Local Health Department Jurisdictions Research Articles

An Analysis of How Characteristics of Local Health Department Jurisdictions Influence Involvement in PHAB Accreditation: Implications for Health Equity.

To explore how characteristics of local health department (LHD) jurisdictions impact involvement in Public Health Accreditation Board (PHAB) accreditation and to characterize the implications for health equity. Data from the 2016 National Profile of LHDs survey were linked with data from the American Community Survey, National Center for Health Statistics, Behavioral Risk Factor Surveillance System, and the 2016 presidential election. Outcome measures included LHDs that were formally engaged in PHAB accreditation and LHDs that planned to apply for PHAB accreditation but were not formally engaged. Logistic regression was used to assess for the impact LHD jurisdictions' socioeconomic position, demographics, population health status, political ideology, and LHD organizational characteristics have on PHAB accreditation. Approximately 37% of the participants were formally engaged (n = 297) and planned to apply (n = 337) for PHAB accreditation. Involvement in PHAB accreditation was equal among LHDs based on poverty and income inequality, but median household income was negatively associated. Diverse jurisdictions were more likely to be involved in PHAB accreditation but less likely to be involved after controlling for covariates. Jurisdictions with worse population health status were either as likely or more likely to be involved in PHAB accreditation. Jurisdictions with a greater conservative political ideology were less likely to be involved. LHD involvement in PHAB accreditation varies by their jurisdiction's characteristics. This has implications for health equity based on socioeconomic, racial, and population health status. Policies and practices are needed to improve the uptake of PHAB accreditation in LHD jurisdictions impacted most by health inequities.

California's Senate Bill 277: Local Health Jurisdictions' Experiences With the Elimination of Nonmedical Vaccine Exemptions.

Objectives. To understand the experiences of local health jurisdictions with Senate Bill 277 (SB277), the California law that eliminated nonmedical vaccine exemptions for public- and private-school entry.Methods. We conducted semistructured telephone interviews with health officers and local health department (LHD) staff in California between August and September 2017.Results. Two overall themes emerged: (1) vague legislative and regulatory language led to variation in the interpretation and implementation of SB277, and (2) lack of centralized review of medical exemptions allowed medical exemptions that are not consistent with valid contraindications for immunizations to be accepted. Variation in the interpretation and implementation was commonly reported with provisions related to individualized education programs and special education, and independent study programs and homeschooling. Without a centralized review of medical exemption requests, respondents reported variation in the interpretation of which specialties of physicians can write medical exemptions, which conditions constitute a valid contraindication for immunization, and the process for reporting a questionable or suspicious medical exemption.Conclusions. The regulatory language within SB277 led to variation in how the law was interpreted and implemented within and across LHD jurisdictions and school districts.

Using a positive deviance framework to identify Local Health Departments in Communities with exceptional maternal and child health outcomes: a cross sectional study.

BackgroundThe United States spends more than most other countries per capita on maternal and child health (MCH), and yet lags behind other countries in MCH outcomes. Local health departments (LHDs) are responsible for administering various maternal and child health programs and interventions, especially to vulnerable populations. The goal of this study was to identify local health department jurisdictions (LHDs) that had exceptional maternal and child health outcomes compared to their in-state peers – positive deviants (PDs) - in Washington, Florida and New York in order to support the identification of strategies that can improve community health outcomes.MethodsWe used MCH expenditure data for all LHDs in FL (n = 67), and WA (n = 35), and most LHDs in NY (n = 48) for 2009–2010 from the Public Health Activities and Services Tracking (PHAST) database. We conducted our analysis in 2014–2015. Data were linked with variables depicting local context and LHD structure. We used a cross-sectional study design to identify communities with better than expected MCH outcomes and multiple regression analysis to control for factors outside of and within LHD control.ResultsWe identified 50 positive deviant LHD jurisdictions across 3 states: WA = 10 (29 %); FL = 24 (36 %); NY = 16 (33 %). Overall, internal factor variables improved model fit for identifying PD LHD jurisdictions, but individual variables were not significant.ConclusionsWe empirically identified LHD jurisdictions with better MCH outcomes compared to their peers. Research is needed to assess what factors contributed to these exceptional MCH outcomes and over which LHDs have control. The positive deviance method we used to identify high performing local health jurisdictions in the area of maternal and child health outcomes can assist in better understanding what practices work to improve health outcomes. We found that funding may not be the only predictor of exceptional outcomes, but rather, there may be activities that positive deviant LHDs are conducting that lead to improved outcomes, even during difficult financial circumstances. This method can be applied to other outcomes, communities, and/or services.

Targeted health department expenditures benefit birth outcomes at the county level.

Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas. This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes. A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000-2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida. Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three specific examined MCH service areas demonstrating the strongest effects. Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and ensuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems.

Assessing Gaps in the Maternal and Child Health Safety Net

The Patient Protection and Affordable Care Act of 2010 proposed sweeping changes to health insurance and health care delivery systems. As a result, local health departments, community health centers, and other safety net providers are expected to play a role in providing access to care for millions of individuals. This study examines the availability of population-based services by local health departments and community health centers in the Midwest/Great Lakes region. For this study, the authors used secondary data on location of community health centers collected by the Health Resources and Services Administration and local health department services delivery from the 2008 National Profile of Local Health Departments. To simultaneously examine the geospatial patterns of service delivery and location of community health centers, the geographic information system shape files of local health department jurisdictions were used to examine prenatal care services. Additionally, the effect of service availability was examined by analyzing the rate of low birth weight births within the service areas of these facilities. Results show large variation in the distribution of community health centers. Additionally, the analysis of local health department services shows that prenatal care services are not available in every jurisdiction. Furthermore, the rates of low birth weight births in these areas are significantly higher than in areas where prenatal care is available. Future studies are needed to examine the relationship between safety net providers as well as their role in improving population health.

