Policy, politics, and child health: four decades of federal initiative and state response.

This paper analyzes the continuity and change in the relationship between federal and state governments in the formation and implementation of child-health programs. After reviewing developments in federal child-health policy since the Sheppard-Towner Act of 1923, methods of implementation and changes in state laws and administrative organization in Vermont and Connecticut are compared with a focus on the major programs authorized by Title V of the Social Security Act. Four broad interactive areas of comparison--governmental relations, program delivery systems, expenditure patterns, and private interests--serve as vantage points for exploring, understanding and explaining the process of policy implementation. Specific conclusions are drawn regarding each area and the overall conclusion is that federal efforts under Title V have not lessened the general neglect of child health in state legislation; nor have they greatly expanded the volume of direct services for child care. They have been sufficiently ambiguous and diffuse to leave the providers dominant, treating diseases and existing conditions rather than focusing energy on preventive measures. Federal resources have been absorbed by expanding administrative overhead, state bureaucracies have been inflated rather than motivated.