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 Public Health, Volume Three, provides the most current data on state health agency services and activities.

Collaboration and TrainingState health agencies enjoy a high level of collaboration with local health departments, the healthcare sector, other state health agencies, and other partners. State health agencies often provide technical assistance to their partners on different topics. The greatest percentage of states provide technical assistance on quality improvement, performance, and accreditation.

State health agencies also provide training to local health department personnel, on topics including disease prevention and control (94% of state health agencies), tobacco (92%), preparedness (89%), and maternal and child health (89%).

Federal InitiativesState 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 typically share it with another state health agency, a local governmental agency, or a nonprofit organization. The five federal initiatives for which the most state health agencies report having responsibility are the Public Health Emergency Preparedness cooperative agreement (100%), 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 Response) (96%).

Access to CareEnsuring access to high quality, affordable healthcare is a key responsibility for state health agencies. The majority of state health agencies engage in activities to promote access to healthcare within their jurisdictions, particularly health disparities and minority health initiatives (94%) and rural health (72%). Additionally, the majority of state health agencies report providing financial support to primary care providers through state-sponsored loan repayment programs. These programs are intended to increase the supply of providers within a state’s jurisdiction.

I s s u e B r I e f

State Health Agency Activities

State-Sponsored Loan Repayment Programs to Increase the Supply of Providers, 2012 (n=47)

Phys

icia

ns

Den

tists

Mid

-leve

l pr

ovid

ers

Nur

ses

Oth

er p

rimar

y ca

re p

rovi

ders

70%

55%

38% 36%

23%

Primary Prevention, Treatment, and ScreeningState health agencies provide a number of services related to population-based primary prevention, screening, and treatment of diseases and conditions.

Population-Based Primary Prevention ServicesThe primary prevention services provided by the most state health agencies are tobacco (87%), HIV (85%), sexually transmitted disease counseling and partner notifi-cation (85%), nutrition (79%), and physical activity (77%).

ImmunizationsMore than 90 percent of state health agencies directly perform vaccine order management and inventory distribution for childhood immunizations, and more than 80 percent are responsible for vaccine order management and inventory distribution for adult immunizations. In contrast, only approximately one-quarter perform order management for interna-tional travel immunizations directly. Less than half of state health agencies directly administer childhood and adult vaccines, and less than one-quarter directly administer international travel vaccines.

Screening and TreatmentIn addition to population-based primary prevention services, state health agencies perform screening and treatment for a variety of diseases and conditions. The three diseases and conditions screened for directly by the most state health agencies are STDs other than HIV/AIDS (65%), HIV/AIDS (63%), and newborn screening (63%).

The greatest percentage of state health agencies provide treatment services for tuberculosis (54%), STDs other than HIV/AIDS (50%), and HIV/AIDS (30%).

Surveillance, Data Collection, and Laboratory ActivitiesState health agencies perform a variety of surveillance, data collection, and laboratory activities. The three laboratory services provided by the greatest number of state health agencies are bioterror agent testing (96%), foodborne illness testing (94%), and influenza typing (94%).

Most state health agencies perform the majority of data collection, epidemiology, and surveillance activities listed in the Profile Survey, with 100 percent directly performing reportable disease data collection,

2010 2012

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

17%25%

17%

Col

on/re

ctum

can

cer

46%

25%

Brea

st a

nd

cerv

ical

can

cer

23%17%

Car

diov

ascu

lar

dise

ase

Pred

iabe

tes

13% 15%

Ast

hma

8%13%

Oth

er c

ance

rs

21% 23%

Oth

er

56%

65%

Oth

er S

TDs

New

born

scr

eeni

ngs

69%63%

Tub

ercu

losi

s

58%56%

Bloo

d le

ad

31%

42%

Body

mas

s in

dex

29% 27%

Hig

h bl

ood

pres

sure

23%

Perc

enta

ge o

f sta

tes

Note: Body mass index and prediabetes only appeared on the 2012 Profile Survey.

