| Course | MPH 500 Introduction to Public Health Systems, Organizations, & Practice |
|---|---|
| Week | 2 |
| Paper type | Public health systems analysis |
| Length | About 1,120 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Public Health (MPH) |
| Updated | October 2026 |
Free sample paper for MPH 500 Week 2
Public Health Systems Analysis: Who Holds Authority Over Legionella in Building Water, Who Pays, and Where the Gap Sits in One County
Student Name
Chamberlain University
MPH 500: Introduction to Public Health Systems, Organizations, & Practice
Instructor Name
Month Day, Year
Public Health Systems Analysis: Who Holds Authority Over Legionella in Building Water, Who Pays, and Where the Gap Sits in One County
Purpose and Scope
This analysis describes the public health system as it bears on one problem in one place: Legionnaires' disease from building water systems in Harbor County, a composite county of 412,000 residents whose reported cases rose from 14 in 2021 to 31 in 2025. It asks what each level of government can do about the problem, what it is paid to do, where mandates and resources fail to match and what non-governmental bodies fill or leave open. The aim is to locate the system's weakness precisely enough that a decision could address it.
Levels by Their Authority
Table 1
Authority Over Legionella in Building Water, by Level of Government
| Level | What it can do about Legionella | What it cannot do | How it is paid for this work |
|---|---|---|---|
| Federal | Conduct national surveillance; support outbreak investigation on request; publish guidance; require water management programs in hospitals and nursing homes through Medicare conditions | Regulate cooling towers or apartment buildings directly | Federal appropriations; cooperative agreements to states |
| State | Make Legionnaires' disease reportable; run the public health laboratory; set the plumbing code | Inspect individual building water systems outside licensed facilities | State general funds; federal epidemiology and laboratory capacity grants |
| County health department | Investigate each case; lead outbreak response; order a building closed in an imminent hazard | Require routine maintenance or registration of cooling towers without a local ordinance | Federal and state grants for disease investigation; county general fund; inspection fees for pools and restaurants |
| City building department | Permit new cooling towers and plumbing work | Track whether towers are maintained after installation | Permit fees |
Note. Note. Summarized for Harbor County, a composite county. Healthcare facility requirements apply only to providers taking part in Medicare and Medicaid.
Funding and What It Is Tied To
The county's work on Legionnaires' disease is paid for almost entirely through categorical funding for infectious disease investigation. The epidemiology and laboratory capacity grant passed from the state pays for part of two epidemiologist positions, and its conditions tie that money to case investigation, surveillance reporting and outbreak response. It cannot be spent on routine environmental inspection of buildings. The county's environmental health inspectors are paid partly by fees charged to restaurants and swimming pools, which are tied to inspecting restaurants and swimming pools. No funding stream in the county is tied to preventing Legionella growth in cooling towers or large building water systems. The system is paid to respond after people become ill and has no money to prevent the conditions that make them ill.
Mandates Against Resources
The mandates the county does carry exceed its resources. State rules require the county to begin investigating each reported case within one business day, interview the patient or family and report findings within seven days. With two epidemiologists covering more than 70 reportable conditions, a summer cluster of nine Legionnaires' cases in 2025 took most of their time for three weeks. During that cluster, investigators wanted to sample every cooling tower within a mile of the cases, but the county had no list; the city's permit records showed 212 towers countywide, and staff estimated that well over 300 exist because older towers predate the permit database. The investigation sampled 14 towers it could locate, and no source was confirmed.
The Healthcare Exception
One part of the system does carry a prevention requirement. Since 2017, federal Medicare and Medicaid rules have required hospitals, critical access hospitals and nursing homes to have water management programs that reduce Legionella risk (Centers for Medicare & Medicaid Services, 2017). Harbor County's three hospitals and eleven nursing homes therefore maintain such programs, which state surveyors check. The requirement stops at the healthcare facility's property line. An apartment building's cooling tower across the street carries no equivalent obligation.
The Non-Governmental System
Much of what happens to building water is decided outside government. Building owners and property managers decide whether to contract for water treatment. Water treatment vendors provide chemical treatment and, sometimes, testing, at a price owners may decline. A national consensus standard sets out how a building water management program should work, but it is voluntary unless a law adopts it (American Society of Heating, Refrigerating and Air-Conditioning Engineers, 2018). Insurers rarely ask about cooling tower maintenance. The result is that well-run buildings maintain their towers carefully and others do not, with no one positioned to know which is which.
Where the Levels Overlap and Conflict
The levels meet at two points, and neither works well. During an outbreak, the county leads the investigation, the state laboratory tests environmental samples and federal staff may assist; in practice this partnership works, but it begins only after cases appear. The second meeting point is the building permit. The city building department applies the state plumbing code when a tower is installed, and the code addresses construction, not operation. A tower permitted in 2008 and never cleaned since is fully compliant with everything the city enforces. The county health department, which would care about that tower, has no access to the permit list except by request and no right to inspect the tower without an outbreak to justify it.
A Weakness Traced Structurally
The county's weakness is not that its staff are slow or careless. Their response to the 2025 cluster was fast, and they did what their authority allowed. The weakness is structural: the only body with public health responsibility for Legionnaires' disease, the county health department, has authority and funding to respond to cases but none to require prevention in the buildings most likely to cause them, and the body that permits those buildings' cooling towers has neither a health mandate nor a reason to track maintenance. Outbreak reviews across North America have found that most investigated outbreaks involved preventable failures in water management (Garrison et al., 2016), which is exactly the kind of failure this structure leaves unaddressed. Changing the structure would mean giving some body both the authority to require registration and maintenance and a way to pay for oversight.
