文章基本信息

标题：The Unique Authority of State and Local Health Departments to Address Obesity
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作者：Jennifer L. Pomeranz
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：7
页码：1192-1197
DOI：10.2105/AJPH.2010.300023
语种：English
出版社：American Public Health Association
摘要：The United States has 51 state health departments and thousands of local health agencies. Their size, structure, and authority differ, but they all possess unique abilities to address obesity. Because they are responsible for public health, they can take various steps themselves and can coordinate efforts with other agencies to further health in all policy domains. I describe the value of health agencies' rule-making authority and clarify this process through 2 case studies involving menu-labeling regulations. I detail rule-making procedures and examine the legal and practical limitations on agency activity. Health departments have many options to effect change in the incidence of obesity but need the support of other government entities and officials. STATES AND LOCALES ARE often innovators in creating and implementing public health policy. They can respond to local concerns and consider issues and costs that directly affect their specific interests.¹ The public health and financial toll of obesity is a burden in every state.^{2 – 4} Annual obesity-attributable medical expenditures range from $87 million to $7.7 billion per state, with approximately half of those expenditures financed by Medicare and Medicaid.⁵ If the government assumes responsibility for addressing this public health issue, action at multiple levels and across disciplines is required. In certain venues officials have a limited view of what state health agencies can do to address obesity⁶; however, more than 90% of these agencies report that they are responsible for obesity prevention.⁷ The United States has 51 state health departments (including the District of Columbia's) and approximately 2800 local health agencies.^{7 , 8} The majority of states also have local health agencies. Depending on the state's structure, local agencies’ authority may flow through the state health department or be granted independently.⁷ Their size, structure, and authority differ, but all were created by a legislative grant and share the common goal of promoting and protecting health within their communities. Health departments traditionally work in concert with other agencies and nongovernmental organizations. Approximately half of the state health agencies have a significant source of authority that allows them to enact rules and regulations to further their public health missions,⁷ and 73% of local health departments report using this authority to adopt public health regulations.⁸ This rule-making authority stems from laws passed to advance public health in specific ways. I explore the actions that are available to health departments through their authority over public health and their ability to coordinate across agencies to bring health concerns into other policy domains. I assess the value of agency rule-making authority, the legal and practical constraints on departments’ ability to use this authority, and the legal procedure of rulemaking through 2 case studies of successful menu-labeling regulations developed and carried out by a state and a local health department. Although health departments have the ability to effect change in the incidence of obesity, they need motivated leaders and the support of other government entities or officials to successfully address this public health problem.