naccho operational definition - local public health information

NACCHO

11111Operational Definition of a Functional Local Health DepartmentOperational Definition of a Functional Local Health DepartmentOperational Definition of a Functional Local Health DepartmentOperational Definition of a Functional Local Health DepartmentOperational Definition of a Functional Local Health Department • November 2005

NACCHO

Operational Definition

of afunct ionallocal healthdepartment

November 2005

NATIONALASSOCIATION OFCOUNTY & CITYHEALTH OFFICIALS

PublicHealthPrevent. Promote. Protect.

22222 Operational DefinitiOperational DefinitioOperational DefinitiOperational DefinitioOperational Definiti


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Governmental public health departments are responsible for creating and maintaining

conditions that keep people healthy.At the local level, the governmentalpublic health presence, or “localhealth department,” can take manyforms.1 Furthermore, eachcommunity has a unique “publichealth system” comprising individualsand public and private entities thatare engaged in activities that affectthe public’s health.

Regardless of its governance orstructure, regardless of where specificauthorities are vested or whereparticular services are delivered,everyone, no matter where they live,should reasonably expect the localhealth department to meet certainstandards.2

A FUNCTIONAL LOCAL HEALTHDEPARTMENT:

Understands the specific healthissues confronting thecommunity, and how physical,behavioral, environmental,social, and economic conditionsaffect them.

Investigates health problems andhealth threats.

Prevents, minimizes, and containsadverse health effects fromcommunicable diseases, diseaseoutbreaks from unsafe food andwater, chronic diseases,environmental hazards, injuries,and risky health behaviors.

Leads planning and responseactivities for public healthemergencies.

Collaborates with other localresponders and with state andfederal agencies to intervene inother emergencies with publichealth significance (e.g., naturaldisasters).

Implements health promotionprograms.

Engages the community toaddress public health issues.

Develops partnerships with publicand private healthcare providersand institutions, community-based organizations, and othergovernment agencies (e.g.,housing authority, criminaljustice, education) engaged inservices that affect health tocollectively identify, alleviate, andact on the sources of publichealth problems.

Coordinates the public healthsystem’s efforts in an intentional,non-competitive, and non-duplicative manner.

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Addresses health disparities.

Serves as an essential resource forlocal governing bodies andpolicymakers on up-to-datepublic health laws and policies.

Provides science-based, timely,and culturally competent healthinformation and health alerts tothe media and to the community.

Provides its expertise to otherswho treat or address issues ofpublic health significance.

Ensures compliance with publichealth laws and ordinances,using enforcement authoritywhen appropriate.

Employs well-trained staffmembers who have the necessaryresources to implement bestpractices and evidence-basedprograms and interventions.

Facilitates research efforts, whenapproached by researchers, thatbenefit the community.

Uses and contributes to theevidence base of public health.

Strategically plans its services andactivities, evaluates performanceand outcomes, and makesadjustments as needed tocontinually improve itseffectiveness, enhance thecommunity’s health status, andmeet the community’sexpectations.

1 For the purposes of this definition, alocal health department may be locallygoverned, part of a region or district, bean office or an administrative unit of thestate health department, or a hybrid ofthese.2 See “Local Health DepartmentStandards,” Pages 4 through 9, for furtherdescription of the functions captured inthis definition.

NOTES



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A ll local health departments (LHDs),1 as governmental entities, derive their authority

and responsibility from the state andlocal laws that govern them.Accordingly, all LHDs exist for thecommon good and are responsiblefor demonstrating strong leadershipin the promotion of physical,behavioral, environmental, social,and economic conditions thatimprove health and well-being;prevent illness, disease, injury, andpremature death; and eliminatehealth disparities.2 However, in theabsence of specific, consistentstandards regarding how LHDs fulfillthis responsibility, the degree towhich the public’s health is protectedand improved varies widely fromcommunity to community.

These standards describe theresponsibilities that every person,regardless of where they live, shouldreasonably expect their LHD to fulfill.They have been developed withinnationally recognized frameworks3

and with input from public healthprofessionals and elected officials4

from across the country. Thestandards provide a framework bywhich LHDs are accountable to thestate health department, the publicthey serve, and the governing bodies(e.g., local boards of health, countycommissioners, and mayors) to whichthey report. In meeting the

standards, LHDs employ strategiesthat are evidence-based and informedby best practices, and they operateaccording to the highest level ofprofessionalism and ethics to inspirepublic confidence and trust.

