NACCHO Operational Definition of a functional local health department
NATIONAL ASSOCIATION OF COUNTY & CITY HEALTH OFFICIALS NACCHO Public Health Operational Definition of a Functional Local Health Department • November 2005Prevent. Promote.1 Protect. November 2005 operational definition of a functional local health department
overnmental public health Prevents, minimizes, and contains departments are responsible adverse health effects from G for creating and maintaining communicable diseases, disease conditions that keep people healthy. outbreaks from unsafe food and At the local level, the governmental water, chronic diseases, public health presence, or “local environmental hazards, injuries, health department,” can take many and risky health behaviors. 1 forms. Furthermore, each Leads planning and response community has a unique “public activities for public health health system” comprising individuals emergencies. and public and private entities that Collaborates with other local are engaged in activities that affect responders and with state and the public’s health. federal agencies to intervene in other emergencies with public Regardless of its governance or health significance (e.g., natural structure, regardless of where specific disasters). authorities are vested or where particular services are delivered, Implements health promotion everyone, no matter where they live, programs. should reasonably expect the local Engages the community to health department to meet certain address public health issues. standards.2 Develops partnerships with public and private healthcare providers A FUNCTIONAL LOCAL HEALTH and institutions, community- DEPARTMENT: based organizations, and other government agencies (e.g., Understands the specific health housing authority, criminal issues confronting the justice, education) engaged in community, and how physical, services that affect health to behavioral, environmental, collectively identify, alleviate, and social, and economic conditions act on the sources of public affect them. health problems. Investigates health problems and Coordinates the public health health threats. system’s efforts in an intentional, non-competitive, and non- duplicative manner.
NACCHO NATIONAL ASSOCIATION OF COUNTY & CITY HEALTH OFFICIALS
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Addresses health disparities. Serves as an essential resource for local governing bodies and policymakers on up-to-date public health laws and policies. Provides science-based, timely, and culturally competent health information and health alerts to the media and to the community. Provides its expertise to others who treat or address issues of public health significance. Ensures compliance with public health laws and ordinances, using enforcement authority when appropriate. Employs well-trained staff members who have the necessary resources to implement best practices and evidence-based programs and interventions. Facilitates research efforts, when approached by researchers, that benefit the community. Uses and contributes to the evidence base of public health. Strategically plans its services and NOTES 1 activities, evaluates performance For the purposes of this definition, a local health department may be locally and outcomes, and makes governed, part of a region or district, be adjustments as needed to an office or an administrative unit of the state health department, or a hybrid of continually improve its these. effectiveness, enhance the 2 See “Local Health Department community’s health status, and Standards,” Pages 4 through 9, for further description of the functions captured in meet the community’s this definition. expectations.
Operational Definition of a Functional Local Health Department • November 2005 3 local health department standards
ll local health departments standards, LHDs employ strategies
(LHDs),1 as governmental that are evidence-based and informed A entities, derive their authority by best practices, and they operate and responsibility from the state and according to the highest level of local laws that govern them. professionalism and ethics to inspire Accordingly, all LHDs exist for the public confidence and trust. common good and are responsible for demonstrating strong leadership A number of factors contribute to the in the promotion of physical, variability of how LHDs operate; behavioral, environmental, social, specifically capacity, authority, and economic conditions that resources, and composition of the improve health and well-being; local public health system: prevent illness, disease, injury, and premature death; and eliminate The LHD may have the capacity health disparities.2 However, in the to perform all of the functions on absence of specific, consistent its own; it may call upon the standards regarding how LHDs fulfill state to provide assistance for this responsibility, the degree to some functions; it may develop which the public’s health is protected arrangements with other and improved varies widely from organizations in the community community to community. or with neighboring LHDs to perform some functions; or it may These standards describe the control the means by which responsibilities that every person, other entities perform some regardless of where they live, should functions. reasonably expect their LHD to fulfill. They have been developed within Government agencies other than nationally recognized frameworks3 the LHD may have the authority and with input from public health to perform services that affect professionals and elected officials4 public health. from across the country. The standards provide a framework by Resources for public health may which LHDs are accountable to the be housed in a different agency. state health department, the public they serve, and the governing bodies Each LHD jurisdiction is served by (e.g., local boards of health, county its own unique public health commissioners, and mayors) to which system: public and private health they report. In meeting the care providers, businesses, community organizations,
