All local public health agencies (LPHAs*), as governmental entities, derive their authority and

responsibility from the state and local laws that govern them. Accordingly, all LPHAs exist

for the common good and are responsible for demonstrating strong leadership in the

promotion of social, economic and environmental conditions that improve health and wellbeing

and prevent illness, disease and injury. However, in the absence of specific,

consistent standards regarding how LPHAs fulfill this responsibility, the degree to which the

public’s health is protected and improved varies widely from community to community.

This definition is composed of standards, framed around the nationally-recognized Ten

Essential Public Health Services, that describe what every person, regardless of where they

live, should reasonably expect their LPHA to meet. The standards provide a framework by

which LPHAs are accountable to the public they serve and to the governing bodies (e.g.,

local boards of health) to which they report. In meeting the standards, it is imperative that

LPHAs operate according to the highest level of professionalism and ethics to inspire public

confidence and trust.

The capacity and the authority of the governmental public health presence at the local level

vary widely, and as a result, how LPHAs perform public health functions to meet the

standards will also vary. For example, with respect to capacity, the LPHA may perform all of

the functions on its own; it may call upon the state to provide assistance for some functions;

it may develop arrangements with other organizations in the community or with neighboring

LPHAs to perform some functions; or it may control the means by which other organizations

perform some functions. With respect to authority, sometimes other governmental entities

perform some public health functions (e.g., environmental health). In these instances, the

LPHA continues to have a leadership role in meeting the standards associated with the

functions: the LPHA informs and influences the other governmental efforts, identifies any

shortcomings in meeting the associated standards, and leads efforts to fill in gaps.

Regardless of the capacity and specific authority of the LPHA in any community, however,

their responsibility to lead governmental public health in meeting the standards is constant.

The standards are intended to provide consistency with respect to the fundamental functions

performed by LPHAs, but the structural characteristics of LPHAs (e.g., governance, staffing

patterns, size of the population served, etc.) will continue to vary, and each LPHA may be

required to perform functions unique to meeting the public health needs of the community it

serves. Finally, embedded throughout the definition are ways in which the LPHA works with

other members of the local public health system (comprising all those entities that contribute

to the public’s health, e.g., public and private health care providers, community

organizations, schools, media, and businesses). LPHAs are the natural leaders in the

development of a cohesive local public health system, working at times as leader, convener,

partner, collaborator, enabler, or evaluator.

*For the purposes of this definition, an LPHA is defined as the governmental public health presence at

the local level. It may be a locally-governed health department; a branch of the state health

department; a state-created district or region; a department governed by and serving a multi-county

area; or any other arrangement that has governmental authority and is responsible for public health

functions at the local level.