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Attempts by One Local Health Department to Provide Only Essential Public Health Services: A 10-Year Retrospective Case Study

Richardson, J. Matthew DrPH; Pierce, J. Rush Jr MD, MPH; Lackan, Nuha PhD

Journal of Public Health Management & Practice: March/April 2012 - Volume 18 - Issue 2 - p 126–131
doi: 10.1097/PHH.0b013e318223b11e
Research Articles

Background: Because of local political circumstances, in 1996, the local public health department in Amarillo, Texas, divested itself of almost all personal health services and chose to retain only essential population-based public health services.

Methods: We analyzed function, funding, and staffing for various health department activities in FY 1997 and again in FY 2007. The figures were adjusted for inflation and population growth. We interviewed key personnel about the motivation and effects of the changes that occurred with this 10-year period.

Results: The local health department both transferred and reassumed some personal health services during this period. This was primarily in the area of immunization services and care for special population such as refugees. Public health preparedness also became a significant new area of activity. Most personal health services provided by the health department before 1996 remained the function of other health care entities in the community. When adjusted for inflation and population growth, most of the growth in the health department's personnel and budget was the result of state and federally mandated program changes.

Conclusions: Growth in this local health department, which was committed to provide only essential health services, was driven primarily by state and federally mandated programs. Real growth for essential public health services did not occur over a 10-year period.

Because of local political circumstances, in 1996, the local public health department in Amarillo, Texas, divested itself of almost all personal health services and chose to retain only essential population-based public health services. This study analyzes function, funding, and staffing for various health department activities in FY 1997 and again in FY 2007.

Department of Public Health, City of Amarillo, Texas (Dr Richardson); School of Medicine, Health Science Center, University of New Mexico, Albuquerque (Dr Pierce); and Public Health Training Center, Health Management and Policy, School of Public Health, Health Sciences Center, University of North Texas (Dr Lackan).

Correspondence: J. Matthew Richardson, DrPH, Department of Public Health, 1000 Martin Rd, Amarillo, TX 79107 (matt.richardson@amarillo.gov).

This study consisted of a program analysis for staffing, budget, and population estimates; human subjects were not involved and therefore approval by an institutional review board was not necessary.

The authors declare no conflict of interest.

© 2012 Lippincott Williams & Wilkins, Inc.