Scientific Data Documentation
National Profile Of National Health Departments, July 1990
ABSTRACT
Supported by:
CENTERS FOR DISEASE CONTROL
Public Health Practice Program Office
Prepared by:
NATIONAL ASSOCIATION OF COUNTY HEALTH OFFICIALS
440 First Street N.W.
Washington, D.C. 20001
(202) 783-5550
FOREWORD
On behalf of the National Association of County Health Officials (NACHO), I am
pleased to present the first findings from the National Profile of Local
Health Departments. This project was established as an adjunct study to the
Assessment Protocol for Excellence In Public Health (APEX/PH). The National
Profile was developed to provide the public health community with a current
and comprehensive description of the nation's local health departments. The
following report presents a detailed portrait of the important role local
health departments play in our public health system.
This study was made possible through the participation of each of the local
health departments described within. I would like to thank all of the local
health officials and their staffs who participated in this project and made
this study possible. Further, all local health officials can and should take
pride in their contributions to public health, which are so clearly depicted
in the pages which follow.
It is anticipated that this report will serve to do more than simply provide a
long-overdue description of local public health. Local, state and federal
public health practitioners will find a variety of uses for the data. Local
health officials will be able to enhance their program analyses by using a
national database, including staffing, expenditure and services data, as a
reference point.
Those involved with local public health recommendations and policy decisions
will have an accurate depiction of the resources, abilities, and contributions
of local health departments nationwide. This report details the sizable role
local health departments play in health assessment, policy development, and
assurance, i.e., the core activities outlined in the Institute of Medicine's
report, The Future of Public Health. It also shows the great extent to which
local health departments provide health care in our communities through
prevention activities and the delivery of personal health services.
In follow-up to this report, NACHO is performing more in-depth analyses of the
database, and is researching specific local health issues that are of national
interest. NACHO also has the potential to use this profile to launch
additional research projects, perhaps using a sampling frame, and to monitor
trends in local health programs and operations. With this in mind, we are
looking forward to presenting many more reports from the National Profile of
Local Health Departments.
Your suggestions and comments on this report are invited. Please address your
communications to the National Association of County Health Officials, 440
First Street, N.W., Suite 500, Washington, D.C. 20001.
Martin P. Wasserman, M.D., J.D.
President, National Association of County Health Officials
Director, Montgomery County Health Department, Maryland
ACKNOWLEDGEMENTS
Special thanks are due to all of the local health officials who participated
in this project and made this report possible. It is our sincere wish that
the results of the National Profile will be of great use to them.
The development of the National Profile of Local Health Departments has been
directed by the APEX/PH Registry Committee and the NACHO Review Board.
The APEX/PH Registry Committee members are:
Arthur P. Liang, M.D., M.P.H., Assistant Director for Surveillance and
Epidemiology, Public Health Practice Program Office, Centers
for Disease Control, Chairperson;
Larry M. Belmont, M.P.H., M.P.A., Director of the Panhandle Health
District, Idaho;
Beverly C. Flynn, R.N., Ph.D., F.A.A.N., Professor and Director, Healthy
Cities Indiana, Department of Community Health Nursing,
Indiana University;
Gary Gurian, M.D., Director of the Allentown Bureau of Health,
Pennsylvania;
William Shonick, Ph.D., Professor of Health Services, UCLA School of
Public Health;
Pomeroy Sinnock, Ph.D., Centers for Disease Control, was Chairperson of
the APEX/PH Registry Committee from its inception in 1988 to
April 1990.
The NACHO Review Board members are:
James Giuffre', M.P.H., Director, North Central District Health
Department, Idaho;
David Gurule', M.P.H., Chief Health Planning Officer, Department of
Health and Hospitals, City of St. Louis, Missouri;
Mary Luth, M.P.H., M.P.A., Director, Washington County Public Health
Department, Minnesota;
Bruce Parsons, M.P.A., Director, Gaston County Health Department, North
Carolina.
This project was made possible by the following individuals who noted the need
for such a profile and guided its progress at all stages:
Robert G. Harmon, M.D., M.P.H., Administrator, Health Resources and
Services Administration, who served as the Chairperson of the
APEX/PH Steering Committee from July 1987 to February 1990:
Joel Nitzkin, M.D., D.P.A., Medical Director, Louisiana Office of Health
and Hospitals, Louisiana, who served as Chairperson of the
APEX/PH Work from July 1987 to September 1989;
William Dyal, Director, Division of Public Health Systems, Public Health
Practice Program Office, CDC;
Charles Bacon, Project Officer APEX/PH, Public Health Advisor, Public
Health Practice Program Office, CDC;
C. Joseph Webb, former Project Officer APEX/PH, Public Health
Advisor, Public Health Practice Program Office, CDC.
This project is also indebted to the members of the APEX/PH Steering Committee
and the APEX/PH Work Group (Appendix 3).
The contributions of the following are also appreciated:
the U.S. Conference of Local Health Officers;
the State Health Agencies and their staffs;
the Association of State and Territorial Local Health Liaison Officials;
the statewide associations of local health officials.
This project is supported by the Public Health Practice Program Office,
Centers for Disease Control.
This report was prepared by the following staff of the National Association of
County Health Officials:
Jani Bigelson, M.P.H., Assistant Director;
John Grasse, M.P.H., Research Assistant;
Clark Greene, M.A., Research Associate;
Nancy Rawding, M.P.H., Executive Director.
Special thanks to Clark Greene, whose diligence, organization and unflappable
calm made possible the development of the National Profile of Local Health
Departments.
