Centralized Versus Decentralized Public Health Infrastructure in the Us - Stronger Together

With public health infrastructure improvements underway in the US strategies on how to best execute these improvements vary due to the governance structures at the state and local level. This study reviewed the literature to understand the strengths and weaknesses of centralized and decentralized governance frameworks. Understanding the strengths and weaknesses allows infrastructure improvement strategies to effectively deploy modernization, data integration, and data standardization practices. Incorporating data from the last 15 years, the study investigated both US and international governance structures to uncover best practices to further benefit the local and state governance structures in the US. In addition to capturing the current strengths and weaknesses this review also seeks to identify barriers the different governance structures may encounter while implementing the infrastructure improvement plans. The number of resources, both in terms of staff and funding, being dedicated to these initiatives underscores the importance of tailoring the initiatives to the strengths and weaknesses of the governance structures. A hybridized approach to public health infrastructure investments may maximize the strengths of both governance structures while minimizing their weaknesses.