Explain the roles of local health agencies and health services.

Local health departments (LHDs) have a fundamental and complex role as the front line for delivery of basic public health services to most of the communities in this country. There are nearly 3,000 local health departments in the United States, varying dramatically in geographic size, size and nature of population, urban and rural mix, economic circumstances, governmental structure within which they work, and governing organization to which they are accountable. The majority of local health departments provide a wide variety of services to very diverse communities with limited resources and too few staff (the median size is 14 full-time equivalents). Although local public health services are often discussed within the framework of the 10 Essential Public Health Services, the services actually provided vary widely from state to state, from urban to rural areas, and are especially adapted to address local priorities and concerns. Despite considerable variation, however, more than two-thirds of local health departments provide the following core services: adult and childhood immunizations; communicable disease control; community outreach and education; epidemiology and surveillance; environmental health regulation such as food safety services and restaurant inspections; and tuberculosis testing

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