STATE RESPONSIBILITY FOR HEALTH PROTECTION

A very large part of the duty of health protection must, however, remain with the states.  Every state has its department of health, headed by a state board of health, or a commissioner of health, or both.  These departments differ greatly in their organization and in the extent and effectiveness of their work.

NEW YORK STATE ORGANIZATION

One of the best organized state departments of health is that of New York.  Among its most important features are (1) a public health council which has power to establish a state-wide sanitary code; (2) the concentration of all administrative power in the hands of a single state commissioner of health, who has a staff of experts to direct special lines of health work; and (3) a well-organized scheme of cooperation between the state department and local health authorities.

LOCAL ORGANIZATION FOR HEALTH PROTECTION

The absence or weakness of local organization for health protection has been one of the obstacles to progress in physical well-being in the United States.  Driven by an appalling death rate and frequent epidemics, our large cities have developed health departments which in many cases have proved very effective.  But in smaller communities, while health departments or health officers usually exist, the organization has for the most part been very ineffective.  The people themselves have not been sufficiently aroused to their needs and to methods of meeting them.  New York and Massachusetts are among the most progressive states in this matter.  Each local community in these states (town, village, or small city) has its board of health and health officer; but these communities are grouped into health districts (8 in Massachusetts, 20 in New York), each district being in charge of a health officer appointed by the state commissioner or board of health.  In New York the district health officer, who is there called the sanitary supervisor, has the following duties: 

To keep informed regarding the work of each local health officer within his sanitary district.

To aid the local health officers in making health surveys of the community under their control.

To aid each local health officer in the performance of his duties, particularly on the appearance of contagious diseases.

To hold conferences of local health officers.

To study the causes of excessive death rates.

To promote efficient registration of births and deaths.

To inspect all labor camps and to enforce in them all public health regulations.

To inspect Indian reservations and to enforce all provisions of the sanitary code in them.