Local Responsibility for Health Service

for many governmental services, notably health protection, and the confusion, overlapping, and inefficiency of units of local government serving very small areas or population groups has yet to be resolved. Fifteen years ago the Social Science Research Committee of the University of Chicago discovered that more than seventeen hundred different governmental jurisdictions were involved to some degree in the administration of public health in the Chicago region-the area within a fiftymile radius of the center of Chicago.' More than three hundred cities, towns, villages, townships, and counties were providing direct local health protection in the sixteen counties, or parts of counties, in Illinois, Indiana, Michigan, and Wisconsin that comprise the Chicago region. Although the wastefulness and ineffectiveness of such administrative machinery were fully detailed in this study, conditions today remain substantially unchanged, except that two of the Illinois counties, with their contained villages, towns, and townships, have each formed a county health unit, thus reducing the jurisdictions providing direct service by a substantial number. Such organization was made possible by a permissive health unit act passed by the Illinois legislature in 1943. The same scattering of responsibility and the resulting unproductive use of financial resources for health service exist in nearly every state in the union. For example, each of Minnesota's more than twenty-seven

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