A number of factors contribute to thevariability of how LHDs operate;specifically capacity, authority,resources, and composition of thelocal public health system:

The LHD may have the capacityto perform all of the functions onits own; it may call upon thestate to provide assistance forsome functions; it may developarrangements with otherorganizations in the communityor with neighboring LHDs toperform some functions; or it maycontrol the means by whichother entities perform somefunctions.

Government agencies other thanthe LHD may have the authorityto perform services that affectpublic health.

Resources for public health maybe housed in a different agency.

Each LHD jurisdiction is served byits own unique public healthsystem: public and private healthcare providers, businesses,community organizations,academic institutions, and mediaoutlets that all contribute to thepublic’s health.

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Currently, not all LHDs have thecapacity to meet the standards. Manyconcerns have been raised regardingthe costs of developing the capacity,and the implications for LHDs that donot meet the standards. It is difficultto anticipate costs, and it is equallyimportant to understand thatimprovements in capacity can bemade in the absence of newresources. NACCHO is committed tocollecting and sharing models ofLHDs and LHD arrangements todemonstrate various means toenhance local governmental publichealth capacity. Furthermore,NACCHO is currently participating ina national dialogue on whether toestablish a voluntary nationalaccreditation system for state andlocal health departments,5 and issupportive of such an effort.6 Theresults of this dialogue may generateimplications for LHDs not meeting thestandards.

NACCHO urges LHDs to embracethese standards both as a means ofworking with their state healthdepartments, communities, andgoverning bodies to develop a morerobust governmental public healthcapacity, and as a means of holdingthemselves uniformly accountable tothe public they serve.

As a result of these differences, howLHDs meet the standards—whetherthey directly provide a service, brokerparticular capacities, or otherwiseensure that the necessary work isbeing done—will vary. Regardless ofits specific capacity, authority, andresources, and regardless of theparticular local public health system,the LHD has a consistentresponsibility to intentionallycoordinate all public health activitiesand lead efforts to meet thestandards.

The standards are a guide to thefundamental responsibilities of LHDs,allowing for varied structuralcharacteristics of LHDs (e.g.,governance, staffing patterns, size ofthe population served, etc.), andrecognizing that each LHD may haveother duties unique to meeting thepublic health needs of the communityit serves. Several states havedeveloped, or are in the process ofdeveloping, state-specific standardsfor LHDs, and the National PublicHealth Performance StandardsProgram (NPHPSP) includes standardsfor local public health systems.NACCHO analyses of several stateinitiatives and the NPHPSP haveshown a high level of consistencybetween these efforts and NACCHO’snationally-developed standards.



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2 Protect people from health problems and health hazards.

a. Investigate health problems andenvironmental health hazards.

b. Prevent, minimize, and containadverse health events andconditions resulting fromcommunicable diseases; food-,water-, and vector-borne outbreaks;chronic diseases; environmentalhazards; injuries; and healthdisparities.

c. Coordinate with othergovernmental agencies thatinvestigate and respond to healthproblems, health disparities, orenvironmental health hazards.

d. Lead public health emergencyplanning, exercises, and responseactivities in the community inaccordance with the NationalIncident Management System, andcoordinate with other local, state,and federal agencies.

e. Fully participate in planning,exercises, and response activitiesfor other emergencies in thecommunity that have public healthimplications, within the context ofstate and regional plans and in amanner consistent with thecommunity’s best public healthinterest.

f. Maintain access to laboratory andbiostatistical expertise and capacityto help monitor community healthstatus and diagnose andinvestigate public health problemsand hazards.

g. Maintain policies and technologyrequired for urgentcommunications and electronicdata exchange.

1Monitor health status andunderstand health issues facingthe community.

a. Obtain and maintain data thatprovide information on thecommunity’s health (e.g., providerimmunization rates; hospitaldischarge data; environmentalhealth hazard, risk, and exposuredata; community-specific data;number of uninsured; andindicators of health disparities suchas high levels of poverty, lack ofaffordable housing, limited or noaccess to transportation, etc.).

b. Develop relationships with localproviders and others in thecommunity who have informationon reportable diseases and otherconditions of public health interestand facilitate informationexchange.

c. Conduct or contribute expertise toperiodic community healthassessments.

d. Integrate data with healthassessment and data collectionefforts conducted by others in thepublic health system.

e. Analyze data to identify trends,health problems, environmentalhealth hazards, and social andeconomic conditions that adverselyaffect the public’s health.

