The Intergovernmental Relationship Among Public Health Care Agencies


The level of influence and participation of inter-governmental agencies in the collective efforts of public health care varies profoundly with the level of the agency in question. The amount of liability and responsibility assumed by each of the agencies depends heavily on the per-capita expenditures as well as the organizational structure that the agency allocates to the maintenance and provision of public health care. Public health is a matter of public interest and the responsibility to secure effective and efficient health care services is a collective responsibility and should be borne by all agencies of government collectively and individually (Wall 1998, p. 88). There should be in existence a smooth flow of duties and responsibilities among these agencies to create a stable and sustainable health care sector. I shall interrogate in this essay the relationship among the three main government agencies as far as public health care is concerned.

The Federal Level

Historically the federal government has maintained a rather distant role in the management and control of public health care affairs. The influence of the federal government has remained at the policy level through the various legislative instruments that have been suggested and put forward to promote and improve public health services. The earliest trace of the federal government participation is in the former marine hospital service now re-branded to the United States public health service. This agency was vested with the responsibility of offering health care services to aliens as well as engaging in medical research for the advancement and improvement of health care standards.

The role of the federal government in health care has however grown over the past few decades. This has been characterized by the formation of more federal agencies whose objective is the maintenance of acceptable public health standards and measures. These agencies including the center for disease control as well as the national institute of health bear the objective and goal of prevention management and research into the elimination of public healthcare concerns. The federal government’s role in the public health sector has tremendously increased with the amount of funding from the federal government invested in public health-related agencies increasing every year.

The federal legal regime has also played an important role in motivating the involvement of the federal government in public health-related efforts. The national health planning and resource development act for instance offer a platform for the development and increase in the number of health care facilities and services.

The federal involvement in public healthcare-related initiatives has blended in with the local and state-level initiatives towards the same cause. The federal government has adopted a strategy that provides funding and aid to a cluster of related programs that support and enhance public healthcare. By so doing the local and state level agencies also receive funding for their public health initiatives. Health care blocks such as the mental and child health block grant, the family planning block as well as the health services block have allowed the various participant agencies to receive funding from the federal government (Scutchfield & Keck 2003, p.79).

The federal government maintains an influence in the local and state-level health care agenda mainly through funding and taxation. The annual budget allocated to specific health care initiatives at the state and local level determines the amount of activity and involvement of the federal agencies in these activities. The federal government proceeds to set standards and requirements that are to be met by states and localities that seek funding for their health care activities. This ensures that states are motivated to meet the basic minimum healthcare requirements to receive federal funding. Taxation on the other hand is used to discourage private activities that may go contrary to public health. It is also used to encourage and motivate and encourage pro-public health activities. For instance, it imposes high taxation on harmful products such as beer and cigarettes to discourage the continued use of such products.


The responsibility for public health has been predominantly left to state-level agencies. The historical participation of these agencies in public health affairs has been of great importance in the campaign for a better and more effective public health system (Scutchfield & Keck, 2003, p.123). This responsibility has been associated with the state’s proximity to the people enabling them to understand and effectively handle the people’s health care needs and preferences. In the same measure, the number size and capacity of state-level health care agencies varied greatly in the structure of organization per-capita expenditure and relationships with other agencies.

The state-level health care agencies have a greater responsibility in the enforcement implementation and regulation of healthcare-related initiatives. They have a responsibility to maintain health care information through recording and issuing certified copies of documents of identity such as birth and death certificates (Wall, 1998, p.90). The information gathered from these records should be analyzed and made public alongside other statistical investigation information. The information should be accurately gathered and analyzed to allow for individual problem identification. They are also under a responsibility to protect, detect and prevent disease and disability. This should be done through screening immunization counseling and testing of members of the population. This allows the health agencies to control regulate and manage the spread of these diseases.

The state also has a responsibility to maintain a healthy environment for the population. This is through inspection treatment and licensing of the various health-related resources such as water laboratories and medical personnel. The structure and organization of state-level health organizations fall in line with the federal structure (Olsen et al., 2007, p. 235). The state-level organizations are therefore below the federal-level organizations and agencies in the hierarchy and structure. Federal agencies are therefore considered as umbrella bodies. The state structure is divided into boards and committees with specific interests in the health system. Boards are vested with the authority to make a review and amend health-related policies and procedures. They monitor the applicability and relevance of the legal regime. The various agencies at the state level have a well-defined management structure that allows them to actively engage the local and federal agencies. They, therefore, play a managerial role over the local level agencies but report to the federal level agencies.


The objective of the local level health agencies like all others is to maintain protect and promote the health status of the people within its territory. They play an on-the-ground role in delivering the actual personalized health care service to the local community. The federal-level agencies have a rather complex structure that may not necessarily present the individual with actual realistic access to the health care service. The local level agencies are government agents in the localities of towns and cities. They, therefore, have a lesser mandate and serve a lesser population. The amount of expenditure attributed to their activities is therefore much lesser than the federal and state-level agencies. The greatest responsibility in public health care is borne by the local agencies. They, therefore, derive their authority from the state health department and will therefore vary depending on the structure of public health administration in the state in question (Gordon Et al 1981, p.64).


The relationship between the various intergovernmental agencies in the public health sector is a hierarchical one. This allows for a smooth and consistent flow of information authority and funding among the various agencies. They all seek to achieve common objectives that are to monitor the health status of the people and identify any pertinent problems, diagnose and investigate health concerns and hazards, create awareness on health-related issues, mobilize funding through partnerships into the health sector, and develop appropriate policy and legislative regime to regulate public health and safety. The current public health system is rather centralized and bureaucratic. It, therefore, suffers the procedural problems of bureaucracy that reduce the effectiveness and efficiency of the various public health agencies and departments. It has also created a dependency of state agencies on federal agencies in the same way the local agencies depend on the state agencies. This increases the effectiveness of any changes in the federal and state-level governance and administration hence affecting the perpetual nature of the public health sector. It is therefore important that the health agencies undergo a restructuring process that will allow for a more decentralized system orientation.


Gordon, H. Et al. (1981). The Program Implications of Administrative Relationships between Local Health Departments and State and Local Government”. AJPH Vol. 71, No. 10.

Olsen A.L. et al. (2007). The learning healthcare system: workshop summary. NY: Routledge Inc.

Scutchfield, F. D., & Keck, C. W. (2003). Principles of public health practice (2nd ed.). New York: Thomson Delmar Learning.

Wall, S. (1998). Transformations in Public Health Systems. Health Affairs ~ Volume 17, Number 3.