Issue Brief State Health Agency Activities

State health agencies protect and promote the health, well-being, and safety of their citizens. To fulfill this responsibility, they perform a wide range of activities and functions. The ASTHO Profile of State , Volume Three, provides the most current data on state health agency services and activities.

Collaboration and Training Access to Care State health agencies enjoy a high level of collaboration Ensuring access to high quality, affordable healthcare with local health departments, the healthcare sector, is a key responsibility for state health agencies. The other state health agencies, and other partners. State majority of state health agencies engage in activities to health agencies often provide technical assistance promote access to healthcare within their jurisdictions, to their partners on different topics. The greatest particularly health disparities and minority health percentage of states provide technical assistance on initiatives (94%) and rural health (72%). Additionally, quality improvement, performance, and accreditation. the majority of state health agencies report providing financial support to primary care providers through state- State health agencies also provide training to local health sponsored loan repayment programs. These programs department personnel, on topics including disease are intended to increase the supply of providers within a prevention and control (94% of state health agencies), state’s jurisdiction. (92%), preparedness (89%), and maternal and child health (89%). State-Sponsored Loan Repayment Programs to Increase the Supply of Providers, 2012 (n=47) Federal Initiatives State health agencies have primary programmatic and fiscal responsibility for a variety of federal initiatives. When they do not have sole responsibility for an initiative, they 70% typically share it with another state health agency, a local 55% governmental agency, or a nonprofit organization. The five federal initiatives for which the most state health 38% 36% agencies report having responsibility are the Public Health Emergency Preparedness cooperative agreement (100%), 23% Maternal and Child Health/Title V (98%), vital statistics (98%), Preventive Health and Health Services Block Grant

(96%), and the Hospital Preparedness Program cooperative agreement (Assistant Secretary for Preparedness and Nurses Dentists providers Response) (96%). Mid-level Physicians care providers care Other primary Primary Prevention, Treatment, Screening and Treatment and Screening In addition to population-based primary prevention services, state health agencies perform screening and State health agencies provide a number of services treatment for a variety of diseases and conditions. The related to population-based primary prevention, three diseases and conditions screened for directly by the screening, and treatment of diseases and conditions. most state health agencies are STDs other than HIV/AIDS (65%), HIV/AIDS (63%), and newborn screening (63%). Population-Based Primary Prevention Services The primary prevention services provided by the most The greatest percentage of state health agencies provide state health agencies are tobacco (87%), HIV (85%), treatment services for tuberculosis (54%), STDs other than sexually transmitted disease counseling and partner notifi- HIV/AIDS (50%), and HIV/AIDS (30%). cation (85%), nutrition (79%), and physical activity (77%). Surveillance, Data Collection, and Immunizations Laboratory Activities More than 90 percent of state health agencies directly perform vaccine order management and inventory State health agencies perform a variety of surveillance, distribution for childhood immunizations, and more data collection, and laboratory activities. The three than 80 percent are responsible for vaccine order laboratory services provided by the greatest number of management and inventory distribution for adult state health agencies are bioterror agent testing (96%), immunizations. In contrast, only approximately foodborne illness testing (94%), and influenza typing (94%). one-quarter perform order management for interna- tional travel immunizations directly. Less than half of Most state health agencies perform the majority state health agencies directly administer childhood of data collection, , and surveillance and adult vaccines, and less than one-quarter directly activities listed in the Profile Survey, with 100 percent administer international travel vaccines. directly performing reportable disease data collection,

Screenings for Diseases and Conditions Performed by State Health Agences, 2010-2012 (n=48)

2010 2012

69% 65% 63% 63% 60% 56% 56% 58%

46% 42%

31% 29% 29% Percentage of states Percentage 27% 27% 25% 25% 23% 23% 21% 23% 17% 17% 17% 13% 15% 13% 8%

Other Asthma Diabetes HIV/AIDS Breast and Breast Blood lead Other STDs Prediabetes Tuberculosis Other cancers cervical cancer Body mass index Newborn screenings High blood pressure Colon/rectum cancer Colon/rectum Cardiovascular disease Cardiovascular

