Separation and Integration in Public Health : Evidence from Organizational Structure in the States

Numerous recent studies contend that public health agencies in the U.S. are in a state of turmoil because their organizational form causes them to take on conflicting mandates. One reason is the tradeoff in design between creating stand-alone agencies for health and environment, and creating super agencies that combine the two. Using data on the organizational form of state health and environmental agencies, we assess the choice of organizational form as a problem of institutional design and employ statistical models intended to uncover the roots of these choices. Our results suggest that historical development and latent community factors can help explain the choice of combined or independent agencies. We believe that this case provides useful information about the roots of organizational design for resolving competing demands, and provides insight into concerns about the delivery of health and environmental protection in the states