LIST OF FIGURES
Local Health Department Overview
Figure 1 Number of Local Health Departments by State
Figure 2 Populations of Local Health Department Jurisdictions
Local Health Officers
Figure 3 Degrees of Local Health Officers
Figure 4 Degrees of Local Health Officers by Jurisdiction
Figure 5 Percent of Local Health Departments with a Full Time
Health Officer by Jurisdiction Population
Figure 6 Tenure of Local Health Officers
Figure 7 Mean and Median Local Health Officer Tenure by
Jurisdiction Population
Local Health Department Jurisdictions
Figure 8 Local Health Department Jurisdictions
Figure 9 Local Health Departments with Boards of Health within
Jurisdiction
Figure 10 Percent of Local Health Departments with Boards of
Health within Jurisdiction by Jurisdiction Population
Local Health Department Budgets and Selected Sources of Revenue
Figure 11 Local Health Department Annual Expenditures
Figure 12 Local Health Department Mean and Median Annual
Expenditures by Jurisdiction Population
Figure 13 Percent of Local Health Departments that Charge for
Personal Health Services by Jurisdiction Population
Figure 14 Percent of Local Health Departments that Accept Medicaid
Reimbursement by Jurisdiction Population
Local Health Department Staff
Figure 15 Local Health Department Number of Full Time Employees
Figure 16 Local Health Department Mean and Median Number of Full
Time Employees by Jurisdiction
Local Health Department Functions and Services
Figure 17 Percent of Local Health Departments that Reported Select
Staff Full and/or Part Time
Figure 18 Percent of Local Health Departments that Reported Select
Staff Full and/or Part Time Jurisdiction Population
Figure 19 Percent of Local Health Departments that Reported Being
Active in Assessment Functions and Services
Figure 20 Percent of Local Health Departments that Reported Being
Active in Assessment Functions and Services by
Jurisdiction Population
Figure 21 Percent of Local Health Departments that Reported Being
Active in Policy Development Functions and Services
Figure 22 Percent of Local Health Departments that Reported Being
Active in Policy Development Functions and Services
by Jurisdiction Population
Figure 23 Percent of Local Health Departments that Reported Being
Active in Selected Assurance Functions and Services
Figure 24 Percent of Local Health Departments that Reported Being
Active in Selected Assurance Functions and Services by
Jurisdiction Population
Figure 25 Percent of Local Health Departments that Reported Being
Active in Environmental Health Assurance Functions and
Services
Figure 26 Percent of Local Health Departments that Reported Being
Active in Environmental Health Assurance Functions and
Services by Jurisdiction Population
Figure 27 Percent of Local Health Departments that Reported Being
Active in Personal Health Assurance Functions and
Services
Figure 28 Percent of Local Health Departments that Reported Being
Active in Personal Health Assurance Functions and
Services (Cont'd)
Figure 29 Percent of Local Health Departments that Reported Being
Active in Personal Health Assurance Functions and
Services by Jurisdiction Population
Figure 30 Percent of Local Health Departments that Reported Being
Active in Personal Health Assurance Functions and
Services by Jurisdiction Population (Cont'd)
Figure 31 Percent of Local Health Departments that Reported Being
Active in Selected Functions and Services by Reported
Number of Full Time Employees
Figure 32 Percent of Local Health Departments that Reported Being
Active in Selected Functions and Services by
Respondent's Public Health Service Region
INTRODUCTION
The National Profile of Local Departments was conceived in 1987 as an adjunct
project to the Assessment Protocol for Excellence in Public Health (APEX/PH).
The goal of APEX/PH, a collaborative effort of public health organizations*,
is the development of a self-assessment process to assist local health
departments to better meet the needs of their communities. The resulting
APEX/PH workbook is a manual for local health departments to use in assessing
and improving their organizational capacity, assessing the health status of
the community, and involving the community in a more effective pursuit of
public health objectives. The National Profile was developed to learn more
about the current capacities of local health departments and to therefore
shape the development of the APEX/PH Workbook so that it would be as useful as
possible to all local health departments.
Beyond its use in the development of the APEX/PH Workbook, the National
Profile serves to additional purposes, First, it provides a much-needed
description of the nation's local health departments; and second, it provides
a sampling frame for future studies of the contributions of local health
departments to the nation's public health. The National Profile is an
extensive compilation of information on local health departments. The
information was obtained from 2,269 local health departments that reported on
their staffing size and patterns, budget expenditures, public health
activities, and other characteristics.
A brief review of the literature shows the importance of local health research
and points to the timeliness of the National Profile. The earliest efforts
were undertaken in 1923 by the American Public Health Association's Committee
on Administrative Practice (CAP)(1). Data were collected from 83 city health
departments on their expenditures, organization and public health practices.
The committee continued to focus on local health services through the
development of "Appraisal Forms" that were used to collect information on
public health practices and provide feedback to the health officer. In 1943,
the committee published the report entitled "Health Practice Indices," which
contained data on 178 local health departments in 31 states and 4 Canadian
provinces(2).
In 1945, Haven Emerson, M.D., Chairman of the CAP, released the milestone
report Local Health Units for the Nation, in which he extensively described
the existing local health system and made recommendations for an ideal local
health system(3). This included the recommendation that local health services
be provided in units (departments) serving no less than 50,000 people. This
was though to represent the smallest population for which a department would
be able to provide efficient and effective public health services. He
suggested that, for the existing population to be served effectively, a total
of 1,197 health units would be needed.
Terris and Kramer studied local health departments in 1947 to measure the
level of medical care being provided by these departments(4). At that time,
they reported a total of 1,385 full time departments (including state health
districts). This work demonstrated that local health departments were moving
beyond the heretofore traditional boundaries of preventive services and into
the provision of therapeutic services.
Joseph Mountin, in 1953, published the Guide to Health Organization in the
United States, which gave a detailed accounting of the nation's health system
on the federal, state and local levels(5). He described the percent of the
population served by local health service sin the various regions of the
country, and outlined sample budgets for health departments serving various
sized populations. He reported a total of 1,239 local health departments (963
county and 276 city units).
The next major study, initiated by the Public Health Service in 1964 and
published in 1968, again focused on the medical activities local health
departments were providing(6). At that time, the Public Health Service
maintained a directory** of local health units that identified 1,703 local
health units, all of which were polled as to their responsibilities, services,
relation to other providers, and role in assuring quality of care in its
jurisdiction. The results, using the earlier data from Terris and Kramer's
study as a baseline, indicated local health departments were becoming
increasingly involved in medical care.
C. Arden Miller's study in the mid-70's identified approximately 1,980 local
health departments(7). This study provided the public community with summary
data concerning the jurisdictions, organization, finance, functions, and
staffing of local health departments. This extensive work also provided
information on local health officer's training and salaries. Miller concluded
that local health departments were extensively involved in rendering health
services, including direct personal health services.
More recent estimates of the numbers and functions of local health departments
have been done. An unpublished study by Mullan and Smith(8) (The Johns Hopkins
University) was conducted by polling the state health departments and resulted
in a count of 3,233 local health departments. The Public Health Foundation,
responsible for maintaining the Association of State and Territorial Health
Officials (ASTHO) Reporting System, reported that, as of 1989, "nearly 3,000
local health departments"(9) existed. Both reports relied primarily on the
states for their estimates.
The need for current and detailed local health department data has been widely
cited. This was most recently emphasized in the Institute of Medicine's
report The Future of Public Health, which included the frank admission that,
"..data on the activities of local health departments are hard to come by."(10)
The National Profile is a response to this problem. It provides current,
detailed, primary source data on our nation's local health departments.
_________________________
* The participating organizations are: The American Public Health
Association (APHA); the Association of Schools of Public Health (ASPH); the
Association of State and Territorial Health Officials (ASTHO); the center for
Disease Control (CDC); the National Association of County Health Officials
(NACHO); the U.S. Conference of Local Health Officers (USCLHO).
** This directory was discontinued after 1971.
OVERVIEW
Data Source
The study population for this profile is all local health departments in the
United States. Three sources were used to insure that all possible local
health departments were identified. The U.S. Conference of Local Health
Officers (USCLHO) and NACHO both contributed their member mailing lists.
Additionally, each state health agency were contacted, and the names and
addresses of the local health departments in their states were obtained from
them. After eliminating duplicates, 3,241 local health entities were
identified as the initial study population.
Definition
One of the challenges of this and similar projects has been the development of
a standard "case definition" for a local health department. A great diversity
exists among the public health units at the local level; this makes it
difficult to arrive at a single definition. For the purpose of this study, a
local health department was defined as:
an administrative or service unit of local or state government, concerned with
health, and carrying some responsibility for the health of a jurisdiction
smaller than the state.
