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, divesteditself of almost all personal health services and chose to retainonly essential population-based public health services.Methods: We analyzed function, funding, and staffing forvarious health department activities in FY 1997 and again in FY2007. The figures were adjusted for inflation and populationgrowth. We interviewed key personnel about the motivation andeffects of the changes that occurred with this 10-year period.Results: The local health department both transferred andreassumed some personal health services during this period.This was primarily in the area of immunization services and carefor special population such as refugees. Public healthpreparedness also became a significant new area of activity.Most personal health services provided by the health departmentbefore 1996 remained the function of other health care entitiesin the community. When adjusted for inflation and populationgrowth, most of the growth in the health department’s personneland budget was the result of state and federally mandatedprogram changes. Conclusions: Growth in this local healthdepartment, which was committed to provide only essentialhealth services, was driven primarily by state and federallymandated programs. Real growth for essential public healthservices did not occur over a 10-year period.

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