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3 Give people information they need to make healthy choices.

a. Develop relationships with themedia to convey information ofpublic health significance, correctmisinformation about publichealth issues, and serve as anessential resource.

b. Exchange information and datawith individuals, communitygroups, other agencies, and thegeneral public about physical,behavioral, environmental, social,economic, and other issuesaffecting the public’s health.

c. Provide targeted, culturally-appropriate information to helpindividuals understand whatdecisions they can make to behealthy.

d. Provide health promotionprograms to address identifiedhealth problems.

4 Engage the community to identify and solve health problems.

a. Engage the local public healthsystem in an ongoing, strategic,community-driven, comprehensiveplanning process to identify,prioritize, and solve public healthproblems; establish public healthgoals; and evaluate success inmeeting the goals.

b. Promote the community’sunderstanding of, and advocacyfor, policies and activities that willimprove the public’s health.

c. Support, implement, and evaluatestrategies that address public

health goals in partnership withpublic and private organizations.

d. Develop partnerships to generateinterest in and support forimproved community health status,including new and emergingpublic health issues.

e. Inform the community, governingbodies, and elected officials aboutgovernmental public healthservices that are being provided,improvements being made inthose services, and priority healthissues not yet being adequatelyaddressed.

5 Develop public health policies and plans.

a. Serve as a primary resource togoverning bodies andpolicymakers to establish andmaintain public health policies,practices, and capacity based oncurrent science and best practices.

b. Advocate for policies that lessenhealth disparities and improvephysical, behavioral, environmental,social, and economic conditions inthe community that affect thepublic’s health.

c. Engage in LHD strategic planningto develop a vision, mission, andguiding principles that reflect thecommunity’s public health needs,and to prioritize services andprograms.



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c. Educate individuals andorganizations on the meaning,purpose, and benefit of publichealth laws, regulations, andordinances and how to comply.

d. Monitor, and analyze over time, thecompliance of regulatedorganizations, entities, andindividuals.

e. Conduct enforcement activities.f. Coordinate notification of violations

among other governmentalagencies that enforce laws andregulations that protect the public’shealth.

7 Help people receive health services.

a. Engage the community to identifygaps in culturally-competent,appropriate, and equitablepersonal health services, includingpreventive and health promotionservices, and develop strategies toclose the gaps.

b. Support and implement strategiesto increase access to care andestablish systems of personal health

services, including preventive andhealth promotion services, inpartnership with the community.

c. Link individuals to available,accessible personal healthcareproviders (i.e., a medical home).

8 Maintain a competent public health workforce.

a. Recruit, train, develop, and retain adiverse staff.

b. Evaluate LHD staff members’ publichealth competencies,7 and addressdeficiencies through continuingeducation, training, and leadershipdevelopment activities.

c. Provide practice- and competency-based educational experiences forthe future public health workforce,and provide expertise indeveloping and teaching publichealth curricula, throughpartnerships with academia.

d. Promote the use of effective publichealth practices among otherpractitioners and agenciesengaged in public healthinterventions.

e. Provide the public health workforcewith adequate resources to dotheir jobs.

9 Evaluate and improve programs and interventions.

a. Develop evaluation efforts to assesshealth outcomes to the extentpossible.

b. Apply evidence-based criteria toevaluation activities wherepossible.

c. Evaluate the effectiveness andquality of all LHD programs and


6 Enforce public health laws and regulations.

a. Review existing laws andregulations and work withgoverning bodies and policy-makers to update them as needed.

b. Understand existing laws,ordinances, and regulations thatprotect the public’s health.

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activities and use the informationto improve LHD performance andcommunity health outcomes.

d. Review the effectiveness of publichealth interventions provided byother practitioners and agenciesfor prevention, containment, and/or remediation of problemsaffecting the public’s health, andprovide expertise to thoseinterventions that needimprovement.

10 Contribute to and apply theevidence base of publichealth.

a. When researchers approach theLHD to engage in researchactivities that benefit the health ofthe community,i. Identify appropriate

populations, geographic areas,and partners;

ii. Work with them to activelyinvolve the community in allphases of research;

iii. Provide data and expertise tosupport research; and,

iv. Facilitate their efforts to shareresearch findings with thecommunity, governing bodies,and policymakers.

b. Share results of research, programevaluations, and best practiceswith other public healthpractitioners and academics.

c. Apply evidence-based programsand best practices where possible.