This definition is adapted from the one used by C. Arden Miller in 1974* and
the one used by ASTHO**. This definition is less restrictive than either, both
of which included one or more full time employee(s). The ASTHO definition
further restricts this by adding that it be a public health employee. In this
analysis responses received from units with fewer than one full time employee,
units that operate on a part time basis, and independently operating nursing
and environmental units were included.
__________________________
* Miller's operational definition of a local health department:"...an
administrative and service unit of local or state government, concerned with
health, employing at least one full time person, and carrying some
responsibility for the health of a jurisdiction smaller than the state."
** The ASTHO definition of a local health department: An official
(governmental) public health agency which is, in whole or part, responsible to
a substate governmental entity or entities. An entity may be a city, county,
city-county, federation of counties, borough, township, or any other type of
substate governmental entity. A local health department must: have a staff
of one or more full-time professional public health employees (e.g., public
health nurse, sanitarian); deliver public health services; serve a definable
geographic area; have identifiable expenditures and/or budget in the political
subdivision (s) it serves.
Responses received from the following entities were excluded from the
analysis:
sub-units or satellite offices of local health departments;
district units providing support for independent local health
units (such as the district offices in Alabama, Georgia,
Louisiana, Mississippi, New Mexico, South Carolina, Tennessee, and
Virginia. However, the independent local health units from these
states were included.);
sub-state extensions of the state that were not considered by the
state to be local health departments (such as the units in
Delaware, Hawaii, Rhode Island, Vermont, and many in
Pennsylvania);
non-governmental agencies (such as those in Alaska, which for the
most part provide local health services through nonprofit
corporations.)
By applying these parameters, eliminating duplicates, and removing units that
not longer existed (noted as miscellaneous below), the study population was
adjusted to 2,932. Table 2 details the exclusions that were made.
_____________________________________________________________________________
TABLE 1
STUDY POPULATION
Initial Study Population 3,241
Exclusions
Corporate Agencies 15
Districts 90
Duplicates 28
State Agency Extensions 84
Sub-units, Satellite Offices 60
Miscellaneous 32
Final Study Population 2,932
_____________________________________________________________________________
Response Rate
Completed data collection instruments were received from 2,269 local health
departments that fit the above definition, and they were from all 46 states
which have local health departments. The overall response rate was 77%.
Thirty states had response rates over 80%; of these, eight states had 100%
response rates. Five states had response rates under 50%, and no state had a
response rate lower than 30%.
Strengths
The response rate has been described above, but it is important to note that
this is one of the highest response rates reported in the literature. Only
the PHS study in 1966 achieved a higher response rate (78.1%); however, the
study population was smaller (1,703). The response rate for this study lends
confidence to the results.
This is the most extensive data set on local health departments available
since the mid-seventies. The database addresses a wide array of local health
department issues, including:
local health department assessment, policy development and
assurance activities;
local health officer degrees, licensure, tenure, and full or part
time status;'
the presence or absence of a local board of health'
numbers and types of employees;
annual expenditures.
Equally important is the fact that these data are primary source data only,
i.e. the database contains reported directly from local health officials.
The data were tested for reliability, with good results. A random sample of
five percent of the respondents were retested, using telephone interviews, on
20 of the variables. Matching responses were give 82% of the time.
A great strength of the National Profile is that it will allow for specific
research of a representative sample of health departments. The ability to
generate representative samples of local health departments is a new capacity
for the public health system. Scientific analyses that could not have been
completed before may now be carried out quickly and efficiently.
Limitations
As previously discussed, it is difficult to derive a case definition for local
health departments that captures the diversity that exists across the nation.
This has clearly been an issue for other studies, as evidenced by the variance
in the number of local health departments reported. Lack of a common
definition limits the ability to directly compare the results of this analysis
to previous studies.
A second limitation is the effect of the non-respondents. In an effort to
learn something about the health departments which did not respond, population
data of the jurisdictions that they served were obtained from the U.S. Census
Bureau(11) and added to the database. Analyzing these data showed that the
response rate was significantly lower for local health departments serving
smaller jurisdiction populations than for those serving larger jurisdiction
populations (Table 2). Additionally, of the 663 non-respondents, 23% of them
were from two New England states, sand 47% of the non-respondents were from 12
Southern states. Therefore, the data are skewed against local health
departments in those regions that serve less populated jurisdictions.
______________________________________________________________________________
TABLE 2
RESPONSE RATE BY JURISDICTION POPULATION
Population Response Rate N
0 To 24,999 71% 1,337
25,000 To 49,999 81% 649
50,000 To 99,999 85% 448
100,000 To 499,999 90% 357
500,000 + 99% 84
Totals 79%* 2,875
*The overall response rate for this analysis is higher than the response rate
mentioned above (77%). This is due to the exclusion from this analysis of 57
non-respondents for which population data was unavailable.
______________________________________________________________________________
A third limitation involves terminology. The data collection instrument may
have been interpreted differently by the respondents, for example: board of
health; health planning; and primary care could have been interpreted
differently. Definitions were not provided for the phrases or terms used, and
the interpretation was left to the respondent.
Similarly, respondents were asked to review a list of local health department
functions and services, and to indicate which of them they were "active in."
No definition was provided for the term "active in". Therefore they could
respond affirmatively if they provided the actual service, if they provided
referrals only, or if the service was contracted out.
RESULTS
These descriptive results provide an excellent overview of this nation's local
public health system. These data represent the initial findings of the
National Profile of Local Health Departments. The continuing analysis of the
database has and will produce more in-depth results pertaining to specific
local health issues, much of which will be released in future reports.
The highlights of the descriptive findings are:
there are 2,932 local health departments in 46 states nationwide;
65% of the respondents serve jurisdictions of less than 50,000
population, and 4% service populations of 500,000 or more;
67% of the departments report having a full time health officer,
and 54% of the health officers report having held their present
position for at least five years;
70% of the respondents report having a board of health within
their jurisdiction;
76% of all local health departments serve a county, multi-county,
or city/county jurisdiction;
18% report annual expenditures of less than $100,000, and 28%
report annual expenditures in excess of $1,000,000;
75% of all respondents charge for services, and 76% accept
Medicaid reimbursement;
46% of the respondents report having fewer than 10 full time
employees, and 10% had 100 or greater;
90% of all local health departments report employing a full and/or
part time registered nurse (either directly or though contracted
services), and 62% report the same for a physician.
The National Profile also provides information on the extent to which local
health departments are assessing the health of their communities, developing
policies to promote public health, and assuring the public's health through
direct or indirect service provision. It is important to note that localities
nationwide have developed unique systems for providing health services. These
systems rely on public, private and volunteer participation. Therefore,
instances in this study where local health departments do not report being
active in specific functions or services may not indicate a lack of services.
In many instances these functions and services are provided elsewhere within
the community.
For assessment functions and services:
87% are active in reportable disease data collection and analysis;
92% report being active in communicable disease epidemiology and
surveillance.
For policy development activities:
52% are active in priority setting;
57% are active in health planning;
59% are active in health code development and enforcement.
For assurance activities:
72% of the respondents report being active in some inspection
activity;
72% of the respondents report being active in some licensing
activity.
74% report being active in health education activities.
