The organizational landscape of the American public health system

Public health is practiced in the United States through the collective actions of governmental and private organizations that vary widely in their resources, missions, and operations.1-3 Governmental public health agencies play central roles in these delivery systems, but most of them rely heavily on their ability to inform, influence, communicate, and collaborate with numerous external organizations that contribute to public health services.4 The range of organizations involved in public health delivery and the division of responsibility between governmental and private organizations vary widely across communities.5-7 Within the governmental sector, public health agencies differ in their statutorily defined powers and duties and in the extent to which these powers are exercised at the state level versus delegated to the local level.8.