Moving the 'standards movement'.

Substantial variations found in state implementation of public health service standards were partially explained by information collected from State Health Departments. A number of structural factors, particularly the distribution of service and supervisory responsibilities between state and local agencies, produce role and tactical differences in the process of standards implementation. Patterns and philosophies of intergovernmental funding were also reported to be critical to the process. In that these and related factors have their roots in political decisions, attention to internal and external political constraints is believed to be important to progress on standards implementation. Finally, the extent of variation reported raises the issue of the degree to which a common paradigm of public health exists and guides practice in state and local communities.