Category Archives: Profile

The 2018 Forces of Change in America’s Local Public Health System

The National Association of County and City Health Officials (NACCHO) has released its 2018 Forces of Change report containing new findings on the forces that are affecting the nation’s local health departments (LHDs). LHDs face both challenges and opportunities as the public health environment evolves, and NACCHO has periodically surveyed LHDs to assess the impact of this changing environment on LHD budgets, programs, and workforce. Topics included in the 2018 Forces of Change focused on changes in LHD budget and workforce capacity, response to opioid use and abuse, population health activities, influenza preparedness and response, informatics capacity, and environmental health activities. Visit NACCHO’s Forces of Change webpage to read the full report.


Although the overall proportion of LHDs reporting budget cuts and job losses has remained steady in recent years, LHDs have eliminated 56,630 jobs over the past decade. In 2017, LHDs reported an estimated 800 jobs lost; of those, 500 were due to layoffs and another 300 were due to attrition. However, this is the lowest reported estimate since 2008. In addition, 2017 saw a positive net change in the number of job positions within LHDs—with 170 more jobs added than were eliminated. This evidence indicates that LHD staffing levels are starting to rebound from the Great Recession.

Overall, approximately two-thirds of LHDs reported conducting activities to address the opioid crisis in 2017. To do so, LHDs often partnered with local/state government agencies and healthcare organizations. Regardless of population size served, the major barrier to conducting opioid-related activities was a lack of dedicated funding. Combating the opioid epidemic and ensuring resilient communities requires a broad and integrated effort across the local public health system.

As the health of a community is impacted by people’s access to resources and supports, LHDs are increasing their work in population health—which includes addressing community infrastructure; community violence; family and social supports; food insecurity, hunger, and nutrition; and housing instability and homelessness. In 2017, nearly 75% of LHDs conducted activities to address food insecurity. Regardless of topic area, most LHDs reported partnering with local/state government agencies and non-profits to conduct population health activities. Although other entities provide these services in some communities, LHDs must be a partner and leader in population health work as they are uniquely positioned as the face of public health.

The 2017–2018 influenza season was particularly bad, with one of the dominant strains, H3N2, being associated with complications in people with certain conditions. To address this risk, the majority of LHDs participated in immunization-focused partnerships or coalitions in some capacity. In addition, the most common activities for LHDs during the most recent flu season were focused on disseminating information through outreach and education within the community and public communications platforms.

Informatics and health information technology (HIT) enable communication between providers to streamline healthcare systems, improve healthcare delivery, and ensure continuity in care across the lifespan. More than half of LHDs had access to data from an electronic syndromic surveillance system that uses hospital emergency department data. In addition, LHDs use these syndromic surveillance systems to detect influenza-like and food-borne illnesses. As LHDs continue to strengthen their informatics capacity, they will need to develop their staff in HIT capabilities.

Environmental health work at the local level protects the public’s health against a wide range of threats that can be worsened by the impacts of climate change. Although environmental health service provision experienced stabilization for many LHDs, the most commonly reported service reduction was in emergency preparedness. Furthermore, for almost all issues impacted by climate change, fewer LHDs reported addressing them in 2017 than in 2012—particularly in water-, food-, and vector-borne diseases; storms, hurricanes, and floods; and unsafe or ineffective sewage and septic system operation. Bolstering LHD capacity to address environmental health threats is an urgent need for the local public health system, especially as evidence for climate change increases.

Get access to the full report.

2016 National Profile of Local Health Departments

2016-national-profileBy Sarah Newman, MPH, NACCHO Senior Research and Evaluation Analyst

NACCHO recently released the 2016 National Profile of Local Health Departments report. The Profile is a comprehensive survey of local health department (LHD) infrastructure and practice that NACCHO administers every three years. This year, 76% of all LHDs across the United States responded to the Profile survey, helping NACCHO to present a complete and accurate overview of LHD funding, workforce programs, and partnerships. Continue reading

The Profile Study at Work

By Carolyn Leep, Senior Director of Research and Evaluation, NACCHO

ProfileLogoFinal 1Ever wonder what NACCHO does with data from that Profile survey that took you so long to complete?

From January through March, approximately 2,000 local health departments (LHDs) completed the National Profile of Local Health Departments (Profile) survey. Profile is a comprehensive (read “long”) survey of LHD infrastructure and practice that NACCHO administers every two to three years. We are truly grateful for the time so many LHD leaders and staff spent gathering the requested information and completing the survey.

Have you ever wondered what NACCHO does with the data we collect in the Profile survey? We hope that everyone knows that having up-to-date data about LHDs is a key to making NACCHO a trusted and credible voice for LHDs at the national level. NACCHO should know more about LHDs than anyone else. Many people know that NACCHO summarizes data from each Profile in a report that serves as an almanac of information about LHDs. We send a printed copy to every LHD that completed their Profile; the reports are also available on the Profile webpage. Some people even know that NACCHO puts Profile data on LHD finances, workforce, and activities into Profile-IQ—a user-friendly Web-based system that lets users make customized Profile tables and figures. For example, you can make tables with statistics from just the LHDs in your state or from only LHDs that serve jurisdictions of similar size to yours. Check it out!

Many people may not know that data from the Profile survey are a critical resource for researchers who study public health systems and services. Under a data use policy approved by NACCHO’s Executive Committee, NACCHO has provided data on LHDs for hundreds of research studies. The recent Keeneland Conference was a great place to see some of the research that uses NACCHO’s Profile data. For example, Kay Lovelace (University of North Carolina- Greensville) and her colleagues used NACCHO’s Profile data to identify characteristics of LHDs that engage in evidence-based decision making. Tracy Hilliard (University of Washington) and her colleagues used Profile data to examine declines in LHD workforce relative to distribution of racial and ethnic minority populations. Gulzar Shah (Georgia Southern University) and his colleagues used Profile data to examine whether completion of PHAB accreditation prerequisites (community health assessment, community health improvement plan, and agency-wide strategic plan) are associated with LHD intent to apply for accreditation. Slides from these and other Keeneland Conference presentations are available on the conference website.

NACCHO’s Profile Team is currently hard at work in the “data bunker” cleaning and analyzing all of the 2013 Profile data. The report of the findings will be available later this year. Have you used data or information from NACCHO’s Profile study? Tell us about it below in the comments section.