• Agencies should review the quality of “street-level” contacts between department employees and clients and where necessary conduct in-service training to ensure that members of the public are treated with cordiality and respect.

  • Greater emphasis in public health curricula should be placed on managerial and leadership skills, such as the ability to communicate important agency values to employees and enlist their commitment; to sense and deal with important changes in the environment; to plan, mobilize, and use resources effectively; and to relate the operation of the agency to its larger community role.

  • Demonstrated management competence as well as technical/professional skills should be a requirement for upper-level management posts.

  • Salaries and benefits should be improved for health department managers, especially health officers, and systems should be instituted so that they can carry retirement benefits with them when they move among different levels of jurisdictions of government.

  • The committee recommends that public health professionals place more emphasis on factors that influence health-related behavior and develop comprehensive strategies that take these factors into account.


The committee recommends the following policies with respect to intergovernmental strategies for strengthening the fiscal base of public health:

  • Federal support of state-level health programs should help balance disparities in revenue-generating capacities and encourage state attention to national health objectives. Particular vehicles for such support should include “core” funding with appropriate accountability mechanisms, as well as funds targeted for specific uses.

  • State support of local-level health services should balance local revenue-generating disparity, establish local capacity to provide minimum levels of service, and encourage local attention to state health objectives; support should include “core” funding. State funds could be furnished with strings attached and sanctions available for noncompliance, and/or general support could be provided with appropriate accountability requirements

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