Local health department effectiveness in addressing the core functions of public health: essential ingredients

Abstract

Objectives: Objective 8.14 of the U.S. Healthy People 2000 objectives calls for 90% of the population to be served by a local health department (LHD) which is effectively carrying out the core functions of public health (assessment, policy development, assurance). This study seeks to describe the structural and service characteristics of an effective LHD.

Methods: Data from a 1993 national random sample survey of LHD practice were merged with data from the 1992-1993 National Association of Country and City Health Officials (NACCHO) profile of local health agencies. Using a definition of effectiveness related to the core functions of public health, the correlates of effectiveness were examined for 264 health departments in the matched sample.

Results: Effectiveness of local health agencies was not related to jurisdiction size of type. Inputs (structural factors) associated with effectiveness included having a full-time agency head, a larger budget derived from a greater number of funding sources, and a larger number of staff. With respect to outputs (services), effective health departments were also more likely to provide a greater number of services directly, particularly personal preventive and treatment services.

Conclusions: Only a few inputs are correlated with core-function related effectiveness. However, a profile of an effective health department emerges. Effective LHDs appear more likely to have full-time leadership which is able to tap diverse funding sources to provide the mix and match of community and personal prevention and treatment services needed to address community needs and improve the public's health.