NACCHO NATIONAL academic institutions, and media ASSOCIATION OF COUNTY & CITY outlets that all contribute to the HEALTH OFFICIALS public’s health. 4 Operational Definitio NACCHO
As a result of these differences, how Currently, not all LHDs have the LHDs meet the standards—whether capacity to meet the standards. Many they directly provide a service, broker concerns have been raised regarding particular capacities, or otherwise the costs of developing the capacity, ensure that the necessary work is and the implications for LHDs that do being done—will vary. Regardless of not meet the standards. It is difficult its specific capacity, authority, and to anticipate costs, and it is equally resources, and regardless of the important to understand that particular local public health system, improvements in capacity can be the LHD has a consistent made in the absence of new responsibility to intentionally resources. NACCHO is committed to coordinate all public health activities collecting and sharing models of and lead efforts to meet the LHDs and LHD arrangements to standards. demonstrate various means to enhance local governmental public The standards are a guide to the health capacity. Furthermore, fundamental responsibilities of LHDs, NACCHO is currently participating in allowing for varied structural a national dialogue on whether to characteristics of LHDs (e.g., establish a voluntary national governance, staffing patterns, size of accreditation system for state and the population served, etc.), and local health departments,5 and is recognizing that each LHD may have supportive of such an effort.6 The other duties unique to meeting the results of this dialogue may generate public health needs of the community implications for LHDs not meeting the it serves. Several states have standards. developed, or are in the process of developing, state-specific standards NACCHO urges LHDs to embrace for LHDs, and the National Public these standards both as a means of Health Performance Standards working with their state health Program (NPHPSP) includes standards departments, communities, and for local public health systems. governing bodies to develop a more NACCHO analyses of several state robust governmental public health initiatives and the NPHPSP have capacity, and as a means of holding shown a high level of consistency themselves uniformly accountable to between these efforts and NACCHO’s the public they serve. nationally-developed standards.
Operational Definition of a Functional Local Health Department • November 2005 5 tional association of county and city health
local health department standards
Monitor health status and Protect people from health 1understand health issues facing 2 problems and health hazards. the community. a. Investigate health problems and a. Obtain and maintain data that environmental health hazards. provide information on the b. Prevent, minimize, and contain community’s health (e.g., provider adverse health events and immunization rates; hospital conditions resulting from discharge data; environmental communicable diseases; food-, health hazard, risk, and exposure water-, and vector-borne outbreaks; data; community-specific data; chronic diseases; environmental number of uninsured; and hazards; injuries; and health indicators of health disparities such disparities. as high levels of poverty, lack of c. Coordinate with other affordable housing, limited or no governmental agencies that access to transportation, etc.). investigate and respond to health b. Develop relationships with local problems, health disparities, or providers and others in the environmental health hazards. community who have information d. Lead public health emergency on reportable diseases and other planning, exercises, and response conditions of public health interest activities in the community in and facilitate information accordance with the National exchange. Incident Management System, and c. Conduct or contribute expertise to coordinate with other local, state, periodic community health and federal agencies. assessments. e. Fully participate in planning, d. Integrate data with health exercises, and response activities assessment and data collection for other emergencies in the efforts conducted by others in the community that have public health public health system. implications, within the context of e. Analyze data to identify trends, state and regional plans and in a health problems, environmental manner consistent with the health hazards, and social and community’s best public health economic conditions that adversely interest. affect the public’s health. f. Maintain access to laboratory and biostatistical expertise and capacity to help monitor community health status and diagnose and investigate public health problems and hazards.