What the Analysis Points To
A local ordinance is the narrowest change that would close the gap: county authority to require cooling tower registration, routine maintenance and testing, with registration fees paying for oversight. Other jurisdictions have taken this route after large outbreaks (Fitzhenry et al., 2017), and the later stages of this work examine whether Harbor County can.
References
American Society of Heating, Refrigerating and Air-Conditioning Engineers. (2018). Legionellosis: Risk management for building water systems (ANSI/ASHRAE Standard 188-2018).
Centers for Medicare & Medicaid Services. (2017). Requirement to reduce Legionella risk in healthcare facility water systems to prevent cases and outbreaks of Legionnaires' disease (LD) (Ref: S&C 17-30). U.S. Department of Health and Human Services.
Fitzhenry, R., Weiss, D., Cimini, D., Balter, S., Boyd, C., Alleyne, L., Stewart, R., McIntosh, N., Econome, A., Lin, Y., Rubinstein, I., Passaretti, T., Kidney, A., Lapierre, P., Kass, D., & Varma, J. K. (2017). Legionnaires' disease outbreaks and cooling towers, New York City, New York, USA. Emerging Infectious Diseases, 23(11), 1769-1776. https://doi.org/10.3201/eid2311.161584
Garrison, L. E., Kunz, J. M., Cooley, L. A., Moore, M. R., Lucas, C., Schrag, S., Sarisky, J., & Whitney, C. G. (2016). Vital signs: Deficiencies in environmental control identified in outbreaks of Legionnaires' disease: North America, 2000-2014. MMWR. Morbidity and Mortality Weekly Report, 65(22), 576-584. https://doi.org/10.15585/mmwr.mm6522e1
The Chamberlain MPH 500 Week 2 instructions
Describe the system for one problem in one place, by what each level can do and what it is paid to do, rather than by listing agencies and reporting lines. Cover federal, state, local and, where relevant, tribal levels, and note where their authority overlaps, conflicts or runs out. Explain how funding is tied, for example through categorical grants or fees restricted to particular programs, and what that funding cannot be spent on. Compare mandates against resources. Include the non-governmental parts of the system, such as owners, vendors, standards bodies and insurers. Then trace one weakness to its structural cause rather than to poor management or individual effort. Close with what the analysis points to, the narrowest change that would close the gap.
How the MPH 500 Week 2 example is put together
The sample sets its scope: Legionnaires' disease in a county of 412,000 with cases rising from 14 to 31. A table lists four levels with their powers, limits and funding. The funding section explains that the epidemiology grant is tied to investigation and pool and restaurant fees to their own programs, leaving nothing for building water. The mandates section describes two epidemiologists, a one-day investigation rule and a 2025 cluster in which 14 of an estimated 35 nearby towers were sampled. A section notes the federal water management requirement for hospitals and nursing homes and where it stops. Another covers owners, vendors, the voluntary standard and insurers. A section shows where the levels meet too late, and the closing proposes a local ordinance.
Where the points sit in the MPH 500 Week 2 rubric
The heaviest loss is the organizational chart in prose: every agency named, every reporting line described and nothing about what any of them can do or afford. It is accurate, long and shows no analysis. The second is dysfunction attributed to inefficiency, where fragmentation or slow response is explained by poor management rather than by how authority and money are arranged. Marks are also lost for funding described without saying what it is tied to, for leaving out the non-governmental system and for weaknesses that are named but not traced. Analyses score well when each level is described by its authority and funding, mandates are set against resources and one weakness is traced to its structure.
MPH 500 Week 2 help from the desk
Most systems analyses describe structure; this one asks what each part can do and afford. Share the problem and place you are analyzing and what you know about the agencies, laws and funding involved, and the analysis can describe each level by its authority and money, compare mandates with resources, include the private actors and trace a weakness to its structural cause. Ending on the narrowest change that would close the gap gives the analysis a purpose. The problem and the setting are your own.
Get a MPH-500 Week 2 example written to your instructions
Send the Week 2 instructions with the template and sources your section requires, and a custom example is written to that structure and returned inside 24 to 48 hours. The first one is free. Which weakness you lead on, and how hard you press it, stays yours to argue.
More MPH 500 papers and MPH samples
- MPH 500 Week 1: Upstream Walk Post
- MPH 500 Week 3: Agency Profile
- MPH 500 Week 4: Essential Services Analysis
- MPH 500 Week 5: Policy Brief
- MPH 500 Week 6: Stakeholder Analysis
- MPH 500 Week 7: Program Evaluation Plan
- MPH 500 Week 8: Synthesis Presentation
MPH 500 Week 2 questions, answered
Why does categorical funding matter so much?
Because it decides what a department can actually do. Money arriving tied to one disease or one program cannot be moved to whatever the local burden is, so a health department may hold substantial funding and still be unable to address its largest problem. Analyses that report total budgets without that distinction miss the constraint practitioners feel most.
Should the analysis cover private organizations?
Yes in nearly every version, since the public health system extends well beyond government. Hospitals do community benefit work, insurers shape prevention through coverage, employers determine a great deal of exposure and access, and community organizations reach populations no agency can. Papers restricted to government describe a fraction of the system.
How do I find what a specific agency can do?
From enabling statutes, agency strategic plans and accreditation documentation where any exist, rather than from the agency's public description of itself. What a body is authorized to compel differs from what it says it does, and the gap between the two is frequently the most interesting finding available in this assignment.
Where can I find a free MPH 500 Week 2 sample paper?
This page holds the full systems analysis of who has authority and money to act on Legionella in one county's building water.
What structural weakness does the MPH 500 Week 2 sample identify?
The health department is funded and empowered to respond to cases but has no authority or funding to require prevention in the buildings most likely to cause them.