Reorganizations of health agencies by local government in American urban centers: what do they portend for "public health"?

The major health agencies of local urban governments--public health department and public hospital--are often dismissed as "irrelevant" or attacked as "unresponsive". The rush to reform through reorganization hasn't often addressed the underlying problems of an eroded tax base, an indifferent federal policy, and intra-professional disputes. Newer corrective steps are called for if complex demands for public and personal service are to be met.