NACCHO NATIONAL g. Maintain policies and technology ASSOCIATION OF COUNTY & CITY required for urgent HEALTH OFFICIALS communications and electronic 6 data exchange. Operational Definitio NACCHO
Give people information they health goals in partnership with 3 need to make healthy choices. public and private organizations. d. Develop partnerships to generate a. Develop relationships with the interest in and support for media to convey information of improved community health status, public health significance, correct including new and emerging misinformation about public public health issues. health issues, and serve as an e. Inform the community, governing essential resource. bodies, and elected officials about b. Exchange information and data governmental public health with individuals, community services that are being provided, groups, other agencies, and the improvements being made in general public about physical, those services, and priority health behavioral, environmental, social, issues not yet being adequately economic, and other issues addressed. affecting the public’s health. c. Provide targeted, culturally- Develop public health policies appropriate information to help and plans. individuals understand what 5 decisions they can make to be a. Serve as a primary resource to healthy. governing bodies and d. Provide health promotion policymakers to establish and programs to address identified maintain public health policies, health problems. practices, and capacity based on current science and best practices. Engage the community to b. Advocate for policies that lessen 4 identify and solve health health disparities and improve problems. physical, behavioral, environmental, social, and economic conditions in a. Engage the local public health the community that affect the system in an ongoing, strategic, public’s health. community-driven, comprehensive c. Engage in LHD strategic planning planning process to identify, to develop a vision, mission, and prioritize, and solve public health guiding principles that reflect the problems; establish public health community’s public health needs, goals; and evaluate success in and to prioritize services and meeting the goals. programs. b. Promote the community’s understanding of, and advocacy for, policies and activities that will improve the public’s health. c. Support, implement, and evaluate strategies that address public
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Enforce public health laws and services, including preventive and 6 regulations. health promotion services, in partnership with the community. a. Review existing laws and c. Link individuals to available, regulations and work with accessible personal healthcare governing bodies and policy- providers (i.e., a medical home). makers to update them as needed. b. Understand existing laws, Maintain a competent public ordinances, and regulations that 8 health workforce. protect the public’s health. a. Recruit, train, develop, and retain a c. Educate individuals and diverse staff. organizations on the meaning, b. Evaluate LHD staff members’ public purpose, and benefit of public health competencies,7 and address health laws, regulations, and deficiencies through continuing ordinances and how to comply. education, training, and leadership d. Monitor, and analyze over time, the development activities. compliance of regulated c. Provide practice- and competency- organizations, entities, and based educational experiences for individuals. the future public health workforce, e. Conduct enforcement activities. and provide expertise in f. Coordinate notification of violations developing and teaching public among other governmental health curricula, through agencies that enforce laws and partnerships with academia. regulations that protect the public’s d. Promote the use of effective public health. health practices among other Help people receive health practitioners and agencies 7 services. engaged in public health interventions. a. Engage the community to identify e. Provide the public health workforce gaps in culturally-competent, with adequate resources to do appropriate, and equitable their jobs. personal health services, including preventive and health promotion Evaluate and improve programs services, and develop strategies to 9 and interventions. close the gaps. a. Develop evaluation efforts to assess b. Support and implement strategies health outcomes to the extent to increase access to care and possible. establish systems of personal health b. Apply evidence-based criteria to evaluation activities where NACCHO NATIONAL ASSOCIATION OF possible. COUNTY & CITY HEALTH OFFICIALS c. Evaluate the effectiveness and quality of all LHD programs and 8 Operational Definitio NACCHO
activities and use the information NOTES to improve LHD performance and 1 For the purposes of these standards, an LHD community health outcomes. is defined as the governmental public health d. Review the effectiveness of public presence at the local level. It may be a locally health interventions provided by governed health department, a branch of the state health department, a state-created other practitioners and agencies district or region, a department governed by for prevention, containment, and/ and serving a multi-county area, or any other or remediation of problems arrangement that has governmental authority affecting the public’s health, and and is responsible for public health functions provide expertise to those at the local level. interventions that need 2 For the purposes of this document, “health improvement. disparities” refer to differences in populations’ health status that are avoidable and can