DOI: 10.3886/icpsr38046.v1
title: National Profile of Local Health Departments, [United States], 2019
title: Version 1

description: Conducted by the National Association of County and City Health Officials (NACCHO), the purpose of this survey of local health departments (LHDs) was to advance and support the development of a database for LHDs to describe and understand their structure, function, and capacities. A core set of questions was submitted to every LHD. In addition, some LHDs received one of two randomly assigned modules of supplemental questions. The core questions covered governance, funding, workforce (staffing levels, occupations employed, top executive education and licensure), LHD activities, community health assessment and health improvement planning, accreditation through the Public Health Accreditation Board, and policy-making and advocacy. The surveyed LHD activities include immunization, screening for diseases and conditions, treatment for communicable diseases, maternal and child health, epidemiology and surveillance activities, population-based primary prevention activities, and regulation, inspection and/or licensing activities. Topics covered by Module 1 included LHD interaction with academic institutions, Partnerships and collaboration, Cross-jurisdictional sharing of services, Emergency preparedness, and Access to healthcare services. Module 2 examined additional issues related to jurisdiction and governance, community health assessment and planning, human resources issues, quality improvement, public health informatics, and use of the Community Guide of Preventive Services.
description: The purpose of this study is to develop a comprehensive and accurate description of local health department (LHD) infrastructure and practices from across the United States. The National Association of County and City Health Officials (NACCHO) conducted the first National Profile of Local Health Departments study during 1989 and 1990. This study helped to define what a LHD is and describe how funding, staffing, governance, and activities of LHDs vary across the United States. Since 1990, NACCHO has conducted eight additional Profile studies, including in 2019. All studies have been funded by the Centers for Disease Control and Prevention; beginning in 2007, NACCHO has also received funding from the Robert Wood Johnson Foundation.
description: Every profile study utilizes the same definition of an LHD, which includes roughly 2,800 agencies who fit the criteria. Some states have a public health system structure that includes both regional and local offices of the state health agency. In those states, the state health agency chooses to respond to the Profile survey at either the regional or local level, but not at both levels.
The NACCHO team developed the 2019 questionnaire by reviewing the most previous version from 2016 to see how each question performed among respondents and what should be kept, modified, or deferred to future questionnaires. Questionnaires from previous years were also reviewed to identify if any questions should be repeated for 2019. Lastly, the team explored developing new questions based on current public health topics. An advisory group including LHD leaders, staff from affiliated groups, researchers, and other subject experts within NACCHO provided feedback on survey revisions. The revised questionnaire was piloted from December 2018 to January 2019 among 28 LHDs (13 of which completed the survey). NACCHO then interviewed select LHDs about the piloted questionnaire, revised the survey as needed, then finalized distribution.
NACCHO fielded the Profile questionnaire from March through August 2019 via an e-mail sent to a contact person at each LHD in the study population. The e-mail included a link to a web-based questionnaire. NACCHO staff conducted follow-up with non-respondents using e-mail and telephone calls. NACCHO also offered technical support to survey respondents through e-mail and a telephone hotline.
Three questionnaire types were developed for this study: Core, Module 1, and Module 2. Core included the following topics: LHD top executive, jurisdiction and governance, workforce, staffing changes, programs and services, public health policy, community health assessment and planning, accreditation, funding, and changes in LHD budget. Module 1 consisted of: LHD interaction with academic institutions, partnerships and collaboration, cross-jurisdictional sharing of services, emergency preparedness, and access to healthcare services. Module 2 was made up of the following: jurisdiction and governance, community health assessment and planning, human resource issues, quality improvement, public health informatics, guide to community preventive services, and evaluation of profile.
description: NACCHO developed survey weights for the items from the Core questionnaire to account for differential non-response by size of population served; survey weights used to produce statistics from modules also accounted for sampling. Post-stratification (based on 7 population size categories) and finite population correction were used to adjust for non-response and to account for the fact that population size by category is known and limited in size. The dataset includes the following variables to recreate post stratification weighting, see the questionnaire for more information: c0popcat7, strata, denom, m0weight, m1weight, m2weight.
Additionally, the dataset contains static weights that may be applied to estimates. For questions located in the core questionnaire, a proportional weight to account for non-responses should be used. An additional scalar weight was generated for analyses to generate total numbers instead of percentages (see variables c0coreweight_p and c0coreweight_s, respectively). For questions in the module sections, a corresponding module weight should be used for all analyses.
description: Response Rates: The overall response rate was 61 percent.
description: NACCHO uses a database of LHDs based on previous Profile studies and consults with state health agencies and state associations of local health officials to identify LHDs for inclusion in the study population. For the 2019 Profile study, a total of 2,453 LHDs were included in the study population.
All LHDs in the study population received the updated questionnaire. A randomly selected group of LHDs also received one of the two sets of supplemental questions (or modules). LHDs were selected to receive the Core questionnaire only or the Core plus one of the two modules using stratified random sampling (without replacement), with strata defined by the size of the population served by the LHD. The module sampling process is designed to produce national estimates but not state-level estimates.
description: Datasets: 
DS0: Study-Level Files
DS1: Public-Use Data
DS2: Restricted-Use Data
description: The survey universe comprises 2,453 of the approximately 3,000 agencies in the United States that met NACHHO's definition of a LHD: 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. Rhode Island was excluded because their state health departments operate on behalf of local public health and have no sub-state units. Smallest Geographic Unit: Zip Code
description: web-based surveyThis is the ninth National Profile of Local Health Departments conducted by NACCHO. The previous rounds were conducted in 1989-1990, 1992-1993, 1996-1997, 2005, 2008, 2010, 2013, and 2016. ICPSR also houses the 2016 Profile (ICPSR 37144 and ICPSR 37145), 2013 Profile (ICPSR 34990), 2010 Profile (ICPSR 32922), and the 2008 Profile (ICPSR 26962) but not the earlier rounds.More information about this study can be found on the NACCHO Web site.Hawaii was included in the analysis for the first time in this series.