NOTES1 For the purposes of these standards, an LHDis defined as the governmental public healthpresence at the local level. It may be a locallygoverned health department, a branch of thestate health department, a state-createddistrict or region, a department governed byand serving a multi-county area, or any otherarrangement that has governmental authorityand is responsible for public health functionsat the local level.

2 For the purposes of this document, “healthdisparities” refer to differences in populations’health status that are avoidable and can bechanged. These differences can result fromsocial and/or economic conditions, as well aspublic policy. Examples include situationswhereby hazardous waste sites are located inpoor communities, there is a lack ofaffordable housing, and there is limited or noaccess to transportation. These and otherfactors adversely affect population health.

3 The standards are framed around the TenEssential Public Health Services, which havebeen reworded to more accurately reflect thespecific LHD roles and responsibilities relatedto each category. In addition, these standardsare consistent with the National Public HealthPerformance Standards Program (NPHPSP),serving to specify the role of governmentalLHDs while the NPHPSP addresses the publichealth system as a whole.

4 This includes those from local healthdepartments, local boards of health, statehealth departments, and federal public healthagencies; as well as county commissioners,mayors, state legislators, and gubernatorialhealth advisors.

5 www.exploringaccreditation.org

6 NACCHO Resolution 04-06 further describesNACCHO’s stance on accreditation.

7 As defined by the Core Public HealthCompetencies developed by the Council onLinkages between Academia and PublicHealth Practice.



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WHAT ARE NACCHO’S

NEXT STEPS?

NACCHO’s first step is education andcommunication about the definitionwith LHDs, local boards of health,state health departments, federalpublic health agenices, and local andstate elected officials. Metrics will bedeveloped to allow LHDs to measuretheir progress in achieving thestandards.

NACCHO will also gather examples ofhow LHDs use the definition. TheExploring Accreditation project willexamine the use of the standards asthe basis for a voluntary nationalaccreditation system for LHDs of allsizes and structures.

WHAT ACTION STEPS CAN

YOU TAKE?

LHDs can use the definition andstandards to assess local efforts,measure performance, expandfunctions, enhance activities, andcommunicate about the role of localpublic health to their governingbodies, elected officials, andcommunity.

NACCHO has developed a set of threefact sheets describing the role of localpublic health and a communicationstoolkit as part of this project. Boththe toolkit and the fact sheets areavailable on NACCHO’s Web site (seethe following column). We encourageLHDs to download the fact sheets andcommunications toolkit.

P ublic health professionals and the communities they serve deserve a common set of

expectations about local healthdepartments (LHDs). More than 600governmental public healthprofessionals and local and stateofficials representing 30 differentstates contributed to this definition,which will be a living document.

By describing the functions of LHDs,the definition will help citizens andresidents understand what they canreasonably expect from governmentalpublic health in their communities.The definition also will be useful toelected officials, who need tounderstand what LHDs do and howto hold them accountable. And, thedefinition will aid LHDs in obtainingtheir fair share of resources.

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Finally, your experiences with thedefinition will inform and help shapethe implementation phase of thiseffort. Please submit examples ofhow LHDs have met the definition(particularly those involving thedevelopment of shared capacity and/or resources), applied the tools in thecommunications toolkit, or otherwiseused the definition or relatedmaterials.

You can find additional materials andsubmit examples online at:

www.naccho.org/topics/infrastructure/operationaldefinition.cfm.

For more information about thisproject, please contactNACCHO at (202) 783-5550and ask to speak with theOperational Definition programmanager, or [email protected].

Funding for this project was provided bythe Robert Wood Johnson Foundation andthe Centers for Disease Control andPrevention (under cooperative agreementU50/CCU302718). The contents of thisdocument are solely the responsibility ofthe authors and do not necessarilyrepresent the official views of the sponsors.

NACCHO thanks the following organizations for their contributions to the developmentof the operational definition: the Association of State and Territorial Health Officials,the Association of State and Territorial Local Health Liaison Officials, the Centers forDisease Control and Prevention, the Health Resources and Services Administration, theNational Association of Counties, the National Association of Local Boards of Health,the National Conference of State Legislatures, the National Governors Association, theNational League of Cities, and the U.S. Conference of Mayors.



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National Association ofCounty and CityHealth Officials

1100 17th Street, NWSecond Floor

Washington, DC 20036(202) 783-5550 Phone

(202) 783-1583 Faxwww.naccho.org

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