In environmental health assurance:
46% are active in hazardous waste management;
55% are active in solid waste management;
60% report being active in water pollution;
68% report being active in public water supply safety;
70% are active in vector and animal control;
77% are active in individual water supply safety;
79% report being active in the sewage disposal systems area.
In personal health assurance services:
43% report laboratory services;
47% report activities assisting handicapped children;
50% are active in home health care;
57% report being active in Acquired Immune Deficiency Syndrome
(AIDS) resting and counseling;
59% report being active in prenatal care;
60% report being active in family planning;
69% report being active in the prevention of chronic diseases;
73% report activity in the control of sexually transmitted
diseases;
81% are active in the control of tuberculosis;
84% are active inn child health;
92% are active in immunization programs.
There recent Institute of Medicine report labeled local health departments,
"...the critical components of the public health system that directly
deliver public health services to citizens."(12)
The National Profile of Local Health Departments demonstrates the truth of
this statement by describing the multitude of activities that local health
departments conduct, both in protecting and promoting the public's health, and
through providing direct health care delivery.
DISCUSSION
The National Profile is an excellent resource for local health department data
and has met its primary goal of providing a description of local health
departments.
It is clear from this description that local health departments contribute
greatly to the nation's health through assessment, policy development, and
assurance. Whereas the approximately 100 units that existed in the early part
of this century were primarily assessment-oriented, local health departments
are now very active in community assessment, communicable disease
surveillance, personal services, environmental epidemiology, and other
emerging environmental health areas. These data demonstrate how local health
departments have responded to new and perhaps more difficult public health
challenges.
Problems involving AIDS, the environment, the indigent care have emerged at a
time when the federal government is returning much of the responsibility for
health to the states, and the states must turn to local health agencies. This
added responsibility is particularly problematic for those at the local level
who are trying to respond to the increasing demand for services without the
added economic base from which to pay for these services.
The increased understanding of the functions of local health departments, the
constraints within which they operate, and their fit within the framework of
all services in the community is one of the most beneficial aspects of this
study. The information from the Profile can also be used to obtain a better
understanding of the totality of public health and personal health services
available in a community. Taken together with information on the presence of
community health centers, hospitals, and private physicians, one gets a more
accurate impression of the services actually available in a community.
Information contained in this Profile also provides the opportunity to better
support these important community institutions. Using the data in the
Profile, technical assistance, professional courses, and other support
services can be tailored to meet the particular needs of local health
departments.
The development and maintenance of the Profile will provide the capacity to
monitor trends in the functions, activities and other characteristics of local
health departments. Changes in staffing patterns, the educational levels or
tenure of local health officials, budget expenditures, services provided,
etc., can be followed. It will be possible to analyze some hypotheses already
set forth in the public health literature. For example, as previously stated,
1945 Emerson(13) recommended that local health departments should serve
populations of no less than 50,000. Many experts have debated the merits of
this. By following the overall development of local health departments, it
will be possible to see if there is a natural progression toward this.
Further study on this and other related issues is warranted, and the National
Profile will facilitate such research.
The National Profile of Local Health Departments helps to make visible the
important role of local health departments in the nation's health system.
FIGURES
Introduction
The data in the following figures are presented as overall
frequency percents, and in relation to the size of the population
of the respondent's jurisdiction. This is done to show the
variations that exist among local health departments, and to
provide a framework in which local health officials may compare
themselves to departments in jurisdictions of similar size. The
population variable was used for this analysis because of its
relatively high predictive value in relation to the other
variables. Select variables are also shown in relation to the
respondent's staff size, and by U.S. Public Health Service
Region (Appendix 2).
Please note, the population or "N" for each analysis varies
slightly due to the fact that not all respondents answered each
item on the data collection instrument.
21. Number of Local Health Departments (LHD) by State
This table displays the definition of a local health department as
stated in this report. The total number of local health
departments nationwide was determined to be 2,932. Due to the
variations that exist among local health departments, the number
in a state is not an indication of the level of local public health
services.
None: VT, DE, RI, HI
1 to 24: ME, NH, PA, MD, IA, ND, SD, NE, WY, ID, NV, UT, AZ, AK
25 to 49: WV, SC, MI, MN, WA, OR, NM
50 to 99: MT, CA, CO, KS, OK, TX, AR, LA, MS, AL, TN, IL, IN,
KY, NC, FL, NY
100 or more: MA, CT, VA, OH, GA, MO, WI, NJ
22. Populations of Local Health Department Jurisdictions
This table shows the distribution of the local health departments
by the reported population of their jurisdiction.
POPULATION PERCENTAGE
0 to 24,999 42%
25,000 to 49,999 23%
50,000 to 99,999 17%
100,000 to 499,999 14%
500,000 + 4%
N = 2,263
23. Degrees of Local Health Officers
This table shows the distribution of the responding local health
officers according to the degrees that they reported to hold. All
degrees and combinations of degrees reported are collapsed into the
five categories shown. The results show that 51% of the
respondents reported holding medical degrees, and 23% reported
holding graduate public health degrees.
DEGREES REPORTED PERCENTAGE
Medical Degree 36%
MD + Graduate Public
Health Degree 14%
MD + Other Graduate
Degree 1%
Graduate Public Health
Degree Only 9%
Other Graduate Degree 13%
Other Non-Graduate
Degree 27%
N = 2,193
24. Degrees of Local Health Officers by Jurisdiction Population
This cross-tabulation table displays the distribution of the
responding local health officers according to their reported
degrees and according to the reported population of their
jurisdictions. The table should be read column-wise to determine
the total distribution of local health officers by their reported
degrees for each population group. (See Figure 3 for overall
data.)
DEGREES- 0 to 25,000 to 50,000 to 100,000 500,000+
24,999 49,999 99,999 499,999
Medical Degree 41% 38% 31% 27% 18%
MD + Graduate
Public Health
Degree 9% 10% 12% 30% 52%
MD + Other Grad.
Degree 0% 1% 1% 2% 6%
Graduate Public
Health Degree
Only 3% 10% 15% 20% 4%
Other Graduate
Degree 9% 16% 19% 13% 10%
Other Non-Graduate
Degree 38% 25% 22% 8% 10%
Column Total 100% 100% 100% 100% 100%
N = 913 511 372 315 82
5. % of LHD w/ a Full Time Health Officer by Jurisdiction Pop.
This table shows the percent of responding health depts that
reported having a full time health officer for each of the five
population groups. Overall, 67% reported a full time health
officer (N = 2,124).
0 to 25,000 to 50,000 to 100,000 to 500,000+
24,999 49,999 99,999 499,999
57% 62% 75% 86% 99%
N = 872 495 363 312 82
6. Tenure of Local Health Officers (Years as of 12/89)
This table displays the distribution of the responding local health
officers according to their reported years of service in their
present position as of December 1989.
Tenure Percent
Less than 2 years 18%
2 to 4.9 years 28%
5 to 9.9 years 23%
10 to 19.9 years 24%
20 years or more 7%
N = 1,965
7. Mean & Median Local Health Officer Tenure by Jurisdiction Pop.
(Years as of 12/89)
This table shows the mean and median reported tenure for the local
health officers in each of the population groups. Overall, the
mean tenure was 8.0 years, and the median tenure was 5.8 years (N = 1,965).