Note: Body mass index and prediabetes only appeared on the 2012 Profile Survey. epidemiology, and surveillance activities and 98 percent Establishment of Health Insurance Exchanges by States in 2012 performing communicable/infectious disease, foodborne (n=48) illness, and vital statistics activities in 2012, as indicated in the corresponding figure. Yes 58% No 42%

Regulation, Inspection, and Licensing State health agencies serve an important role in enforcing laws and regulations that protect and promote health and ensure safety. The five regulatory activities performed by the greatest percentage of state health agencies in 2012 were regulation, inspection, and licensing of laboratories (89%), food service (81%), hospitals (81%), trauma systems (81%), and emergency Health Insurance Exchanges medical services (79%). The 15 regulatory activities State health agencies were asked whether or not their performed by the most state health agencies are state was currently establishing a health insurance displayed in the related figure. exchange. Of the 48 states that responded to this question, more than half indicated that they are. Among the 28 State health agencies are also involved in the oversight of states that are establishing exchanges, 20 (71%) of state professional licensure for a variety of different healthcare health agencies report being engaged in the process of providers. Just under one-quarter of state health establishing the health insurance exchange in their state. agencies are involved in the licensure of dentists, nurses, physicians, physician assistants, and pharmacists. Additional Information For additional information on state health agency activities, including maternal and child health services, Human health is inextricably linked to the environments other clinical services provided by state health agencies, in which we live. As such, state health agencies serve as and registry maintenance, as well as a variety of other key players in environmental health. The five environ- data, please refer to the ASTHO Profile of State Public activities performed by the greatest Health, Volume Three, available at www.astho.org/ percentage of state health agencies are environmental profile. The Profile is the only comprehensive source of epidemiology (94%), training and education information about state public health agency activities, (83%), radiation control (69%), toxicology (69%), and structure, and resources. Launched in 2007 and fielded indoor air quality (65%). every two to three years, the Profile Survey aims to define the scope of state public health services, identify variations in practice among state health agencies, Other Public Health Activities and contribute to the development of best practices in State health agencies also perform a range of services governmental public health. not typically considered traditional public health activities. The six such activities performed by the most Recommended citation: Association of State and state health agencies are trauma system coordination Territorial Health Officials.ASTHO Profile of State Public (88%), veterinarian services (81%), state health planning Health, Volume Three. , DC: Association of and development (77%), healthcare consultations for State and Territorial Health Officials. 2014. childcare environments (69%), institutional review boards (63%), and nonclinical services in correctional facilities (63%). Top 15 Regulation, Inspection, and Licensing Activities Performed Directly by State Health Agencies, 2010-2012 (n=47)

2010 2012

89%89% 83% 81% 81% 79% 81% 79% 75% 77% 75% 70% 72% 72% 70% 70% 70% 66% 64% 64% 64% 62% 62% 60% 60% 62% 57% 55% 53% 49% Percentage of states Percentage

Hospice Hospitals Laboratories and tattooing Assisted living Body pierceing Body pierceing Trauma system Trauma Nursing homes Lead inspection Campgrounds/RVs Public swimming pools Smoke-free ordinances Smoke-free Long-term-care facilities Long-term-care Emergency medical services Food service establishments

Data Collection, Epidemiology, and Surveillance Activities Performed Directly by State Health Agencies, 2010-2012 (n=48)

2010 2012

100% 96% 98% 98% 98% 96% 96% 94% 94% 94% 96% 94% 94% 94% 94% 94% 92% 92% 92% 92% 90% 88% 88% 79% 77% 77%

52% 44% Percentage of states Percentage

Injury risk factors Vital statistics Morbidity data Communicable/ Chronic diseases Chronic Cancer incidence Foodborne illness medical insurance Perinatal events or infectious diseases and enrollment for and enrollment Reportable diseases Adolescent behavior Uninsured, outreach, outreach, Uninsured, Environmental health Environmental Behavioral risk factors Syndromic surveillance Syndromic

2231 Crystal Drive, Suite 450 | Arlington, VA 22202 | www.astho.org