# 23 {#section .Chapter-# .unnumbered}

# Public Health Infrastructure 

#### Data and Information Systems 

23-1 Public health employee access to the Internet

23-2 Public health access to information and surveillance data

23-3 Use of geocoding in health data systems

23-4 Data for all population groups

23-5 Data for Leading Health Indicators, Health Status Indicators, and
Priority Data Needs at Tribal, State, and local levels

23-6 National tracking of Healthy People 2010 objectives

23-7 Timely release of data on objectives

#### Workforce

23-8 Competencies for public health workers

23-9 Training in essential public health services

23-10 Continuing education and training by public health agencies

#### Public Health Organizations

23-11 Performance standards for essential public health services

23-12 Health improvement plans

23-12a Tribes

23-12b States and the District of Columbia

23-12c Local jurisdictions

23-13 Access to public health laboratory services

23-14 Access to epidemiology services

23-15 Model statutes related to essential public health services

#### Resources

23-16 Data on public health expenditures

#### Prevention Research

23-17 Population-based prevention research

### Data and Information Systems

  ----------------------- -----------------------------------------------
  23-1. (Developmental)   
  Increase the proportion 
  of Tribal, State, and   
  local public health     
  agencies that provide   
  Internet and e-mail     
  access for at least 75  
  percent of their        
  employees and that      
  teach employees to use  
  the Internet and other  
  electronic information  
  systems to apply data   
  and information to      
  public health practice. 

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the National Public
                          Health Performance Standards Program, CDC,
                          PHPPO; the Indian Health Service (IHS) for
                          Tribes; the Association of State and
                          Territorial Health Officials (ASTHO) for
                          States; and the National Association of County
                          and City Health Officials (NACCHO) for local
                          public health agencies.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ---------------------- -------------- -----------------------------------------------
  23-2. (Developmental)                 
  Increase the                          
  proportion of Federal,                
  Tribal, State, and                    
  local health agencies                 
  that have made                        
  information available                 
  to the public in the                  
  past year on the                      
  Leading Health                        
  Indicators, Health                    
  Status Indicators, and                
  Priority Data Needs.                  

  **Comments**                          An operational definition could not be
                                        specified at the time of publication.

                                        Proposed data sources are the National Public
                                        Health Performance Standards Program, CDC,
                                        PHPPO; CDC, National Center for Health
                                        Statistics (NCHS) for Federal agencies; the
                                        Indian Health Service (HIS) for Tribes; the
                                        Association of State and Territorial Health
                                        Officials (ASTHO) for States; and the National
                                        Association of County and City Health Officials
                                        (NACCHO) for local public health agencies.

                                        See Appendix A for focus area contact
                                        information.

  23-3. Increase the                    
  proportion of all                     
  major national, State,                
  and local health data                 
  systems that use                      
  geocoding to promote                  
  nationwide use of                     
  geographic information                
  systems (GIS) at all                  
  levels.                               

  **National Data        National       
  Source**               Center for     
                         Health         
                         Statistics     
                         (NCHS), CDC.   

  **State Data Source**  Not            
                         applicable.    

  **Healthy People 2000  Not            
  objective**            applicable.    

  **Measure**            Percent.       

  **Baseline**           45 (2000).     

  **Numerator**          Number of      
                         major          
                         national,      
                         State, and     
                         local health   
                         data systems   
                         that collect   
                         street address 
                         or latitude    
                         and longitude  
                         information to 
                         enable         
                         geocoding      
                         analysis.      

  **Denominator**        Number of      
                         major          
                         national,      
                         State, and     
                         local health   
                         data systems.  

  **Questions Used To    Not            
  Obtain the National    applicable.    
  Data**                                

  **Expected             Annual.        
  Periodicity**                         

  **Comments**           A major health 
                         data system is 
                         one that is    
                         being used to  
                         track five or  
                         more Healthy   
                         People 2010    
                         objectives.    
                         These data     
                         systems are    
                         listed in Part 
                         C of this      
                         volume.        

                         See Appendix A 
                         for focus area 
                         contact        
                         information.   
  ---------------------- -------------- -----------------------------------------------

  ---------------------- ------------------------------------------------
  23-4. Increase the     
  proportion of          
  population-based       
  Healthy People 2010    
  objectives for which   
  national data are      
  available for all      
  population groups      
  identified for the     
  objective.             

  **National Data        National Center for Health Statistics (NCHS),
  Source**               CDC.

  **State Data Source**  Not applicable.

  **Healthy People 2000  Not applicable.
  objective**            

  **Measure**            Percent.

  **Baseline**           11 (2000).

  **Numerator**          Number of Healthy People 2010 population-based
                         objectives or lettered subobjectives that have
                         baselines for which national data are available
                         for all population groups identified for the
                         objective.

  **Denominator**        Number of Healthy People 2010 population-based
                         objectives or lettered subobjectives that have
                         baselines.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Both objectives and lettered subobjectives that
                         target the U.S. population are considered for
                         this objective. In addition to the baselines for
                         all persons targeted by the measure, Healthy
                         People 2010 population-based measures are
                         required to show a minimum set of
                         sociodemographic population groups called a
                         template (see General Data Issues, section 4).

