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Government's responsibility for public health

Areas of public health responsibility
The roles of local, state, and federal governments
Accreditation and national public health standards
Key resources

Public health is one of the greatest things in which a government can invest. Early prevention, which is relatively inexpensive, can prevent dire and expensive health care problems later in life.

Early in their development, both Minnesota and the United States recognized the role of the government in protecting the public's health, and each entity makes reference to this in their constitutions as part of a "general welfare" clause. Public health promotes the welfare of the entire population, ensures its security and protects it from the spread of infectious disease and environmental hazards, and helps to ensure access to safe and quality care to benefit the population.

Governmental responsibilities for public health extend beyond voluntary activities and services to include additional authorities such as quarantine, mandatory immunization laws, and regulatory authorities. The state's partnership functions by encouraging residents to do things that benefit their health (e.g., physical activity) or create conditions to promote good health, and requiring certain actions (e.g., food safety).

Minnesota's areas of public health responsibility within the Local Public Health Act follow. They describe what people in Minnesota should expect to receive from their local health department no matter where they live, and are used by community health boards for assessment and planning purposes.

The areas of public health responsibility include (1) assuring an adequate local public health infrastructure, (2) promoting healthy communities and healthy behaviors, (3) preventing the spread of communicable disease, (4) protecting against environmental health hazards, (5) preparing for and responding to emergencies, and (6) assuring health services. You can find more information on public health activities relating to these areas online.

Assure an adequate local public health infrastructure

Assuring an adequate local public health infrastructure means maintaining the basic capacities foundational to a well-functioning public health system such as data analysis and utilization; health planning; partnership development and community mobilization; policy development, analysis and decision support; communication; and public health research, evaluation and quality improvement.

Promote healthy communities and healthy behavior

Promoting healthy communities and healthy behaviors means activities that improve health in a population, such as investing in healthy families; engaging communities to change policy, systems or environments to promote positive health or prevent adverse health; providing information and education about healthy communities or population health status; and addressing issues of health equity, health disparities, and the social determinants of health.

Prevent the spread of communicable disease

Preventing the spread of infectious disease means preventing diseases that are caused by infectious agents, such as by detecting acute infectious diseases, assuring the reporting of infectious diseases, preventing the transmission of disease, and implementing control measures during infectious disease outbreaks.  

Protect against environmental health hazards

Protecting against environmental health hazards means addressing aspects of the environment that pose risks to human health, such as monitoring air and water quality, developing policies and programs to reduce exposure to environmental health risks and promote healthy environments, and identifying and mitigating environmental risks such as foodborne and waterborne diseases, radiation, occupational health hazards, and public health nuisances.

Prepare and respond to emergencies

Preparing and responding to emergencies means engaging in activities that prepare public health departments to respond to events and incidents and assist communities in recovery, such as providing leadership for public health preparedness activities within a community; developing, exercising and periodically reviewing response plans for public health threats; and developing and maintaining a system of public health workforce readiness, deployment, and response.

Assure health services

Assuring health services means engaging in activities such as assessing the availability of health-related services and health care providers in local communities; identifying gaps and barriers; convening community partners to improve community health systems; and providing services identified as priorities by the local assessment and planning process.

Public health is population-based. Although local health departments and community health boards provide services to individuals, the goal of a population-based approach is very different from that of a patient-based or client-based approach that addresses the needs or concerns of an individual. Since public health activities are based on community needs, resources, funding, and support, services vary among local public health departments.

Minnesota's commissioner of health has the general authority for the development and maintenance of an organized system of programs and services for protecting, maintaining, and improving the health of the citizens (Minn. Stat. § 144.05). Such programs and services are related, but not limited to, maternal/child health, environmental health, public health emergency preparedness, disease prevention, control and epidemiology, public health administration, healthy communities and behaviors, licensing and inspection, and health care access.

The Minnesota Department of Health (MDH) is also responsible for monitoring, detecting, and investigating disease outbreaks; researching causes of illness and operating prevention programs; providing laboratory services; safeguarding the quality of health care, working to contain health care costs and assure that all Minnesotans have access to health care; safeguarding the quality of food, drinking water, and indoor air; developing strategies to improve the health of vulnerable populations; and working to eliminate health disparities.

In partnership with local public health entities, MDH helps with everything from developing guidelines, to providing technical assistance and support, to funneling state and federal funds to community health boards. Its specialists and scientists collect and analyze data that are used for research, resource development, and program development throughout the state. Public health system consultants provide specialized assistance on local and tribal public health to regions around the state.

MDH also has staff in seven district offices that provide assistance to local health departments (and others) regarding epidemiological investigations and consultation, emergency preparedness, environmental health, public and nonpublic water supplies, maternal/child health, public health nursing, and the practice of public health, as well as other areas. The MDH district offices are located in Duluth, St. Cloud, Bemidji, Fergus Falls, Marshall, Mankato, and Rochester.

Federal influences

State and local health departments work with a number of federal agencies, primarily those within the U.S. Department of Health and Human Services. For example, the Centers for Disease Control and Prevention (CDC) leads efforts to control communicable disease outbreaks and promote mass immunization. The federal government also assists states with funding (when state resources are not available) and guidance for work such as emergency preparedness. At both the state and local level, Minnesota relies on these offices for grant funding and expertise.

Related: PHAB standards and measures

In recent years, there has been recognition at the national level of the lack of standardization between health departments, and a need to identify what state and local health departments should do to deliver quality public health programs and services. This led to the development of a set of standards that health departments can put into practice to ensure that they are providing the best services possible to keep their communities safe and healthy.

The Public Health Accreditation Board (PHAB) has developed a national voluntary accreditation program for state, local, territorial, and tribal public health departments. The accreditation process will drive public health departments to continuously improve the quality of the services they deliver to the community, as well as offering the following benefits:

• Accountability and credibility
• Leverage for funding
• Visibility
• Increased efficiency and effectiveness

The State Community Health Services Advisory Committee, or SCHSAC, which is comprised of representatives from across the state, has recommended that Minnesota's local public health annual reporting align with national standards, and that community health boards interested in applying for accreditation will be ready to apply by 2020.

• National public health accreditation for local and tribal public health
• Minnesota Department of Health district office locations
• Public Health Accreditation Board
• Healthy People 2030
• A call to action: Advancing health for all through social and economic change (PDF)
  Minnesota Health Improvement Partnership Social Conditions and Health Action Team
• Making your case (PDF)
  Governor's Council on Developmental Disabilities
• County government essentials: Educational webinar series
  Association of Minnesota Counties

Next: Background on CHS administration