Ensuring an adequate local public health infrastructure requires maintaining the basic capacities essential to the proper functioning of the public health system, such as data analysis and use; health planning; develop partnerships and mobilize the community; policy development, analysis and decision support; Communication; and public health research, evaluation and quality improvement. Shattuck`s report was widely circulated after its release, but due to political turmoil at the time of publication, nothing was done. The report „fell flat from the printer`s hand.“ In the years following the civil war, however, the creation of dedicated agencies became a more common method of dealing with societal problems. Massachusetts created a state health department in 1869. The creation of this body reflected a tendency to strengthen government rather than new knowledge about the causes and control of disease. Nevertheless, the type of data collected by Shattuck was used to justify the advice. And the council built on many of the recommendations in Shattuck`s report on designing a public health system. (Rosenkrantz, 1972; Hanlon and Pickett, 1984) Although Shattuck`s report was largely ignored at the time of its publication, it is considered one of the most far-sighted and influential documents in the history of the American public health system. Many of the principles and activities he proposed were subsequently considered fundamental to public health. And Shattuck established the fundamental utility of keeping important records and statistics. Public health agencies and institutions began at the local and state levels in the United States. Federal health care activities were limited to the Marine Hospital Service, a system of public hospitals for the care of merchant seamen. Since merchant seamen did not have local citizenship, the federal government assumed responsibility for their health care.

A National Board of Health to take over the functions of the Marine Hospital Service was adopted in 1879, but against the Marine Hospital Service and many southern states, the board existed only until 1883 (Anderson, 1985). (Hanlon & Pickett, 1984) 2. Organize knowledge of the problem, its natural course of history and its consequences. The following chapter, which summarizes the current public health system in the United States and public health activities in six states visited by the Committee, illustrates the diversity of public health approaches that have evolved over the course of the current system. The Minnesota Health Commissioner has general authority to develop and maintain an organized system of programs and services to protect, maintain, and enhance the health of citizens (Minn. Stat. § 144.05). These programs and services include, but are not limited to, maternal and child health, environmental health, public health emergency preparedness, disease prevention, control and epidemiology, public health administration, healthy communities and behaviours, licensing and inspection, and access to health care. In the United States, public health surveillance systems are established in the exercise of state policing powers.

These government systems are designed for the reporting of diseases and conditions of public health interest by health professionals and laboratories. All states have laws and regulations requiring the reporting of a list of diseases and conditions, as well as the timing and type of information to be reported and penalties for non-compliance with reporting laws (7). Mandatory disease reporting varies considerably from state to state and territory to territory. Some states have general laws authorizing the health commissioner or state health authorities to establish, monitor, and revise the list of notifiable diseases and conditions (8). Some states require reporting under Department of Health laws and regulations (9). Various professionals and organizational units, including physicians and other health care providers, diagnostic laboratories, clinical facilities, schools, and daycares, may require reports (7,10,11). Before conducting epidemiological field investigations, auditors should be aware of certain legal issues related to the collection, analysis and dissemination of data that their investigative work may entail. Important issues to consider include that public health is one of the most important things a government can invest in. Early prevention, which is relatively inexpensive, can prevent serious and costly health problems later in life.

The identification of bacteria and the development of interventions such as immunization and water purification techniques have provided a means to control the spread of disease and even prevent disease. The germ theory of the disease has provided a solid scientific basis for public health. Public health action continued to focus primarily on certain communicable diseases, but the means of controlling these diseases changed dramatically. Laboratory research has identified the exact causes and specific prevention strategies for certain diseases. For the first time, it was known that diseases had individual and specific causes. Science has also shown that the environment and humans can be pathogens. During this period, the public bodies that had been established to implement and enforce hygiene measures refined their activities and expanded to include laboratory science and epidemiology. Public responsibility for health encompasses both environmental and individual health. Despite the great successes achieved through scientific discoveries and social reforms, and despite phenomenal growth in government activities in the health sector, the resolution of public health problems has not been without controversy.

The role of government in regulating individual behaviour has been repeatedly questioned. For example, as early as 1853 the British Health Board was dissolved because Chadwick, its director, „claimed wide latitude for government intervention at a time when laissez-faire was the doctrine of the time.“ (Chave, 1984) The relationship between public health and private medical practice was also the subject of much discussion. In 1920, the New York Medical Society vehemently opposed and successfully rejected a proposal for a system of public rural clinics across the state. (Starr, 1982) Discussions on the scope of public health and the extent of public sector responsibility for health continue to this day. Although science laid the foundation for public health, social values shaped the system. The task of the Department of Health was not only to define the goals of the health system based on facts about disease and health, but also to find ways to implement health goals within a social structure. „The boundaries of public health have changed over time with the perception of new social and health issues and with political, economic and ideological changes within government and nation.“ (Royalty, 1987) The history of public health has been about identifying health problems, developing the knowledge and expertise to solve problems, and garnering political and social support for solutions. Public health is population-centred. While local health services and community health services provide services to individuals, the goal of a population-based approach is very different from that of a patient- or client-centred approach that responds to an individual`s needs or concerns. Because public health activities are based on community needs, resources, funding and support, services vary from one local health service to another. MDH also has staff in seven county offices who support local (and other) health departments with respect to epidemiological investigations and consultations, emergency preparedness, environmental health, public and non-public water supply, maternal and child health, public health care and public health practice, among other areas.