Get documents about "Operational Definition booklet FINAL.pmd
Document Sample
NACCHO
Operational
Definition
of a
functional
local health
department
NACCHO
NATIONAL
ASSOCIATION OF
COUNTY & CITY
HEALTH OFFICIALS
Public Health
Prevent. Promote. Protect.
Operational Definition of a Functional Local Health Department • November 2005 1
November 2005
o p e r a t i o n a l d e f i n i t i o n o f a
f u n c t i o n a l l o c a l h e a l t h d e p a r t m e n t
G
overnmental public health Prevents, minimizes, and contains
departments are responsible adverse health effects from
for creating and maintaining communicable diseases, disease
conditions that keep people healthy. outbreaks from unsafe food and
At the local level, the governmental water, chronic diseases,
public health presence, or “local environmental hazards, injuries,
health department,” can take many and risky health behaviors.
forms.1 Furthermore, each Leads planning and response
community has a unique “public activities for public health
health system” comprising individuals emergencies.
and public and private entities that
Collaborates with other local
are engaged in activities that affect
responders and with state and
the public’s health.
federal agencies to intervene in
other emergencies with public
Regardless of its governance or
health significance (e.g., natural
structure, regardless of where specific
disasters).
authorities are vested or where
particular services are delivered, Implements health promotion
everyone, no matter where they live, programs.
should reasonably expect the local Engages the community to
health department to meet certain address public health issues.
standards.2
Develops partnerships with public
and private healthcare providers
A FUNCTIONAL LOCAL HEALTH
and institutions, community-
DEPARTMENT:
based organizations, and other
government agencies (e.g.,
Understands the specific health housing authority, criminal
issues confronting the justice, education) engaged in
community, and how physical, services that affect health to
behavioral, environmental, collectively identify, alleviate, and
social, and economic conditions act on the sources of public
affect them. health problems.
Investigates health problems and Coordinates the public health
health threats. system’s efforts in an intentional,
non-competitive, and non-
duplicative manner.
NACCHO NATIONAL
ASSOCIATION OF
COUNTY & CITY
HEALTH OFFICIALS
2
NACCHO
Addresses health disparities.
Serves as an essential resource for
local governing bodies and
policymakers on up-to-date
public health laws and policies.
Provides science-based, timely,
and culturally competent health
information and health alerts to
the media and to the community.
Provides its expertise to others
who treat or address issues of
public health significance.
Ensures compliance with public
health laws and ordinances,
using enforcement authority
when appropriate.
Employs well-trained staff
members who have the necessary
resources to implement best
practices and evidence-based
programs and interventions.
Facilitates research efforts, when
approached by researchers, that
benefit the community.
Uses and contributes to the
evidence base of public health.
Strategically plans its services and
NOTES
1
For the purposes of this definition, a
activities, evaluates performance
local health department may be locally
and outcomes, and makes governed, part of a region or district, be
adjustments as needed to an office or an administrative unit of the
state health department, or a hybrid of
continually improve its these.
effectiveness, enhance the 2
See “Local Health Department
community’s health status, and Standards,” Pages 4 through 9, for further
description of the functions captured in
meet the community’s this definition.
expectations.
Operational Definition of a Functional Local Health Department • November 2005 3
l o c a l h e a l t h d e p a r t m e n t
s t a n d a r d s
A
ll local health departments standards, LHDs employ strategies
(LHDs),1 as governmental that are evidence-based and informed
entities, derive their authority by best practices, and they operate
and responsibility from the state and according to the highest level of
local laws that govern them. professionalism and ethics to inspire
Accordingly, all LHDs exist for the public confidence and trust.
common good and are responsible
for demonstrating strong leadership A number of factors contribute to the
in the promotion of physical, variability of how LHDs operate;
behavioral, environmental, social, specifically capacity, authority,
and economic conditions that resources, and composition of the
improve health and well-being; local public health system:
prevent illness, disease, injury, and
premature death; and eliminate The LHD may have the capacity
health disparities.2 However, in the to perform all of the functions on
absence of specific, consistent its own; it may call upon the
standards regarding how LHDs fulfill state to provide assistance for
this responsibility, the degree to some functions; it may develop
which the public’s health is protected arrangements with other
and improved varies widely from organizations in the community
community to community. or with neighboring LHDs to
perform some functions; or it may
These standards describe the control the means by which
responsibilities that every person, other entities perform some
regardless of where they live, should functions.
reasonably expect their LHD to fulfill.
