The US Public Health System and Ethics

The public health enterprise is responsible for the protection and promotion of population health across the United States. Approximately 2,800 local health departments join state and territorial health agencies, federal agencies, and other government organizations in constituting the core of the governmental public health system in the United States. Spending on governmental public health accounts for less than 3 percent of the nation’s multi-trillion-dollar health budget. Yet it is responsible for health improvement, infectious disease control, pandemic planning, chronic disease control, environmental health, maternal and child health, and more. This chapter reviews the genesis and structure of the public health system. It examines the implications of that organizational structure for the many and varied ethical considerations that arise in the practice of public health.