We sought to document the structure and functions of state public health agencies throughout the United States in 2007 and compare findings with those from a similar 2001 assessment. In 2007 a survey of the structure and functions of state public health agencies was sent to and completed by senior deputies in all 50 states and the District of Columbia (a 100% response rate). The results of the survey showed that all emerging practice areas in 2001 had expanded by 2007. Also, state health departments generally had greater levels of responsibility in 2007 than they did in 2001, emphasizing the need for continued support of governmental public health systems and research on the operations of those systems.