Dia

bete

s

29% 27%

HIV

/AID

S

60%63%

epidemiology, and surveillance activities and 98 percent performing communicable/infectious disease, foodborne illness, and vital statistics activities in 2012, as indicated in the corresponding figure.

Regulation, Inspection, and LicensingState 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 medical services (79%). The 15 regulatory activities performed by the most state health agencies are displayed in the related figure.

State health agencies are also involved in the oversight of professional licensure for a variety of different healthcare providers. Just under one-quarter of state health agencies are involved in the licensure of dentists, nurses, physicians, physician assistants, and pharmacists.

Environmental HealthHuman health is inextricably linked to the environments in which we live. As such, state health agencies serve as key players in environmental health. The five environ-mental health activities performed by the greatest percentage of state health agencies are environmental epidemiology (94%), food safety training and education (83%), radiation control (69%), toxicology (69%), and indoor air quality (65%).

Other Public Health ActivitiesState health agencies also perform a range of services not typically considered traditional public health activities. The six such activities performed by the most state health agencies are trauma system coordination (88%), veterinarian services (81%), state health planning and development (77%), healthcare consultations for childcare environments (69%), institutional review boards (63%), and nonclinical services in correctional facilities (63%).

Health Insurance ExchangesState health agencies were asked whether or not their state was currently establishing a health insurance exchange. Of the 48 states that responded to this question, more than half indicated that they are. Among the 28 states that are establishing exchanges, 20 (71%) of state health agencies report being engaged in the process of establishing the health insurance exchange in their state.

Additional InformationFor additional information on state health agency activities, including maternal and child health services, other clinical services provided by state health agencies, and registry maintenance, as well as a variety of other data, please refer to the ASTHO Profile of State Public Health, Volume Three, available at www.astho.org/profile. The Profile is the only comprehensive source of information about state public health agency activities, structure, and resources. Launched in 2007 and fielded 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, and contribute to the development of best practices in governmental public health.

Recommended citation: Association of State and Territorial Health Officials. ASTHO Profile of State Public Health, Volume Three. Washington, DC: Association of State and Territorial Health Officials. 2014.

Establishment of Health Insurance Exchanges by States in 2012 (n=48)

Yes 58% No 42%

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

Top 15 Regulation, Inspection, and Licensing Activities Performed Directly by State Health Agencies, 2010-2012 (n=47)

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

Perc

enta

ge o

f sta

tes

2010 2012

89%

75%

83%79%

70%66%

62%

72%75%

64%70%

49%53%

62% 64%

89%

81% 81% 81% 79% 77%72% 70% 70%

64% 62% 60% 60%57% 55%

Labo

rato

ries

Food

ser

vice

est

ablis

hmen

ts

Hos

pita

ls

Trau

ma

syst

em

Emer

genc

y m

edic

al s

ervi

ces

Lead

insp

ectio

n

Publ

ic s

wim

min

g po

ols

Long

-ter

m-c

are

faci

litie

s

Nur

sing

hom

es

Body

pie

rcei

ng

and

tatt

ooin

g

Hos

pice

Cam

pgro

unds

/RV

s

Food

pro

cess

ing

Ass

iste

d liv

ing

Smok

e-fr

ee o

rdin

ance

s

Perc

enta

ge o

f sta

tes

2010 2012

Repo

rtab

le d

isea

ses

Com

mun

icab

le/

infe

ctio

us d

isea

ses

Food

born

e ill

ness

Vita

l sta

tistic

s

Mor

bidi

ty d

ata

Perin

atal

eve

nts

or

risk

fact

ors

Beha

vior

al r

isk

fact

ors

Chr

onic

dis

ease

s

Synd

rom

ic s

urve

illan

ce

Envi

ronm

enta

l hea

lth

Inju

ry

Can

cer

inci

denc

e

Ado

lesc

ent

beha

vior

Uni

nsur

ed, o

utre

ach,

an

d en

rollm

ent

for

med

ical

insu

ranc

e

96%100%

96% 98%92%

98% 96% 98%92% 94% 94% 94% 96% 94% 94% 94%

79%

94%88% 88%

92% 92% 94%90%

77% 77%

52%

44%