be Contribute to and apply the changed. These differences can result from 10 evidence base of public social and/or economic conditions, as well as health. public policy. Examples include situations whereby hazardous waste sites are located in a. When researchers approach the poor communities, there is a lack of LHD to engage in research affordable housing, and there is limited or no activities that benefit the health of access to transportation. These and other the community, factors adversely affect population health. i. Identify appropriate 3 The standards are framed around the Ten populations, geographic areas, Essential Public Health Services, which have and partners; been reworded to more accurately reflect the specific LHD roles and responsibilities related ii. Work with them to actively to each category. In addition, these standards involve the community in all are consistent with the National Public Health phases of research; Performance Standards Program (NPHPSP), iii. Provide data and expertise to serving to specify the role of governmental support research; and, LHDs while the NPHPSP addresses the public iv. Facilitate their efforts to share health system as a whole. research findings with the 4 This includes those from local health community, governing bodies, departments, local boards of health, state and policymakers. health departments, and federal public health b. Share results of research, program agencies; as well as county commissioners, evaluations, and best practices mayors, state legislators, and gubernatorial health advisors. with other public health 5 practitioners and academics. www.exploringaccreditation.org c. Apply evidence-based programs 6 NACCHO Resolution 04-06 further describes and best practices where possible. NACCHO’s stance on accreditation. 7 As defined by the Core Public Health Competencies developed by the Council on Linkages between Academia and Public Health Practice.
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ublic health professionals and WHAT ARE NACCHO’S
the communities they serve NEXT STEPS? deserve a common set of P NACCHO’s first step is education and expectations about local health communication about the definition departments (LHDs). More than 600 with LHDs, local boards of health, governmental public health state health departments, federal professionals and local and state public health agenices, and local and officials representing 30 different state elected officials. Metrics will be states contributed to this definition, developed to allow LHDs to measure which will be a living document. their progress in achieving the standards. By describing the functions of LHDs, the definition will help citizens and NACCHO will also gather examples of how LHDs use the definition. The residents understand what they can Exploring Accreditation project will reasonably expect from governmental examine the use of the standards as public health in their communities. the basis for a voluntary national The definition also will be useful to accreditation system for LHDs of all elected officials, who need to sizes and structures. understand what LHDs do and how to hold them accountable. And, the definition will aid LHDs in obtaining WHAT ACTION STEPS CAN their fair share of resources. YOU TAKE? LHDs can use the definition and standards to assess local efforts, measure performance, expand functions, enhance activities, and communicate about the role of local public health to their governing bodies, elected officials, and community.
NACCHO has developed a set of three fact sheets describing the role of local public health and a communications toolkit as part of this project. Both the toolkit and the fact sheets are available on NACCHO’s Web site (see the following column). We encourage NACCHO NATIONAL LHDs to download the fact sheets and ASSOCIATION OF COUNTY & CITY communications toolkit. HEALTH OFFICIALS
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Finally, your experiences with the definition will inform and help shape the implementation phase of this effort. Please submit examples of how LHDs have met the definition (particularly those involving the development of shared capacity and/ or resources), applied the tools in the communications toolkit, or otherwise used the definition or related materials.
You can find additional materials and For more information about this submit examples online at: project, please contact NACCHO at (202) 783-5550 www.naccho.org/topics/ and ask to speak with the infrastructure/ Operational Definition program operationaldefinition.cfm. manager, or e-mail [email protected].
NACCHO thanks the following organizations for their contributions to the development of the operational definition: the Association of State and Territorial Health Officials, the Association of State and Territorial Local Health Liaison Officials, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the National Association of Counties, the National Association of Local Boards of Health, the National Conference of State Legislatures, the National Governors Association, the National League of Cities, and the U.S. Conference of Mayors.
Funding for this project was provided by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention (under cooperative agreement U50/CCU302718). The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the sponsors.
Operational Definition of a Functional Local Health Department • November 2005 11 National Association of County and City Health Officials 1100 17th Street, NW Second Floor Washington, DC 20036 (202) 783-5550 Phone (202) 783-1583 Fax www.naccho.org
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