America's public health system (PHS) is the largest in the world. It is directed by the assistant secretary for health, a position appointed by the President and confirmed by the Senate. The secretary's efforts are assisted by the surgeon general of the Public Health Service. As a system, the PHS has several duties and responsibilities. According to the United States Department of Health and Human Services (1994), the major responsibilities and duties of the system are:
(1) To conduct and support biomedical, behavioral and health services research.
(2) To communicate the results of the system's research to health professionals and to the public.
(3) To help in providing health care and related services to medically underserved populations (e.g. migrant workers, the mentally ill, substance abusers, underpriveledged ethnic groups, etc.)
(4) To prevent and control disease.
(5) To identify health hazards in the environment and take steps to correct them once identified.
(6) To promote healthy lifestyles for the nation's citizens.
(7) To ensure that drugs and medical devices are safe and effective.
(8) To ensure that food is safe and wholesome.
(9) To ensure that cosmetics are harmless.
(10) To ensure that electronic products do not expose users to dangerous amounts of radiation.
(11) To work with other nations and international agencies on global health problems and their solutions.
Turnock, Handler, Potsic, Nalluri and Vaughn (1994) state that the responsibilities and duties of the PHS can be categorized as three basic functions. These are the functions of assessment, policy development, and assurance. The authors further state that these functions are fulfilled, at the federal level, through mandated state services. These services are then filtered down by the state to their local health departments.
In an effort to determine how well these local health departments are meeting these bas...