THE ROLE OF STATE HEALTH DEPARTMENTS IN FORMULATING POLICY - A SURVEYON THE CASE OF AIDS

Objectives. Public health departments have been criticized for not bei ng on the cutting edge of health policy formation in the United States and, in particular, for being ineffective in dealing with acquired im munodeficiency syndrome (AIDS). This study examines the attitudes and influence of public health officials on this problem. Methods. A surve y of state health department officials was supplemented by surveys of state legislature health committee chairs and hospital association dir ectors, as well as by interviews with key AIDS policymakers and observ ers in six states. Results. Both in their own eyes and in the eyes of legislative leaders and hospital association officials, public health officials were considered to be the principal initiators of public pol icy on AIDS. Conclusions. Contrary to the Institute of Medicine's 1988 report, state health departments are leaders in the fight against AID S at the state level. Moreover, we argue that public health department s should be judged on how effectively they perform functions for which they have primary legal responsibilities, not for other roles for whi ch they have been given neither responsibility nor resources.