                         There were 432 population-based objectives
                         and/or lettered subobjectives that had baselines
                         (and are, thus, measurable) in the Conference
                         Edition of Healthy People 2010. Forty-eight had
                         complete templates, and 103 had no template
                         displayed. Among those objectives with no
                         template displayed, did not qualify for a
                         template because the measures were raw numbers,
                         not rates or percents. Thus, the denominator for
                         the baseline was 409.

                         The remaining objectives with templates had some
                         incomplete data cells that were designated "DSU"
                         (data statistically unreliable), "DNA" (data not
                         analyzed), or "DNC" (data not collected).

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ----------------------- -----------------------------------------------
  23-5. (Developmental)   
  Increase the proportion 
  of Leading Health       
  Indicators, Health      
  Status Indicators, and  
  Priority Data Needs for 
  which data---especially 
  for select              
  populations---are       
  available at the        
  Tribal, State, and      
  local levels.           

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the National Center
                          for Health Statistics (NCHS), CDC, for States
                          and localities, and the Indian Health Service
                          (IHS) for Tribes.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ---------------------- ------------------------------------------------
  23-6. Increase the     
  proportion of Healthy  
  People 2010 objectives 
  that are tracked       
  regularly at the       
  national level.        

  **National Data        National Center for Health Statistics (NCHS),
  Source**               CDC.

  **State Data Source**  Not applicable.

  **Healthy People 2000  Not applicable.
  objective**            

  **Measure**            Percent.

  **Baseline**           82 (2000).

  **Numerator**          Number of Healthy People 2010 objectives or
                         lettered subobjectives that have baselines and
                         are tracked nationally at least every 3
                         years**.**

  **Denominator**        Number of Healthy People 2010 objectives and
                         lettered subobjectives that have baselines.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The Healthy People 2010 objectives and lettered
                         subobjectives that are measurable (have
                         baselines) are used to obtain the data for this
                         objective. There were 579 measurable objectives
                         and lettered subobjectives in the Conference
                         Edition of Healthy People 2010, of which 474 are
                         tracked with data systems that collect data at
                         least every 3 years; 383 are tracked annually.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  23-7. Increase the     
  proportion of Healthy  
  People 2010 objectives 
  for which national     
  data are released      
  within\                
  1 year of the end of   
  data collection.       

  **National Data        National Center for Health Statistics (NCHS),
  Source**               CDC.

  **State Data Source**  Not applicable.

  **Healthy People 2000  Adapted from 22.7 (Surveillance and Data
  objective**            Systems).

  **Measure**            Percent.

  **Baseline**           36 (2000).

  **Numerator**          Number of Healthy People 2010 objectives and
                         lettered subobjectives tracked with major health
                         data systems that release data within 1 year
                         after the end of data collection.

  **Denominator**        Number of Healthy People 2010 objectives and
                         lettered subobjectives that are tracked by major
                         health data systems.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Major health data systems are defined as data
                         systems that are used to track five or more
                         Healthy People 2010 objectives (see Part C for a
                         descriptive list of these systems). In the
                         Conference Edition of Healthy People 2010, major
                         data systems provided baselines for 338
                         objectives and lettered subobjectives. Of these
                         338, 123 were provided data by major health data
                         systems that release data within 1 year of data
                         collection.

                         This objective differs from Healthy People 2000
                         objective 22.7, which tracked all objectives
                         instead of those tracked by major health data
                         systems and did not take into consideration the
                         periodicity of the data source.**^1^**

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

### Workforce

  ----------------------- -----------------------------------------------
  23-8. (Developmental)   
  Increase the proportion 
  of Federal, Tribal,     
  State, and local        
  agencies that           
  incorporate specific    
  competencies in the     
  essential public health 
  services into personnel 
  systems.                

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the Health Services
                          and Resources Administration (HRSA) for Federal
                          agencies; the Indian Health Service (IHS) for
                          Tribes; the Association of State and
                          Territorial Health Officials (ASTHO) for
                          States; and the National Association of County
                          and City Health Officials (NACCHO) for local
                          agencies.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  23-9. (Developmental)   
  Increase the proportion 
  of schools for public   
  health workers that     
  integrate into their    
  curricula specific      
  content to develop      
  competency in the       
  essential public health 
  services.               

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the Association of
                          Schools of Public Health (ASPH); the American
                          Association of Medical Colleges; the Bureau of
                          Health Professions, HRSA; and the American
                          Association of Colleges of Nursing.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  23-10. (Developmental)  
  Increase the proportion 
  of Federal, Tribal,     
  State, and local public 
  health agencies that    
  provide continuing      
  education to develop    
  competency in essential 
  public health services  
  for their employees.    

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the Department of
                          Health and Human Services (HHS) for Federal
                          agencies; the Indian Health Service (IHS) for
                          Tribes; the Association of State and
                          Territorial Health Officials (ASTHO) for
                          States; and the National Association of County
                          and City Health Officials (NACCHO) for local
                          agencies.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

### Public Health Organizations

  ----------------------- -----------------------------------------------
  23-11. (Developmental)  
  Increase the proportion 
  of State and local      
  public health agencies  
  that meet national      
  performance standards   
  for essential public    
  health services.        

