Consolidating Local Health Departments in the United States: Challenges, Evidence, and Thoughts for the Future

Hoornbeek, John; Morris, Michael; Libbey, Patrick; Pezzino, Gianfranco

doi:10.1177/0033354919829054

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Researchers, for example, have found that restrictive state budgets that allow for only specific programs to be implemented are a reason for LHDs using fewer EBPs. 5 Consequently, as the roles and responsibilities of LHDs in communities continue to expand and require resources to be distributed across more programs and services, 24 it may continue to be difficult for LHDs to use EBPs. It is also possible, however, that these results are an artifact of the questions used in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes

Hearld

Kelly

Tafili

2021

Journal of Public Health Management and Practice

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Objective:The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering. Design: Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence. Participants: Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States. Main Outcome Measure(s): Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings. Results: In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education. Conclusions: While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.

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Section: Discussionmentioning

confidence: 99%

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes

Hearld

Kelly

Tafili

2021

Journal of Public Health Management and Practice

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“…( Maani and Galea, 2020 , Alfonso et al, 2021 ) The U.S. spends less on prevention and public health services relative to overall health expenditures as compared to other OECD countries such as Canada, Italy, and South Korea, ( Gmeinder et al, 2017 ) while median per-capita spending among U.S. local health departments decreased by 25% from 2008 to 2016. ( Hoornbeek et al, 2019 ) Public health expenditures may provide a proxy measure of public health infrastructure, preparedness, and disposition for handling impacts of the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality

Liang,

Kiang,

Grant

et al. 2023

Preventive Medicine Reports

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“…While federal agencies are key food policy regulators, LHDs are primarily responsible for conducting foodborne illness prevention activities, inspections of food processing and food service establishments, and food safety education [ 14 ]. Variation may exist in LHDs’ engagement in the provision of such services, depending on their type of governance relative to state health agency authority configured as a centralized, decentralized, mixed, or shared structure [ 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Ensuring Food Safety for Americans: The Role of Local Health Departments

Shah

Shankar

Sittaramane

et al. 2022

IJERPH

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(1) Background: Several agencies in the United States play a primary role in ensuring food safety, yet foodborne illnesses result in about 3000 deaths and cost more than USD 15.6 billion each year. The study objectives included analyzing local health departments’ (LHDs) level of engagement in food safety and other related services, and LHDs’ characteristics associated with those services. (2) Methods: We used data from 1496 LHDs that participated in the 2019 National Profile of Local Health Departments Survey, administered to all 2459 LHDs in the United States. Logistic regression analyses were performed to model multiple dichotomous variables. (3) Results: An estimated 78.9% of LHDs performed food safety inspections, 78.3% provided food safety education, 40.7% provided food processing inspections, and 48.4% engaged in policy and advocacy. The odds for LHDs to directly provide preventive nutrition services were 20 times higher if the LHDs had one or more nutritionists on staff (Adjusted Odds Ratio or AOR = 20.0; Confidence Interval, CI = 12.4–32.2) compared with LHDs with no nutritionists. Other LHD characteristics significantly associated with the provision of nutrition services (p < 0.05) included population size, state governance (rather than local), and LHD having at least one registered, licensed, practical, or vocational nurse. The odds of providing food processing services were lower for locally governed than state-governed LHDs (AOR = 0.5; CI = 0.4–0.7). The odds of performing food safety inspections varied by LHD’s population size, whether a nutritionist was on staff, whether it was state-governed (vs. locally), and whether it completed a community health assessment (CHA) within 5 years. (4) Conclusions: LHDs play a critical role in ensuring safe food for Americans, yet variations exist in their performance based on their specific characteristics. Adequate funding and a competent workforce are essential for LHDs to utilize evidence-based practices and engage in policymaking and advocacy concerning food safety.

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Consolidating Local Health Departments in the United States: Challenges, Evidence, and Thoughts for the Future

Cited by 4 publications

References 18 publications

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes

Associations between county-level public health expenditures and community health planning activities with COVID-19 incidence and mortality

Ensuring Food Safety for Americans: The Role of Local Health Departments

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