Where is obesity prevention on the map?: distribution and predictors of local health department prevention activities in relation to county-level obesity prevalence in the United States.

The system of local health departments (LHDs) in the United States has the potential to advance a locally oriented public health response in obesity control and reduce geographic disparities. However, the extent to which obesity prevention programs correspond to local obesity levels is unknown. This study examines the extent to which LHDs across the United States have responded to local levels of obesity by examining the association between jurisdiction-level obesity prevalence and the existence of obesity prevention programs. Data on LHD organizational characteristics from the Profile Study of Local Health Departments and county-level estimates of obesity from the Behavioral Risk Factor Surveillance System were analyzed (n = 2300). Since local public health systems are nested within state infrastructure, multilevel models were used to examine the relationship between county-level obesity prevalence and LHD obesity prevention programming and to assess the impact of state-level clustering. Two thousand three hundred local health department jurisdictions defined with respect to county boundaries. Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments. Likelihood of having obesity prevention activities and association with area-level obesity prevalence. The existence of obesity prevention activities was not associated with the prevalence of obesity in the jurisdiction. A substantial portion of the variance in LHD activities was explained by state-level clustering. This article identified a gap in the local public health response to the obesity epidemic and underscores the importance of multilevel modeling in examining predictors of LHD performance.

Effectiveness and Challenges of Regional Public Health Partnerships in Nebraska

The purpose of this study is to examine the effectiveness and challenges of regional public health partnerships by exploring the experiences of 2 multicounty LHDs in Nebraska. The selection of the 2 local health department (LHD) sites was on the basis of the history of prior collaborative partnership in the LHD jurisdiction. Both regional LHD jurisdictions cover a service area of 9 counties. A mixed method research design was used for this study. We first conducted an online survey to create an inventory of partnerships for each LHD site. Then, we collected quantitative data to measure the effectiveness of partnerships through a survey of community partners in both LHD sites. We also collected qualitative information through telephone interviews with community partners and LHD staff to examine the challenges for building an effective regional partnership. Regional public health partnerships are most effective in efficiency, but less effective in the areas of management and resource sufficiency. More effort is still needed to maximize the collaborative potential for the majority of partnerships in both regions. In particular, geographic distance and work demand were identified as the 2 major challenges by community partners. The community health planning partnership in the LHD site with prior history of collaboration was more effective than its counterpart without such history. Policy makers should consider developing policies to assist multicounty LHDs with improving their management of regional partnerships and with providing sufficient resources to support their regional partnerships. If possible, the formation of regional community health planning partnership should follow the geographic boundaries where prior collaboration already existed.

Preparedness for Climate Change Among Local Health Department Officials in New York State

Climate-change adaptation strategies that address locally specific climate hazards are critical for preventing negative health outcomes, and local public health care officials are key foci for adaptation planning. To assess New York State Local Health Department officials' perceptions and preparedness related to climate-sensitive health areas, and compare these with a national sample. Online survey instrument, originally used in a national survey of local health department (LHD) officials. New York State. Eligible participants included all New York State city and county LHD officials, 1 respondent per LHD. LHD officials' perceptions of (1) local climate-related public health effects, (2) preparation status and programming areas of LHDs, and (3) necessary resources to better address climate-related health risks. : Survey participants, representing a 54% response rate (with 93% of respondents completing more than 90% of the questions), perceived climate change as relevant to public health, and most noted that some of their existing programs already use or are planning to use climate adaptation strategies. Overall, fewer New York State respondents identified concerns or related expertise compared with the previous national survey. Many respondents expressed uncertainty regarding necessary additional resources. This type of assessment makes clear the high variability in perceived impacts and capacity at the level of LHD jurisdictions, and underscores the importance of sustained support for local climate-change preparedness programming. The implications of these findings are germane to other states with similar decentralized jurisdiction of public health. Findings from such surveys can bolster existing LHD programs, as well as inform long-term and emergency planning for climate change.

Understanding People Who Have Never Received HIV Medical Care: A Population-Based Approach

A substantial number of people living with human immunodeficiency virus (HIV) have never received HIV medical care despite the benefits of early entry to care. The United States has no population-based system that can be used to estimate the number of people who have never received HIV care or to monitor the reasons that care is delayed. Although local efforts to describe unmet need and barriers to care have been informative, nationally representative data are needed to increase the number of people who enter care soon after diagnosis. Legal requirements to report all CD4 counts and all HIV viral load levels (indicators of HIV care) in most states now make national estimates of both care entry and non-entry feasible. The Centers for Disease Control and Prevention (CDC) and five state and local health department jurisdictions are testing and evaluating methods for a standardized supplemental HIV surveillance system to characterize HIV-infected people across the U.S. who have not entered HIV care after their diagnosis. This article reviews the context, rationale, and potential contributions of a nationally representative surveillance system to monitor delays in receiving HIV care, and provides data from the formative phase of the CDC pilot project.

Involving Local Health Departments in Community Health Partnerships: Evaluation Results from the Partnership for the Public’s Health Initiative

Improving community health "from the ground up" entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an "inter-sector" enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public's Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative's five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served.