ANALYSIS OF THE CURRENT STATUS OF PUBLIC-HEALTH PRACTICE IN LOCAL HEALTH DEPARTMENTS

This article describes the performance by local health departments of core public health functions. A post hoc analysis based on these essen tial functions was implemented using the 1994 dataset from a cooperati ve project with the Centers for Disease Control and Prevention (CDC) a nd National Association of County and City Health Officials, which inv olved a survey of the nation's 2,888 local health departments. Applyin g guidelines for each functional area drafted by the Office of Disease Prevention and Health Promotion/Office of the Assistant Secretary for Health, CDC, and the Public Health Foundation in conjunction with the health officers in five states, a score was created for each core pub lic health function: (1) health-related data collection, surveillance, and outcomes monitoring, (2) protection of environment, housing, food , and water, (3) investigation and control of diseases and injuries, ( 4) public information and education, (5) accountability and quality as surance, (6) laboratory services, (7) training and education, and (8) leadership, policy development, and administration. The individual and summary scores provide a mechanism to measure and describe the 2,079 local health departments' performance of these core functions acid to examine their relationship to several characteristics and practices-pl anning, administrative units, annual total expenditures, and jurisdict ion population size. This article shows that the core performance inde x is highest for the data function and for local health departments se rving a population of 50,000 or more people. In addition, the performa nce index increases as budget increases and is greater for all eight f unctions in those local health departments using health planning model s such as Assessment Protocol for Excellence in Public Health (APEX PH ), Planned Approach to Community Health (PATCH), Healthy People 2000, or Healthy Communities 2000. These results may be used to facilitate c ooperation between local, state, and federal health agencies and the c ommunities they serve; strengthen the core functions at the local, sta te, and federal levels; and improve public health practice.