MEAN MEDIAN
0 to 24,999 8.1 5
(N = 790)
25,000 to
49,999 8.4 6.1
(N = 460)
50,000 to
99,999 8 6.2
(N = 340)
100,000 to
499,999 8 6.5
(N = 300)
500,000 + 5.7 3.5
(N = 75)
8. Local Health Department Jurisdictions
This table shows the distribution of the local health departments
by their reported jurisdictions.
Jurisdiction Percent
County 49%
City/County 20%
Multi-County 7%
City 10%
Town-Township 13%
Other 1%
9. Local Health Depts. w/ Boards of Health within Jurisdiction
This table shows the percent of the responding local health
departments that reported having a board of health within their
jurisdiction, and those that reported not having a board of health.
Has Board of Health 70%
No Board of Health 30%
N = 2,211
10. % of LHD w/ Boards of Health within Jurisdiction
This table shows the percent of responding local health departments
that reported having boards of health for each population group.
(See Figure 9 for overall data.)
N = Percent
0 to 24,999 920 67%
25,000 to 49,999 514 75%
50,000 to 99,999 376 77%
100,000 to 499,999 319 72%
500,000 + 82 49%
11. Local Health Department Annual Expenditures
This table displays the distribution of the respondents according
to their reported annual expenditures. The fiscal years that were
reported for were mostly FY88 and FY89. In a few instances data
were submitted by FYs 87 and 86. These data were used without
adjustment.
Expenditures ($) Percent
0 to 99,999 18%
100,000 to 249,999 21%
250,000 to 499,999 19%
500,000 to 999,999 14%
1,000,000 + 28%
N = 1,960
12. Local Health Dept. Mean & Median Annual Expenditures
This table shows the mean and median reported annual expenditures
for the local health departments in each of the population groups.
The axis indicating annual expenditures is scaled logarithmical to
display the great disparity of annual expenditures among local
health departments serving different populations. Overall, the
reported mean annual expenditure was $2,734,540, and the median was
$364,436 (N = 1,960).
Annual Expenditures ($)
1 to 1,000,000,000 Mean Median
0 to 24,999 197,431 131,273
(N = 758)
25,000 to 49,999 499,898 375,000
(N = 467)
50,000 to 99,999 1,079,206 860,000
(N = 359)
100,000 to 499,999 3,629,878 2,588,965
(N = 295)
500,000 + 43,602,004 16,100,000
(N = 81)
13. % of LHD that Charge for Personal Health Services
This table indicates the percent of local health departments that
reported charging for services for each of the population groups.
Overall, 75% reported charging for services (N = 2,105).
N = Percent
0 to 24,999 838 67%
25,000 to 49,999 509 75%
50,000 to 99,999 366 79%
100,000 to 499,999 311 88%
500,000 + 81 95%
14. % of Local Health Depts. that Accept Medicaid Reimbursement
This table indicates the percent of local health departments that
reported accepting Medicaid reimbursement for each of the
population groups. Overall, 76% reported accepting Medicaid
reimbursement (N = 1,951).
N = Percent
0 to 24,999 762 70%
25,000 to 49,999 462 75%
50,000 to 99,999 347 78%
100,000 to 499,999 300 87%
500,000 + 80 95%
15. Local Health Dept. Number of Full Time Employees
This table shows the distribution of the responding local health
departments by the number of full time employees that they
reported.
No. of Full Time
Employees Percent
0 - 4 26%
5 - 9 20%
10 - 24 22%
25 - 99 22%
100 + 10%
N = 2,137
16. Local Health Dept. Mean & Median # of Full Time Employees
This table shows the mean and median number of full time employees
reported by the respondents for each of the population sets. The
axis indicating number of employees is scaled logarithmical.
Overall, the mean number of full time employees is 61.1, and the
median is 11 (N = 2,137).
Mean Median
0 to 24,999 6.3 4
(N = 857)
25,000 to 49,999 15.4 11
(N = 513)
50,000 to 99,999 33.5 29
(N = 375)
100,000 to 499,999 96.1 72
(N = 310)
500,000 + 914.9 800
(N = 82)
17. % of LHD that Reported Select Staff Full and/or Part Time
This table shows the percents of the responding local health
departments that reported employing the listed personnel, either
directly or through contracted services, in a full and/or part time
capacity.
Staff Positions Percent
Clerical/Secretarial 94%
Dentist 17%
Engineer/Sanitarian 77%
Epidemiologist/Statistician 11%
Health Educator 37%
Licensed Practical Nurse 33%
Nutritionist/Dietician 51%
Physician 62%
Planner/Analyst 8%
Public Information Specialist 6%
Registered Nurse 90%
Social Worker 27%
Toxicologist/Environmental Specialist 18%
N = 2,263
18. Figure 17 by Jurisdiction Population
This table shows the percents of the responding local health
departments in each of the population groups that reported
employing the list personnel, either directly or through contracted
services, in a full and/or part time capacity. (See Figure 17 for
overall data).
Jurisdiction Population
Staff
Positions 0 to 25,000 to 50,000 to 100,000 to 500,000+
24,999 49,999 99,999 499,999
Clerical/
Secretarial 89% 97% 98% 99% 100%
Dentist 7% 14% 18% 36% 73%
Engineer/
Sanitarian 65% 80% 87% 92% 93%
Epidemiologist/
Statistician 4% 3% 8% 33% 87%
Health
Educator 17% 31% 54% 71% 95%
Licensed
Practical
Nurse 23% 28% 39% 54% 72%
Nutritionist/
Dietician 33% 49% 67% 78% 93%
Physician 44% 65% 75% 88% 99%
Planner/
Analyst 2% 2% 5% 21% 71%
Public Information
Specialist 2% 2% 5% 14% 52%
Registered
Nurse 83% 93% 98% 96% 99%
Social Worker 13% 24% 35% 52% 68%
Toxicologist/
Environmental
Specialist 10% 14% 18% 37% 59%
N = 954 526 380 320 83
19. % of LHD Active in Assessment Functions & Services
Percent of Local Health Departments that Reported Being Active in
Assessment Functions and Services
This table shows the percent of respondents that reported being
active in the listed assessment functions and services.
Data Collection and Analysis Percent
Behavioral Risk Assessment 33%
Morbidity Data 49%
Reportable Diseases 87%
Vital Records and Statistics 64%
Epidemiology and Surveillance
Chronic Disease 55%
Communicable Disease 92%
N = 2,263
20. Figure 19 by Jurisdiction Population
Percent of Local Health Departments that Reported Being Active in
Assessment Functions and Services by Jurisdiction Population
This table shows the percent of respondents that reported being
active in the listed assessment functions and services for each of
the population groups. (See Figure 19 for overall data.)
Jurisdiction
Population 0 to 25,000 to 50,000 to 100,000 to 500,000+
24,999 49,999 99,999 499,999
Functions & Services
Data Collection and Analysis Activities
Behavioral Risk
Assessment 25% 33% 42% 43% 51%
Morbidity
Data 39% 50% 58% 63% 76%
Reportable
Diseases 81% 90% 92% 93% 95%
Vital Records
& Statistics 53% 67% 69% 75% 89%
Epidemiology and Surveillance Activities
Chronic
Disease 48% 59% 58% 59% 65%
Communicable
Disease 87% 94% 95% 96% 98%
N = 954 526 380 320 83
21. % of LHD Active in Policy Development Functions and Services
Percent of Local Health Departments that Reported Being Active in
Policy Development Functions and Services
This table shows the percent of respondents that reported being
active in the listed policy development functions and services.
