Findings from the 2008 National Profile ofLocal Health Departments Study

“Big City” LocalHealth Departments

National Profile of Local Health Departments Study• The National Profile of Local Health

Departments is a survey of local health department (LHD) infrastructure and activities

• NACCHO sends the Profile questionnaire to every LHD in the U.S.– Completed by 83% of all LHDs in 2008

• Data are self-reported by LHDs and not independently verified by NACCHO

• Source of all data in this presentation is from 2008 findings

“Big City” Local Health Departments

• Defined for the purpose of this report as LHDs that serve a city of 350,000 or more– Based on 2008 Census estimates

• 49 LHDs meet the “Big City” definition– 47 Big City LHDs included in this analysis– 1 Big City LHD did not respond to the 2008 Profile

questionnaire– District of Columbia omitted because of unique status

• Big City LHDs serve a variety of jurisdictions– 36% serve combined city-county jurisdictions– 34% serve county jurisdictions– 28% serve city jurisdictions– 2% serve multi-county, district or regional jurisdictions

• Many Big City LHDs (62%) have a Local Board of Health

Big City LHDs Included in Analysis

Alameda County Public Health Department (Oakland)

El Paso County Department of Health and Environment (Colorado Springs)

New York City Department of Health and Mental Hygiene

Austin/Travis County Health and Human Services

Fresno County Department of Public Health Oklahoma City-County Health Department

Baltimore City Health Department Fulton County Department of Health and Wellness (Atlanta)

Philadelphia Department of Public Health

Boston Public Health Commission Houston Department of Health andHuman Services

Pima County Health Department (Tucson)

Chicago Department of Public Health Kansas City Health Department Public Health - Seattle and King County

City of Cleveland Department of Public Health Long Beach Department of Health and Human Services

Sacramento County Department of Health and Human Services

City of El Paso Department of Public Health Louisville Metro Department of PublicHealth and Wellness

San Antonio Metropolitan Health District

City of Milwaukee Health Department Maricopa County Department of Public Health (Phoenix & Mesa)

San Francisco Department of Public Health

City of Saint Louis Department of Health Marion County Health Department (Indianapolis)

Santa Clara County Public Health Department (San Jose)

Columbus Public Health Mecklenburg County Health Department (Charlotte)

Sedgwick County Health Department (Wichita)

County of Los Angeles Departmentof Public Health

Memphis and Shelby County Health Department

Southern Nevada Health District (Las Vegas)

County of San Diego Health and Human Services Agency, Public Health Services

Metro Public Health Department (Nashville) Tarrant County Public Health Department (Fort Worth & Arlington)

Denver Department of EnvironmentalHealth and Denver Public Health

Miami-Dade County Health Department Tulsa City-County Health Department

Detroit Department of Health andWellness Promotion

Minneapolis Department Health andFamily Support

Virginia Beach Department of Public Health

Douglas County Health Department (Omaha) Multnomah County Health Department (Portland)

Wake County Human Services (Raleigh)

Duval County Health Department (Jacksonville) New Mexico Department of Health, Albuquerque and Las Cruces Districts (Albuquerque)

Distribution of Big City LHDs by Size of Population Served

Distribution of Big City LHDs by Total Annual Expenditures

Big City LHDs: Mean and Median LHD Expenditures

by Size of Population Served

Size of Population Served

Mean Median

350,000 – 499,999 $27,900,000 $21,700,000

500,000 – 749,999 $54,100,000 $27,700,000

750,000 – 999,999 $167,000,000 $54,500,000

1,000,000 – 1,999,999 $158,000,000 $87,800,000

2,000,000+ $384,000,000 $105,000,000

Mean Percentage of Total LHD Revenues:Big City and Nationally

from Various Sources

*List does not represent all sources of revenue

Mean and Median Per Capita Revenues: Big City and Nationally

from Selected Sources

Mean MedianSource of Revenue

Big City National Big City National

All revenues $105 $66 $51 $37

Local revenues $31 $15 $13 $7

State direct revenues

$14 $11 $4 $6

Federal pass-through revenues

$10 $8 $8 $5

Federal direct revenues

$12 $2 $4 $0

Characteristics of LHDs’ Top Executives: Big City and Nationally

 Characteristic Big City National

Full-time position 100% 86%

Less than two years in position

28% 21%

Ten or more years in position 21% 35%

% Race White 70% 94%

% Hispanic 11% 2%

% Female 40% 56%

Holds graduate degree 98% 62%

Holds public health degree 53% 21%

Holds medical degree (MD) 47% 14%

Holds registered nurse (RN) licensure

20% 39%

Percentage of Big City LHDsEmploying Selected Occupations

FTEs * Employed by Big City LHDs: Median and Median per 100,000 Population

for All Staff and Selected Occupations

OccupationMedian(FTEs)

