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Public Health Foundation
1220 L Street, NW
Washington, DC 20005
Phone: (202) 898-5600

Represents the Association of State and Territorial Health Officials in compiling and publishing data on state health agencies, issuing newsletter Public Health Macroview 6/ year.

Center for Health Promotion
Program Development Section
Michigan Department of Public Health
PO Box 30035
Lansing, MI 48909
Phone: (517) 335-8376

Publishes data and issue papers on state health problems, needs and strategies, such as Minority Health in Michigan: Closing the Gap; produces video and other media and public health information sources.

Massachusetts Medical Society
C.S.P.O. Box 9120
Waltham, MA 02254-9120

Publishes the Morbidity & Mortality Weekly Report for CDC, with weekly comparisons of state incidence data on reportable diseases and deaths; periodic state comparisons from Behavioral Risk Factor Survey.

National Governors' Association
Hall of the States
444 North Capitol Street
Washington, DC 20001-1572
Phone: (202) 642-5300

Monitors and reports on state Medicaid programs' coverage of low-income pregnant women, children, and families.

Office of the Administrator
Oregon Health Division
PO Box 231
Portland, OR 97207-2731
Phone: (503) 229-5032

For copies of Oregon Health 2000 Project report with health objectives for the state for the year 2000.

New York State Health Department
Office of Health Comm. & Education
Tower Building, Empire State Plaza
Albany, NY 12237
Phone: (518) 474-2029

Publications catalog listing available printed material. Pamphlets for general audiences on health and hygiene; public health and administration; posters and charts can be ordered; catalogs on exhibits, films and professional films.

835 Penobscot Bldg.
645 Griswold St.
Detroit, MI 48226-4094

Medical and Health Information Directory, Vol. 1: Organization, Agencies and Institutions. Anthony T. Kruzas, Kay Gill and Kren Backus, editors. Chapter 6 lists state government agencies and offices concerned with health.

A List of State Immunization Coordinators in the U.S.




Bowen, K. A., Marshall Jr., William, N. Pediatric Death Certification.  Archives Of Pediatrics & Adolescent Medicine.  SEP 01 1998 v 152 n 9: 852-854.

Assessment of Public Health Computer Readiness for 2000 --- United States, 1999. Morbidity and Mortality Weekly Report 48(17), May 7, 1999.


1. The coordination paradox of health promotion today. This box discusses methods for coordinating the delivery of health services and health education to the public. An important factor in coordinating services is to consider the level at which cooperation is to take place: between federal and state agencies, between state agencies and community health centers, between public and private sectors, between university researchers and community health practitioners. Cooperation between the public health sector and other service sectors may be facilitated if agency directors are encouraged to participate in the identification of mutual interests and the setting of realistic priorities. Pick an issue of interest, e.g., alcohol consumption on campus, unintended pregnancy, or HIV/AIDS, and discuss answers to the questions posed in the box relative to this issue.

2. The Ontario Provincial Health Act. The Ontario Provincial Health Act of 1984 is important broadly to health promotion for a number of reasons. First, the emphasis of this legislation is on disease prevention. This represents an innovative shift from use of the medical model of disease to one which recognizes the role lifestyles play in major health problems. This act is an excellent example of the role governments can play in enacting and implementing legislation for the welfare of all citizens. Delineate the differing perspectives inherent in the medical model of disease and the public health model promoting healthful lifestyles.

3. Behind organizational charts. The text makes the point that state and provincial health department organizational charts are deceptive, "giving the illusion that the programs and services are of similar scope." Obtain a copy of the organizational chart and budget for your state or provincial health department. Identify each major division. How does this compare with Figure 19-2 or 19-3? What additional services does your state health department have? What divisions represented in Figures 19-2 and 19-3 are absent from your state health department? B. What division receives the most funds? What division the least? Relative to other divisions, where do health education and health promotion activities rank?

4. Legislative authority. Obtain a copy of your state's constitution. Locate those provisions which legislate health and health services. To what extent is health authority delegated to various health agencies? To which agencies is this authority delegated? To what extent are specific health services mandated by law? Which specific health services are required?

5. Health planning. Contact the state health department or provincial health ministry and request a copy of the health plan. (This may also be available in the library.) What goals are stated? How are they to be achieved? What barriers exist to the attainment of these goals? What conditions exist to enhance goal attainment? 

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