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State Health Department Structure and Pandemic Planning

Klaiman, Tamar PhD, MPH; Ibrahim, Jennifer K. PhD, MPH

Journal of Public Health Management and Practice: March-April 2010 - Volume 16 - Issue 2 - p e1–e7
doi: 10.1097/PHH.0b013e3181b83475

Pandemic influenza is an imminent threat, with the April/May 2009 A(H1N1) outbreak as a testament to the potential for rapid transmission and spread of a novel influenza strain. Research has shown that there are great disparities in state pandemic planning; however, little work has been done to assess how health department structure impacts pandemic preparedness. The purpose of this article was to examine the impact of state health department structure on state pandemic influenza plan integration of federal recommendations. The study consisted of a cross-sectional analysis of 41 states and found that structural and strategy-making variables have the greatest impact on pandemic plan inclusion of federal recommendations. Strong, multilayered health department hierarchies and the tenure of senior staff are negatively associated with preparedness, whereas professionalization is positively associated with pandemic plan comprehensiveness. State health departments can take minimally invasive steps to increase their effectiveness in pandemic preparedness by reducing layers of bureaucracy and increasing training for staff.

The purpose of this study was to evaluate the impact of state health department structure on the effectiveness of state pandemic influenza planning as measured by integration of CDC recommendations in written plans.

Tamar Klaiman, PhD, MPH, is Research Assistant Professor, Department of Health Systems Administration, and Postdoctoral feliow, O'Neill Institute for National and Global Health Law, Georgetown University, Washington, District of Columbia.

Jennifer K. Ibrahim, PhD, MPH, is Assistant Professor, Department of Public Health, Temple University, Philadelphia, Pennsylvania.

Corresponding Author: Tamar Klaiman, PhD, MPH, Department of Health Systems Administration, O'Neill Institute for National and Global Health Law, Georgetown University, 3700 Reservoir Rd, NW, Washington, DC 20057 (

Partial support was provided by the Robert Wood Johnson Foundation through the University of Kentucky's Assuring the Future of Public Health Systems and Services Research Award.

© 2010 Lippincott Williams & Wilkins, Inc.