Median FTE per 100,000

population

Total FTEs 436.5 53.7

Clerical staff 84.6 9

Nurse 62 5.4

Environmental health professional**

33 4.7

Manager/Director 20 2.6

*FTE=Full-time Equivalent

**Environmental health professional includes EH specialists (Sanitarian) and Other EH scientists

FTEs Employed by Big City LHDs: Median and Median per 100,000 Population

for Selected Occupations

Occupation MedianMedian per

100,000 population

Nutritionist 11 1.3

Behavioral health professional

9.5 1.3

Health educator 9 1

Information systems specialist

4 0.6

Epidemiologist 3 0.5

Physician 5 0.4

Public information specialist

1 0.2

Emergency preparedness coordinator

1 0.2

Top Activities & ServicesProvided by Big City LHDs

Activity or ServicePercent of

LHDs Communicable/Infectious disease surveillance

98%

Adult Immunization 96%

Child Immunization 96%

Tuberculosis screening 96%

Population-based nutrition services 96%

Tuberculosis treatment 94%

HIV/AIDS screening 94%

Maternal and child health surveillance 91%

STD treatment 91%

Activities & ServicesProvided More Frequently by Big City

LHDsCompared Nationally

Activity or ServiceBig City

LHDsNationa

l

Difference (Big City -

National)

Laboratory services 83% 25% 58%

Syndromic surveillance 89% 40% 50%

Asthma prevention and/or management

64% 26% 38%

STD treatment 91% 57% 35%

Vital records 84% 50% 35%

HIV/AIDS screening 94% 59% 34%

Oral health services 62% 29% 33%

Maternal and child health surveillance

91% 61% 30%

Activities & ServicesProvided Less Frequently in Big City

LHDsCompared Nationally

Activity or ServiceBig City

LHDsNationa

l

Difference (Big City -

National)

Children's camps regulation 23% 48% -25%

Home health care 7% 25% -18%

Campgrounds/ Recreational vehicles regulation

24% 42% -18%

Septic systems regulation 50% 68% -18%

Private drinking water regulation

47% 59% -12%

High blood pressure screening 58% 68% -10%

Groundwater protection 33% 41% -8%

Solid waste haulers regulation 22% 29% -7%

Mobile homes regulation 24% 30% -6%

Emergency Preparedness Activities in Big City LHDs

ActivityPercent

of LHDs

Participated in tabletop drills or exercises 98% Developed or updated pandemic flu preparedness plans 96% Updated a written emergency response plan based on recommendations from an exercise After Action Report (AAR)

96%

Participated in functional drills or exercises 96% Provided emergency preparedness training to staff on NIMS compliance

91%

Reviewed relevant legal authorities to isolate and/or quarantine individuals, groups, facilities, animals, food products

87%

Participated in full-scale drills or exercise 81% Assessed emergency preparedness competencies of staff based on the nine core Emergency Preparedness Competencies and the agency’s all-hazard response plan

57%

Addressing Health Disparities in Big City LHDs

ActivityPercent

of LHDs

Supported community efforts to change the causes of health disparities

96%

Described health disparities in jurisdiction using data 96% Prioritized resources and programs specifically for the reduction in health disparities

85%

Educated elected or appointed officials about health disparities and their causes

83%

Trained workforce on health disparities and their causes 81% Recruited workforce from communities adversely impacted by health disparities

68%

Took public policy positions on health disparities 64% Conducted original research that links health disparities to difference in social or environmental conditions

47%

Percentage of Big City LHDs Performing Community Health Assessment and

Improvement Planning in Past Three Years

For more information, email:

ProfileTeam@naccho.org

The 2008 Profile was made possible through funding from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. 

Mission

The mission of the National Association of County and City Health Officials is to be a leader, catalyst, and voice for local health departments in order to ensure the conditions that promote health and equity, combat disease, and improve the quality and length of all lives.