They have been developed within Government agencies other than
nationally recognized frameworks3 the LHD may have the authority
and with input from public health to perform services that affect
professionals and elected officials4 public health.
from across the country. The
standards provide a framework by Resources for public health may
which LHDs are accountable to the be housed in a different agency.
state health department, the public
they serve, and the governing bodies Each LHD jurisdiction is served by
(e.g., local boards of health, county its own unique public health
commissioners, and mayors) to which system: public and private health
they report. In meeting the care providers, businesses,
community organizations,
NACCHO NATIONAL academic institutions, and media
ASSOCIATION OF
COUNTY & CITY outlets that all contribute to the
HEALTH OFFICIALS
public’s health.
4
NACCHO
As a result of these differences, how Currently, not all LHDs have the
LHDs meet the standards—whether capacity to meet the standards. Many
they directly provide a service, broker concerns have been raised regarding
particular capacities, or otherwise the costs of developing the capacity,
ensure that the necessary work is and the implications for LHDs that do
being done—will vary. Regardless of not meet the standards. It is difficult
its specific capacity, authority, and to anticipate costs, and it is equally
resources, and regardless of the important to understand that
particular local public health system, improvements in capacity can be
the LHD has a consistent made in the absence of new
responsibility to intentionally resources. NACCHO is committed to
coordinate all public health activities collecting and sharing models of
and lead efforts to meet the LHDs and LHD arrangements to
standards. demonstrate various means to
enhance local governmental public
The standards are a guide to the health capacity. Furthermore,
fundamental responsibilities of LHDs, NACCHO is currently participating in
allowing for varied structural a national dialogue on whether to
characteristics of LHDs (e.g., establish a voluntary national
governance, staffing patterns, size of accreditation system for state and
the population served, etc.), and local health departments,5 and is
recognizing that each LHD may have supportive of such an effort.6 The
other duties unique to meeting the results of this dialogue may generate
public health needs of the community implications for LHDs not meeting the
it serves. Several states have standards.
developed, or are in the process of
developing, state-specific standards NACCHO urges LHDs to embrace
for LHDs, and the National Public these standards both as a means of
Health Performance Standards working with their state health
Program (NPHPSP) includes standards departments, communities, and
for local public health systems. governing bodies to develop a more
NACCHO analyses of several state robust governmental public health
initiatives and the NPHPSP have capacity, and as a means of holding
shown a high level of consistency themselves uniformly accountable to
between these efforts and NACCHO’s the public they serve.
nationally-developed standards.
Operational Definition of a Functional Local Health Department • November 2005 5
l o c a l h e a l t h d e p a r t m e n t
s t a n d a r d s
1 Monitor health status and
understand health issues facing 2 Protect people from health
problems and health hazards.
the community.
a. Investigate health problems and
a. Obtain and maintain data that environmental health hazards.
provide information on the b. Prevent, minimize, and contain
community’s health (e.g., provider adverse health events and
immunization rates; hospital conditions resulting from
discharge data; environmental communicable diseases; food-,
health hazard, risk, and exposure water-, and vector-borne outbreaks;
data; community-specific data; chronic diseases; environmental
number of uninsured; and hazards; injuries; and health
indicators of health disparities such disparities.
as high levels of poverty, lack of c. Coordinate with other
affordable housing, limited or no governmental agencies that
access to transportation, etc.). investigate and respond to health
b. Develop relationships with local problems, health disparities, or
providers and others in the environmental health hazards.
community who have information d. Lead public health emergency
on reportable diseases and other planning, exercises, and response
conditions of public health interest activities in the community in
and facilitate information accordance with the National
exchange. Incident Management System, and
c. Conduct or contribute expertise to coordinate with other local, state,
periodic community health and federal agencies.
assessments. e. Fully participate in planning,
d. Integrate data with health exercises, and response activities
assessment and data collection for other emergencies in the
efforts conducted by others in the community that have public health
public health system. implications, within the context of
e. Analyze data to identify trends, state and regional plans and in a
health problems, environmental manner consistent with the
health hazards, and social and community’s best public health
economic conditions that adversely interest.
affect the public’s health. f. Maintain access to laboratory and
biostatistical expertise and capacity
to help monitor community health
status and diagnose and
investigate public health problems
and hazards.
