Primary health care centers have been proposed to meet the health care needs of rural America.

A typology of organizational arrangements between state and local public health agencies was used as a framework within which the organizational environment of the local health department was studied for its effects on program development and implementation by local public health departments. Data collected in a national sample of local health officers were used in measuring the effect of four different patterns of administrative relationships on the selected characteristics of local health department programs. Important differences were observed among the four organizational types with regard to constraints on programs and program priorities, and health officers' perceptions of the primary functions of local health departments and sources of local health department funding.In 1974, a group of researchers at the University of North Carolina surveyed the nation's local health officers. This survey compiled one of the few known sets of data within recent history on the organization, financing, functions, and staffing at local health departments as well as important personal and professional characteristics of local health officers. ' It now appears that the United States is entering a period of great change in the financing and organization of its public health system. The Reagan Administration has proposed that large block grants replace the present system of local and state health agencies appear to have on local health department program planning and development. These data provide a baseline from which to consider the possible impact of recent federal budgetary and health program policy development on the current patterns of intergovernmental relationships between local health departments and state and local governments and the consequences of these relationships for the funding and operation of local health department programs.

In 1974 a questionnaire was mailed to the nation's local health officers. Responses were received from 1,345, at least 68 per cent of all local health departments. The present paper presents selected summary data from respondents concerning the health departments, their jurisdictions, organization, finance, functions, staffing, and about the training, salaries, and other characteristics of local health officers.Health departments are extensively involved in rendering health services, including direct personal Current data about local health departments are not readily available. In 1966 a survey questionnaire was conducted of all local health units, and from that survey a report on their medical care activities was published in 1968.1 The Department of Health, Education, and Welfare once maintained a registry of local health departments but this was abandoned after 1971.Interest in the real or potential roles for local health departments has increased. Published reports have emphasized the importance of local governments and their health departments with regard to health planning, monitoring and regulation of health services, provision of personal health care, maintenance of community health services, and other functions.2-6 These reports with few exceptions have focused on policy analysis that has not benefited from up-to-date data on the actual structure and function of local health departments. MethodIn 1973 a group of investigators associated with the University of North Carolina developed plans for a study of lo- Addressees: For purposes of addressing and mailing the questionnaires, the rosters that were provided by the state health departments were used. The rosters presented difficulties in several states where many hundreds of "local health officers" were listed. Further inquiry revealed that the title "local health officer" in these states was conferred on physicians in private practice as well as non-professional persons in order to honor their functions in reporting vital statistics. The titles in these instances have nothing to do with authority over an administrative or service unit that is traditionally regarded as a local health department. In states where the number of local health officers exceeded 200 a spe-*Available on request to authors.

The design of a comprehensive evaluation of subsidized rural primary care programs on a large national scale is described. Its major purpose is to derive data whose analysis will answer major policy questions about the factors influencing the outcome of the major types of such programs in different communities. This first paper also delineates a typology whichIn the 1960s, the long recognized problem of making good quality personal health services available to people in rural areas was given greatly increased attention in the United States. For many years prior to this, various measures to correct this persistent deficiency had been tried by rural people themselves, by agencies such as governments at local, state, and national levels, and by local and national foundations. Few of these efforts seemed to provide satisfactory solutions. During the 1970s, growing concern about this problem led to greatly expanded and strengthened efforts and some new approaches which included the requirement that subsidized primary care projects adopt specific programmatic goals and particular methods of organization, staffing, and operation.Toward the end of the 1970s, national economic constraints produced increasing competition for the public dollar, thus heightening an interest in comprehensive evaluation studies that might lead to policy changes for future sup-

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