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 2 Operational Definitio NACCHO 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