Functions and Services Percent
Health Code Development and
Enforcement 59%
Health Planning 57%
Priority Setting 52%
N = 2,263
22. Figure 21 by Jurisdiction Population
Percent of Local Health Depts. that Reported Being Active in Policy
Development Functions and Services by Jurisdiction Population
This table shows the percent of respondents that reported being
active in the listed policy development functions and services for
each of the population groups. (See Figure 21 for overall data.)
Functions &
Services 0 to 25,000 to 50,000 to 100,000 to 500,00+
24,999 49,999 99,999 499,999
Health Code
Development and
Enforcement 47% 58% 71% 73% 84%
Health
Planning 47% 57% 66% 71% 83%
Priority
Setting 37% 52% 63% 74% 84%
N = 954 526 380 320 83
23. % of LHD Active in Selected Assurance Functions and Services
Percent of Local Health Departments that Reported Being Active
in Selected Assurance Functions and Services
This table shows the percent of respondents that reported being
active in assurance functions and services, in the inspection,
licensing and health education areas.
Functions and Services Percent
Inspection Activities
Food and Milk Control 72%
Health Facility Safety/Quality 47%
Recreational Facility Safety/Quality 54%
Other Facility Safety/Quality 32%
Licensing Activities
Health Facility 22%
Other Facility 72%
Health Education 74%
N = 2,263
24. Figure 23 by Jurisdiction Population
Percent of Local Health Departments that Reported Being Active
in Selected Assurance Functions and Services
This table shows the percent of respondents that reported being
active in the listed assurance functions and services, in the
inspection, licensing and health education areas, for each of the
population groups. (See Figure 23 for overall data.)
Functions & 0 to 25,000 to 50,000 to 100,000 to 500,000+
Services 24,999 49,999 99,999 499,999
Inspection Activities
Food & Milk
Control 65% 74% 77% 84% 80%
Health Facility
Safety/
Quality 43% 49% 48% 49% 55%
Recreational
Facility Safety/
Quality 45% 57% 61% 65% 68%
Other Facility
Safety/
Quality 25% 33% 34% 40% 58%
Licensing Activities
Health
Facilities 24% 20% 16% 22% 29%
Other
Facilities 63% 74% 77% 83% 78%
Health
Education 66% 74% 80% 88% 95%
N = 954 526 380 320 83
25. % of LHD Active in Enviro. Health Assurance Func. & Serv.
Percent of Local Health Departments that Reported Being Active
in Environmental Health Assurance Functions and Services
This table shows the percent of respondents that reported being
active in environmental health assurance functions and services.
Functions and Services Percent
Air Quality 33%
Hazardous Waste Management 46%
Individual Water Supply Safety 77%
Noise Pollution 20%
Occupational Health and Safety 23%
Public Water Supply Safety 58%
Radiation Control 21%
Sewage Disposal Systems 79%
Solid Waste Management 55%
Vector and Animal Control 70%
Water Pollution 60%
N = 2,263
26. Figure 25 by Jurisdiction Population
Percent of Local Health Departments that Reported Being Active
in Environmental Health Assurance Functions and Services
By Jurisdiction Population
This table shows the percent of respondents that reported being
active in the listed environmental health assurance functions and
services for each of the population groups. (See Figure 25 for
overall data.)
Functions & 0 to 25,000 to 50,000 to 100,000 to 500,000+
Services 24,999 49,999 99,999 499,999
Air Quality 24% 37% 37% 41% 52%
Hazardous
Waste Mgmt 39% 46% 48% 57% 76%
Individual
Water Supply
Safety 70% 81% 80% 86% 75%
Noise
Pollution 16% 21% 24% 24% 40%
Occupational
Health and
Safety 19% 22% 26% 27% 53%
Public Water
Supply Safety 52% 58% 62% 64% 71%
Radiation
Control 16% 20% 24% 26% 43%
Sewage Disposal
Systems 72% 84% 81% 87% 82%
Solid Waste
Management 48% 59% 57% 66% 64%
Vector and
Animal
Control 58% 76% 78% 83% 78%
Water
Pollution 52% 63% 67% 68% 71%
N = 954 526 380 320 83
27. % of LHD Active in Personal Health Assurance Func. & Serv.
Percent of Local Health Departments that Reported Being Active
in Personal Health Assurance Functions and Services
This graph shows the percent of respondents that reported being active in
assurance functions and services in the personal health services area.
Functions and Services Percent
Aids Testing and Counseling 57%
Alcohol Abuse 16%
Child Health 84%
Chronic Disease 69%
Dental Health 38%
Drug Abuse 17%
Emergency Medical Services 13%
Family Planning 60%
Handicapped Children 47%
Home Health Care 50%
Hospitals 50%
N = 2,263
28. Figure 27 continued
Percent of Local Health Departments that Reported Being Active
in Personal Health Assurance Functions and Services (Cont'd)
This table shows the percent of respondents that reported being
active in assurance functions and services in the personal health
services area.
Functions and Services Percent
Immunizations 92%
Laboratory Services 43%
Long Term Care Facilities 6%
Mental Health 14%
Obstetrical Care 20%
Prenatal Care 59%
Primary Care 22%
Sexually Transmitted Diseases 73%
Tuberculosis 81%
WIC 69%
N = 2,263
29. Figures 27 and 28 by Jurisdiction Population
Percent of Local Health Departments that Reported Being Active
in Personal Health Assurance Functions and Services
by Jurisdiction Population
This table shows the percent of respondents that reported being
active in the listed personal health assurance function and
services for each of the population groups. (See Figure 27 for
overall data.)
Functions & 0 to 25,000 to 50,000 to 100,000 to 500,000+
Services 24,999 49,999 99,999 499,999
Aids Testing
and Counseling 44% 47% 70% 88% 96%
Alcohol Abuse 13% 12% 16% 20% 43%
Child Health 74% 87% 92% 95% 99%
Chronic Disease 62% 71% 76% 76% 89%
Dental Health 27% 36% 41% 55% 80%
Drug Abuse 17% 15% 17% 18% 40%
Emergency Medical
Services 9% 11% 15% 18% 39%
Family Planning 53% 59% 64% 67% 87%
Handicapped
Children 39% 49% 55% 55% 63%
Home Health
Care 49% 55% 54% 44% 42%
Hospitals 2% 2% 4% 3% 15%
N = 954 526 380 320 83
30. Figure 29 continued
This table shows the percent of respondents that reported being
active in the listed personal health assurance function and
services for each of the population groups. (See Figure 27 for
overall data.)