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          A proposed data source is the National Public
                          Health Performance Standards Program, CDC,
                          PHPPO.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

23-12. Increase the proportion of Tribes, States, and the District of
Columbia that have a health improvement plan and increase the proportion
of local jurisdictions that have a health improvement plan linked with
their State plan.

  ---------------------- ------------------------------------------------
  23-12a.                
  (Developmental)        
  Tribes.                

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the Indian Health
                         Service (IHS).

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  23-12b. States and the 
  District of Columbia.  

  **National Data        Association of State and Territorial Health
  Source**               Officials (ASTHO).

  **State Data Source**  Association of State and Territorial Health
                         Officials (ASTHO).

  **Healthy People 2000  Not applicable.
  objective**            

  **Measure**            Percent.

  **Baseline**           78 (1997).

  **Numerator**          Number of States, including the District of
                         Columbia, with a health improvement plan.

  **Denominator**        50 States and the District of Columbia.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Periodic.
  Periodicity**          

  **Comments**           The baseline refers to the number of States
                         including the District of Columbia that
                         developed objectives for the year 2000. This
                         definition is a proxy for health improvement
                         plans, and will change with subsequent updates.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  23-12c. Local          
  jurisdictions.         

  **National Data        National Profile of Local Health Departments
  Source**               (NPLHD), NACCHO.

  **State Data Source**  National Profile of Local Health Departments
                         (NPLHD), NACCHO.

  **Local Area Data      National Profile of Local Health Departments
  Source**               (NPLHD), NACCHO.

  **Healthy People 2000  Not applicable.
  objective**            

  **Measure**            Percent.

  **Baseline**           32 (1992--93).

  **Numerator**          Number of local jurisdictions with a health
                         improvement plan linked with their State plan.

  **Denominator**        Number of local jurisdictions.

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Periodic.
  Periodicity**          

  **Comments**           The baseline reflects the proportion of local
                         health departments that developed objectives for
                         the year 2000. This definition is a proxy for
                         health improvement plans and will change with
                         subsequent updates.

                         See Part C for a description of NPLHD and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ----------------------- -----------------------------------------------
  23-13. (Developmental)  
  Increase the proportion 
  of Tribal, State, and   
  local health agencies   
  that provide or ensure  
  comprehensive           
  laboratory services to  
  support essential       
  public health services. 

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are CDC and the
                          Association of Public Health Laboratories; the
                          Association of State and Territorial Health
                          Officials (ASTHO) for States; and the National
                          Association of County and City Health Officials
                          (NACCHO) for local health agencies.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  23-14. (Developmental)  
  Increase the proportion 
  of Tribal, State, and   
  local public health     
  agencies that provide   
  or ensure comprehensive 
  epidemiology services   
  to support the          
  essential public health 
  services.               

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the Council of State
                          and Territorial Epidemiologists (CSTE) for
                          State and local jurisdictions and the Indian
                          Health Service (IHS) for Tribes.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  23-15. (Developmental)  
  Increase the proportion 
  of Federal, Tribal,     
  State, and local        
  jurisdictions that      
  review and evaluate the 
  extent to which their   
  statutes, ordinances,   
  and bylaws ensure the   
  delivery of essential   
  public health services. 

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the Indian Health
                          Service (IHS) for Tribes; the National
                          Conference of State Legislators (NCSL) and the
                          Association of State and Territorial Health
                          Officials (ASTHO) for States; and the National
                          Association of County and City Health Officials
                          (NACCHO) for local jurisdictions.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

### Resources

  ----------------------- -----------------------------------------------
  23-16. (Developmental)  
  Increase the proportion 
  of Federal, Tribal,     
  State, and local public 
  health agencies that    
  gather accurate data on 
  public health           
  expenditures,           
  categorized by          
  essential public health 
  service.                

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the Operating
                          Divisions of the Department of Health and Human
                          Services (HHS) for Federal agencies; the Indian
                          Health Service (IHS) for Tribes; the
                          Association of State and Territorial Health
                          Officials (ASTHO) for States; and the National
                          Association of County and City Health Officials
                          (NACCHO) for local public health agencies.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

### Prevention Research

  ----------------------- -----------------------------------------------
  23-17. (Developmental)  
  Increase the proportion 
  of Federal, Tribal,     
  State, and local public 
  health agencies that    
  conduct or collaborate  
  on population-based     
  prevention research.    

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed data sources are the Association of
                          Schools of Public Health (ASPH); the CDC
                          Sentinel Network; the Association of State and
                          Territorial Health Officials (ASTHO) for
                          States; and the National Association of County
                          and City Health Officials (NACCHO) for local
                          public health agencies.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

## Reference

1\. National Center for Health Statistics. *Healthy People 2000 Review,
1998--99*. Hyattsville, MD: Public Health Service, 1999.