Why does North Carolina have a public health system and local public health agencies?

A North Carolina law describes the purpose and mission of the state’s public health system. The purpose is “to ensure that all citizens in the State have equal access to essential public health services,” and the mission is “to promote and contribute to the highest level of health possible for the people of North Carolina” by:

• identifying and preventing or reducing health risks
• detecting, investigating and preventing the spread of disease
• promoting healthy lifestyles and a safe and healthful environment
• promoting the accessibility and availability of quality health care services in the private sector, and
• providing health care services when they are not otherwise available.[1]

This mission and purpose is consistent with the Institute of Medicine’s 1988 definition of public health as “what we, as a society, do collectively to ensure the conditions in which people can be healthy.”[2] The emphasis this definition places on collective action and the conditions that promote good health reveals a distinction between public health and clinical health care: public health is concerned with the health of populations, not just the health status or condition of a particular individual.

Although the mission and purpose of the public health system is set by the state legislature and extends to all residents, most public health activities and services are carried out locally. Under North Carolina law, the legal responsibility for providing local public health services is given to counties. A county may satisfy this duty by operating a county health department, participating in a multi-county district health department, forming or joining a public health authority, establishing a consolidated human services agency, or contracting with the state to provide public health services.[3]