This doesn't cover everything, but does provide an outline of how funding & structures work with each other.
We've seen this in how the pandemic has played out. Local factors, local leadership has mattered so so much in this.
Wonder how flu shots are free/low-cost? PH $$ at work!
This is where the bulk of CDC funding goes because the US has a decentralized PH system.
LHJs take care of local needs, with assistance from state & feds, if requested.
Fargo (no offense) might have a multi-yr gonorrhea outbreak that requires $$$ spent on screening/testing/treatment to end, while while Atlanta might have a short-term Legionnaires outbreak that needs fewer $.
Each LHJ gets CDC (& other federal funding) to collect, monitor, and analyze health data (aka surveillance). The state often acts as a conduit for fed $$.
Surveillance data like new HIV infections in adults & # of babies born with birth defects, allows LHJs to understand the scope of a PH problem.
PH Surveillance=core function of an LHJ!
Develop programs & services to improve or prevent the PH problem!
e.g., Food fortification of staples (like flour) with vitamins & nutrients (iron, zinc) helps to prevent birth defects & anemia in pregnant people.
Labs, private doctors & other healthcare facilities report these to LHJ ➡️State➡️ CDC.
There's a whole list, enjoy: wwwn.cdc.gov/nndss/conditio…
So why are we all up in arms about CDC's role in this pandemic so far?
Bulk of CDC efforts are focused on evaluating & applying science at the frontline by funding local (county, state, territory) programs including providing policies & guidelines.
CDC has politically appointed directors.
As an agency within a (political) cabinet department, it's subject to the whims of the Chief Executive.
Satcher, Sencer, Foege & @DrTomFrieden have had significant civil service + credibility & influenced with some success.
CDC staff=excellent. 💯
What happens when LHJs don't have guidance they can trust from CDC?
LHJs get funding for specific disease work from CDC/federal agencies but it is meant to *supplement* state funding.
Since 2009, spending at state & LHJs have ⬇️ 16% & 18%, respectively!!
We saw this play out re: schools this week. Media focused on the language on the landing page, which was 👎🏾.
Meanwhile local school systems had to rely on their LHJs to help them figure out what to do. The effect? Confusion & debate about whether reopening is safe.
Short answer: where there is significant community transmission (large swathes of the US) reopening is not advised.
Most parts of the US are experiencing significant delays in test results (because no supplies, lol), which makes contact tracing difficult (if not near impossible to do).