Functions & 0 to 25,000 to 50,000 to 100,000 to 500,000+
Services 24,999 49,999 99,999 499,999
Immunizations 86% 95% 98% 98% 100%
Laboratory
Services 36% 38% 45% 65% 83%
Long Term Care
Facilities 4% 6% 10% 8% 17%
Mental Health 14% 13% 13% 12% 34%
Obstetrical
Care 15% 19% 22% 31% 39%
Prenatal Care 49% 59% 67% 73% 83%
Primary Care 16% 18% 25% 34% 59%
Sexually Transmitted
Diseases 61% 72% 85% 93% 95%
Tuberculosis 69% 86% 91% 92% 95%
WIC 63% 67% 75% 80% 89%
N = 954 526 380 320 83
31. % of LHD Active in Functions & Services by # of Employees
Percent of Local Health Departments that Reported Being Active in Selected
Functions and Services by Reported Number of Full Time Employees
This table shows the percent of respondents that reported being
active in the listed function and services with the respondents
distributed into 5 separate groups based upon their reported number
of full time employees. (See Figure 19, 21, 23, 25, 27 and 28 for
overall data.)
Functions Number of Employees
& Services 0 to 4 5 to 9 10 to 24 25 to 100 100+
Reportable Disease
Data Collection 79% 88% 91% 95% 98%
Health Planning 46% 55% 59% 68% 81%
Food and Milk
Control 58% 70% 78% 83% 82%
Health Education 63% 74% 77% 84% 94%
Hazardous Waste
Management 42% 41% 44% 51% 69%
Individual Water
Supply Safety 63% 80% 81% 87% 84%
Vector and Animal
Control 55% 69% 76% 83% 84%
Aids Testing and
Counseling 27% 53% 62% 85% 96%
Child Health 66% 87% 93% 97% 99%
Family Planning 35% 61% 70% 74% 85%
Immunizations 84% 95% 98% 99% 100%
Prenatal Care 35% 55% 71% 77% 85%
Sexually Transmitted
Diseases 44% 73% 86% 93% 97%
Tuberculosis 60% 85% 90% 95% 96%
N = 547 433 478 475 205
32. % of LHD Active in Functions & Services by Service Region
Percent of Local Health Departments that Reported Being Active in Selected
Functions and Services by Respondent's Public Health Service Region
This table shows the percent of respondents that reported being
active in the listed function and services with the respondents
distributed by their U.S. Public Health Service Region. (The
regions are described in appendix 3, see figures 19, 21, 23, 25, 27
and 28 for overall data.)
PHS REGION 1 2 3 4 5 6 7 8 9 10
Functions &
Services
Reportable Disease
Data Collection 75% 92% 97% 94% 87% 88% 80% 77% 96% 96%
Health Planning 39% 80% 62% 55% 64% 49% 51% 58% 74% 78%
Food and Milk
Control 83% 82% 94% 81% 66% 73% 42% 49% 73% 70%
Health Education 47% 90% 84% 79% 77% 75% 74% 71% 83% 81%
Hazardous Waste
Management 60% 70% 40% 36% 42% 47% 23% 42% 70% 66%
Individual Water
Supply Safety 66% 79% 93% 89% 76% 80% 62% 60% 73% 80%
Vector and Animal
Control 57% 85% 81% 77% 77% 70% 41% 57% 77% 72%
Aids Testing and
Counseling 12% 41% 86% 94% 41% 62% 45% 56% 93% 99%
Child Health 35% 96% 92% 99% 86% 94% 89% 83% 91% 93%
Family Planning 6% 29% 92% 98% 44% 82% 58% 55% 86% 74%
Immunizations 61% 98% 100% 100% 96% 98% 96% 85% 97% 100%
Sexually Transmitted
Diseases 20% 77% 97% 99% 68% 92% 55% 63% 99% 95%
Tuberculosis 40% 83% 98% 99% 78% 96% 74% 60% 97% 100%
N = 327 158 124 478 486 239 206 108 69 74
APPENDIXES
Appendix 1
NATIONAL PROFILE OF LOCAL HEALTH DEPARTMENTS
DATA COLLECTION INSTRUMENT
APEX/PH
NATIONAL ASSOCIATION OF COUNTY HEALTH OFFICIALS
National Profile of Local Health Departments
I. LOCAL HEALTH DEPARTMENT
A. Agency Name_______________________________________________________________
B. MailingAddress___________________________________________________________
C. City______________________________________________________________________
D. State_____________________________________________________________________
E. Zip Code__________________________________________________________________
F. County____________________________________________________________________
G. Telephone Number__________________________________________________________
H. Facsimile (FAX) Telephone Number__________________________________________
II. LOCAL HEALTH OFFICER
The person legally appointed or otherwise designated to serve as the
official health officer of the local health department.
A. Name_____________________________________________________________________
Last First Middle Initial
B. Title____________________________________________________________________
C. Degrees/Licenses (Please check those that apply.)
1. DEGREES 2. PROFESSIONAL LICENSES
__ __ __
|__| MD |__| DO |__| MD
__ __ __
|__| DrPH |__| PhD |__| RN
__ __ __
|__| MPH |__| MBA |__| RS
__ __ __
|__| DVM |__| MS |__| RD
__ __
|__| Other________________ |__| Other________________
(Please specify) (Please specify)
D. Month and year local health officer was appointed to present position:
Month____________________ Year____________________
E. The Health Officer position is:
__ __
Full Time |__| Part Time |__|
F. Does the local health officer serve as Administrator/Director for the
local health department?
__ __
Yes |__| No |__|
If "No" please give name and title of the Administrator/Director.
Name_____________________________________________________________
Last First Middle Initial
Title____________________________________________________________
The position of the Administrator/Director is:
__ __
Full Time |__| Part Time |__|
III. JURISDICTION OF LOCAL HEALTH DEPARTMENT
A. What is the geographic jurisdiction served by your local health
department? (Please check appropriate response.)
__
|__| City
__
|__| County
__
|__| City/County
__
|__| Multi-County District or Region
(Please list names of all counties)
_____________________________________________________________
_____________________________________________________________
__
|__| Town/Township
__
|__| State
__
|__| Other____________________________
(Please specify)
B. Are there any other local health departments operating within your
jurisdiction?
__ __
Yes |__| No |__|
If "yes" please list names of all other health departments.
___________________________________________________________
___________________________________________________________
___________________________________________________________
C. Are you part of a regional/district health agency?
__ __
Yes |__| No |__|
If "yes" please give the name of the regional/district health
agency.
D. Is there a local Board of Health within your jurisdiction?
__ __
Yes |__| No |__|
E. Estimated 1988 total population of jurisdiction served by local health
department is:
__________________________________________________________________
F. Which best describes the status of your local health department in
relation to the state health agency? (Please check appropriate response.)
__
|__| Independent
(Local government operates the local health department
independent of state health agency.)
__
|__| Shared/Combined State - Local
(Local government operates the local health department in
conjunction with the state health agency.)
__
|__| Local Unit of State Health Agency
(Local health department is operated by the state health
agency.)
__
|__| Local Unit of Regional/District Health Agency
(Local Health department is operated by a regional/district
office of the state health agency.)
__
|__| Other (Please specify.)_____________________________________
IV. STAFF
A. The total number of persons employed full time by the local health
department is:___________________________________________________________
B. The total number of authorized full time equivalents (FTE's) in the local
health department is:____________________________________________________
C. Which of the following does your local health department employ on a full
time and or part time basis (either directly or through contracted services)?
