INCREASING LOCAL PUBLIC HEALTH EMERGENCY PREPAREDNESS CAPACITY BY BUILDING FROM WITHIN THE CURRENT INFRASTRUCTURE

Abstract

State and local public health departments are losing the ability to respond to and protect the community from public health threats. Increase to public health funding follows after an identified threat because current capacity cannot absorb a new mission. Given the decrease in federal funding and subsequent loss of response capacity, how can local public health reconfigure its organizational structure or find alternate sources of funding to maintain or increase current response capacity? This thesis traces the growth of public health from a single program to today’s U.S. Department of Health and Human Services supporting state and local health departments through federal grant funds. Using case studies and comparing federal grant awards to the structures of state and local departments, this thesis reveals how reliance on federal funding affects the organization of public health. The research demonstrates the direct correlation between the current structure and a century of funding one program per threat. Reliance on federal grants imperils the United States public health system because state and local departments must reorganize in order to sustain ongoing public health missions. The conclusion includes four recommendations that may improve the overall public health network by modifying funding to a more inclusive process, changing the type of federal grants, restructuring to support larger domains, and increasing state and local budgets to support response capacity.