Attempts by one local health department to provide only essential public health services: a 10-year retrospective case study.

BACKGROUND

Because of local political circumstances, in 1996, the local public health department in Amarillo, Texas, divested itself of almost all personal health services and chose to retain only essential population-based public health services.

METHODS

We analyzed function, funding, and staffing for various health department activities in FY 1997 and again in FY 2007. The figures were adjusted for inflation and population growth. We interviewed key personnel about the motivation and effects of the changes that occurred with this 10-year period.

RESULTS

The local health department both transferred and reassumed some personal health services during this period. This was primarily in the area of immunization services and care for special population such as refugees. Public health preparedness also became a significant new area of activity. Most personal health services provided by the health department before 1996 remained the function of other health care entities in the community. When adjusted for inflation and population growth, most of the growth in the health department's personnel and budget was the result of state and federally mandated program changes.

CONCLUSIONS

Growth in this local health department, which was committed to provide only essential health services, was driven primarily by state and federally mandated programs. Real growth for essential public health services did not occur over a 10-year period.