(Please check all appropriate responses.)
Full Time Part Time
__ __
Clerical/Secretarial |__| |__|
__ __
Dentists |__| |__|
__ __
Engineers/Sanitarians |__| |__|
__ __
Epidemiologist/Statisticians |__| |__|
__ __
Health Educators |__| |__|
__ __
Licensed Practical Nurses |__| |__|
__ __
Nutritionists/Dieticians |__| |__|
__ __
Physicians |__| |__|
__ __
Planners/Analysts |__| |__|
__ __
Public Information Specialists |__| |__|
__ __
Registered Nurses |__| |__|
__ __
Social Workers |__| |__|
__ __
Toxicologists/Environmental Specialists |__| |__|
D. Which type of employee do you consider the majority of your local health
department staff to be? (Please check appropriate response.)
__
|__| Local government employee
__
|__| State government employee
__
|__| Other________________________________________________________
(Please specify.)
V. BUDGET
A. Please give total expenditures for your local health department for the
most recent fiscal year available. $__________________________________________
B. Please indicate the fiscal year in which these expenditures occurred.
(e.g.) 1985, 1986, 1987):_____________________________________________________
C. Does your local health department charge patients for any personal health
services it provides? __ __ __
Yes |__| No |__| N/A |__|
D. Does your local health department accept Medicaid reimbursement for any
personal health services it provides? __ __ __
Yes |__| No |__| N/A |__|
VI. FUNCTIONS/SERVICES
Please indicate which of the following function and or service areas your
local health department is active in. (Please note; this is not intended to
be a complete listing of all health department functions and services.
Step I. Please mark an "X" by all appropriate responses.
Step II. Place a second "X" by the five which are most important.
____ A. ASSESSMENT ACTIVITIES
|____|1. Data Collection/Analysis
|____|a. Behavioral Risk Assessment
|____|b. Morbidity Data
|____|c. Reportable Diseases
|____|d. Vital Records and Statistics
|____|e. Other___________________________________
(Please specify.)
____ 2. Epidemiology/Surveillance
|____|a. Chronic Disease
|____|b. Communicable Disease
|____|c. Other___________________________________
(Please specify.)
____ B. POLICY DEVELOPMENT
|____|1. Health Code Development and Enforcement
|____|2. Health Planning
|____|3. Priority Setting
SECTION VI continued on next page
C. ASSURANCE ACTIVITIES
____ 1. Inspection
|____|a. Food and Milk control
|____|b. Health Facility Safety/Quality
|____|c. Recreational Facility/Safety/Quality
|____|d. Other Facility Safety/Quality (Beauty Parlors, Pet Shops etc.)
____ 2. Licensing
|____|a. Health Facilities
|____|b. Other Services/Facilities (Restaurants, Beauty Shops, etc.)
3. Health Education
____ 4. Environmental
|____|a. Air Quality
|____|b. Hazardous Waste Management
|____|c. Individual Water Supply Safety
|____|d. Noise Pollution
|____|e. Occupational Health and Safety
|____|f. Public Water Supply Safety
|____|g. Radiation Control
|____|h. Sewage Disposal Systems
|____|i. Solid Waste Management
|____|j. Vector and Animal Control
|____|k. Water Pollution
____ 5. Personal Health Services
|____|a. AIDS Testing and Counseling
|____|b. Alcohol Abuse
|____|c. Child Health
|____|d. Chronic Disease
|____|e. Dental Health
|____|f. Drug Abuse
|____|g. Environmental
|____|h. Family Planning
|____|i. Handicapped Children
|____|j. Home Health Care
|____|k. Hospitals
|____|l. Immunizations
|____|m. Laboratory Services
|____|n. Long Term Care Facilities
|____|o. Mental Health
|____|p. Obstetrical Care
|____|q. Prenatal Care
|____|r. Primary Care
|____|s. Sexually Transmitted Diseases
|____|t. Tuberculosis
|____|u. WIC
Name of person completing profile_____________________________________________
Title_________________________________________________________________________
Telephone number______________________________________________________________
Date__________________________________________________________________________
THANK YOU FOR YOUR TIME AND EFFORT
PLEASE RETURN COMPLETED PROFILE TO,
OR DIRECT ANY COMMENTS OR QUESTIONS TO:
Clark Greene
Research Associate
Project APEX/PH
National Association of County Health Officials
440 First Street N.W.
Washington, D.C. 20001
(202) 783-5550
Appendix 2
U.S. PUBLIC HEALTH SERVICE REGIONS
Region 1 Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island*,
Vermont*
Region 2 New Jersey, New York, Puerto Rico**, Virgin Islands**
Region 3 Delaware*, District of Columbia, Maryland, Pennsylvania,
Virginia, West Virginia
Region 4 Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, Tennessee
Region 5 Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin
Region 6 Arkansas, Louisiana, New Mexico, Oklahoma, Texas
Region 7 Iowa, Kansas, Missouri, Nebraska
Region 8 Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
Region 9 American Samoa**, Arizona, California, Guam**, Hawaii*, Nevada,
N. Mariana Islands**, Trust Territories**
Region 10 Alaska, Idaho, Oregon, Washington
*Delaware, Hawaii, Rhode Island, and Vermont have no local health departments
as defined in this report.
**The scope of this report is limited to the continental United States,
Alaska, and Hawaii.
Appendix 3
APEX/PH PROJECT MEMBERS
The APEX/PH Steering Committee:
H. Denman Scott, M.D., M.P.H., Chairperson (ASTHO);
Larry M. Belmont, M.P.H., M.P.A. (NACHO);
William Bridgers, M.D. (ASPH);
Claude A. Burnett, III, M.D., M.P.H. (NACHO)
Joyce D. K. Essien, M.D., M.B.A. (CDC);
Beverly C. Flynn, R.N., Ph.D., F.A.A.N. (APHA);
Gary L. Gurian, M.A. (USCLHO);
George E. Hardy, Jr., M.D., M.P.H. (CDC);
Lawrence Hart, M.D., M.P.H. (USCLHO);
Cheryl Healton, M.P.A. (ASPH);
Joel Nitzkin, M.D., D.P.A. (At Large);
William Shonick, Ph.D. (APHA);
Bernard J. Turnock, M.D. (ASTHO);
John B. Waller, Dr.P.H. (At Large).
The APEX/PH Work Group:
Paul Wiesner, M.D. Chairperson (NACHO);
M. Jane Ford, M.B.A. (USCLHO);
Joseph Latoff, M.A., M.S. (NACHO);
Arthur P. Liang, M.D., M.P.H. (CDC);
Jim Parker (ASTHO).
Former APEX/PH members:
Charles Cameron, M.D., M.P.H. (ASPH);
Robert G. Harmon M.D., M.P.H. (ASTHO);
Katherine Kinsman (ASTHO);
Pomeroy Sinnock, Ph.D. (CDC);
Rugmini Shah, M.D. (USCLHO).
APEX/PH Project Officer:
Charles Bacon, Public Health Advisor, Public Health Practice
Program Office, CDC;
C. Joseph Webb, Public Health Advisor, Public Health Practice
Program Office, CDC, served as APEX/PH Project Officer from
July 1987 to March 1990.
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