Objectives: We assessed the structure and functions of state health departments throughout the United States and compared our findings with those from a previous national assessment conducted in 1990.

Methods: In 2001, we sent a survey to the state health officers of all 50 states. The survey asked about the structure and functions of the state health agency.

Results: The survey was completed by state health officers from 47 states (a 94% response rate). More than half of the states responding had a freestanding state public health agency and a state board or council of health. Forty-four percent had a regional or district structure. Although some traditional public health functions have been curtailed, important new public health functions have emerged since 1990.

Conclusions: Our current findings confirm core changes in the structure and functions of state public health systems over the past decade and emphasize the need for more research into these systems to maximize their organizational performance.