This report describes the state of the public health system in Texas and its strengths and weaknesses. There are many changes taking place in the public health care system in Texas, including privatizing public clinics, changes in federal grants, and the switch to managed care for the Medicaid program. While all of these developments are important to the health of Texans, core public health functions affect more people but are often left out of the picture. The 65 state-participating local health departments in Texas often have to do more with less, as funding becomes more competitive and scarce, and this can only hurt public health efforts at the local level. If the local health department does not have the resources to carry out adequate prevention, investigation, or follow-up activities, the emergence of new or old diseases can pose a significant threat. Some areas of the state do not even have local health departments, since they are not mandatory in Texas. The Texas Department of Health tries to fill in at the local level in these areas, but the state cannot perform all the functions of a local health department. In this report, the definitions and history of public health and the public health systems on the federal, state (Texas), and local levels are presented. Funding mechanisms, recent changes in various systems, health indicators in Texas, and case studies of several localities and states are discussed. Conclusions and recommendations are presented at the end, detailing changes that are needed to improve the public health system in Texas.