State and local health departments fulfill important governmental roles for protecting and assuring the health of the public. Health departments have a well-established, yet complex and slowly evolving, history in the United States. According to the Institute of Medicine's book The Future of Public Health (1988):
New ideas about causes of disease and about social responsibility stimulated the development of public health agencies and institutions. As environmental and social causes of diseases were identified, social action appeared to be an effective way to control diseases. When health was no longer simply an individual responsibility, it became necessary to form public boards, agencies, and institutions to protect thehealth of citizens. Sanitary and social reform provided the basis for the formation of public health organizations (p.62).
Baltimore, Maryland, established the first city health department in 1798. In general, city health departments were established before state health departments, and well before county health departments. State health agencies developed first in Massachusetts and then across the country during the latter half of the nineteenth century. As American ambivalence about government gave way to a desire for the benefits that local government intervention could provide to the public through sanitation and control of communicable disease, several more health departments were formed in the first half of the twentieth century. In 1953, Joseph Mountin reported that there were 1,239 local health departments in the United States. By 2000, there were state health agencies in every state, and approximately 2,832 local health departments nationwide. The state health departments, and many of the local health departments, were developed and have evolved independently. As a result, health departments vary considerably from state to state and from community to community in their organizational structure, responsibilities, funding mechanisms, performance of core services and competencies, and in the implications for agency accreditation and workforce certification.
THOMAS L. MILNE, CAROL K. BROWN, The Gale Group Inc., Macmillan Reference USA, New York,