What characterizes centralized public health systems?

• A. Fewer state employees per capita, lower labor expenditures, larger populations, and more local autonomy.
• B. A highly decentralized system with county-level decision-making.
• C. A hybrid model with equal balance of federal and local control.
• D. More state employees per capita, higher labor expenditures, smaller populations, and less local autonomy.

Answer: (D)

Centralized public health systems concentrate authority and resources at the state level, so the state maintains a larger workforce and higher spending dedicated to public health across the entire state. This setup means programs are implemented and overseen centrally, which reduces the decision-making power of local jurisdictions and leads to less local autonomy. The pattern contrasts with decentralized models, where counties or localities drive decisions and employ more of the public health workforce locally, often with lower per-capita state expenditures. The option describing more state employees per capita, higher labor expenditures, smaller populations, and less local autonomy best captures the centralized structure.