NACCHO NATIONAL g. Maintain policies and technology
ASSOCIATION OF
COUNTY & CITY required for urgent
HEALTH OFFICIALS
communications and electronic
6 data exchange.
NACCHO
3 Give people information they
need to make healthy choices.
health goals in partnership with
public and private organizations.
d. Develop partnerships to generate
a. Develop relationships with the
interest in and support for
media to convey information of
improved community health status,
public health significance, correct
including new and emerging
misinformation about public
public health issues.
health issues, and serve as an
e. Inform the community, governing
essential resource.
bodies, and elected officials about
b. Exchange information and data
governmental public health
with individuals, community
services that are being provided,
groups, other agencies, and the
improvements being made in
general public about physical,
those services, and priority health
behavioral, environmental, social,
issues not yet being adequately
economic, and other issues
addressed.
affecting the public’s health.
c. Provide targeted, culturally-
appropriate information to help
individuals understand what
5 Develop public health policies
and plans.
decisions they can make to be a. Serve as a primary resource to
healthy. governing bodies and
d. Provide health promotion policymakers to establish and
programs to address identified maintain public health policies,
health problems. practices, and capacity based on
current science and best practices.
4 Engage the community to
identify and solve health
b. Advocate for policies that lessen
health disparities and improve
problems. physical, behavioral, environmental,
social, and economic conditions in
a. Engage the local public health
the community that affect the
system in an ongoing, strategic,
public’s health.
community-driven, comprehensive
c. Engage in LHD strategic planning
planning process to identify,
to develop a vision, mission, and
prioritize, and solve public health
guiding principles that reflect the
problems; establish public health
community’s public health needs,
goals; and evaluate success in
and to prioritize services and
meeting the goals.
programs.
b. Promote the community’s
understanding of, and advocacy
for, policies and activities that will
improve the public’s health.
c. Support, implement, and evaluate
strategies that address public
Operational Definition of a Functional Local Health Department • November 2005 7
l o c a l h e a l t h d e p a r t m e n t
s t a n d a r d s
6 Enforce public health laws and
regulations.
services, including preventive and
health promotion services, in
partnership with the community.
a. Review existing laws and
c. Link individuals to available,
regulations and work with
accessible personal healthcare
governing bodies and policy-
providers (i.e., a medical home).
makers to update them as needed.
b. Understand existing laws,
ordinances, and regulations that
protect the public’s health.
8 Maintain a competent public
health workforce.
a. Recruit, train, develop, and retain a
c. Educate individuals and
diverse staff.
organizations on the meaning,
b. Evaluate LHD staff members’ public
purpose, and benefit of public
health competencies,7 and address
health laws, regulations, and
deficiencies through continuing
ordinances and how to comply.
education, training, and leadership
d. Monitor, and analyze over time, the
development activities.
compliance of regulated
c. Provide practice- and competency-
organizations, entities, and
based educational experiences for
individuals.
the future public health workforce,
e. Conduct enforcement activities.
and provide expertise in
f. Coordinate notification of violations
developing and teaching public
among other governmental
health curricula, through
agencies that enforce laws and
partnerships with academia.
regulations that protect the public’s
d. Promote the use of effective public
health.
health practices among other
practitioners and agencies
7 Help people receive health
services. engaged in public health
interventions.
a. Engage the community to identify e. Provide the public health workforce
gaps in culturally-competent, with adequate resources to do
appropriate, and equitable their jobs.
personal health services, including
preventive and health promotion
services, and develop strategies to 9 Evaluate and improve programs
and interventions.
close the gaps. a. Develop evaluation efforts to assess
b. Support and implement strategies health outcomes to the extent
to increase access to care and possible.
establish systems of personal health b. Apply evidence-based criteria to
evaluation activities where
NACCHO NATIONAL
ASSOCIATION OF
possible.
COUNTY & CITY
HEALTH OFFICIALS
c. Evaluate the effectiveness and
quality of all LHD programs and
8
NACCHO
activities and use the information NOTES
to improve LHD performance and 1
For the purposes of these standards, an LHD
community health outcomes. is defined as the governmental public health
d. Review the effectiveness of public presence at the local level. It may be a locally
governed health department, a branch of the
health interventions provided by
state health department, a state-created
other practitioners and agencies
district or region, a department governed by
for prevention, containment, and/ and serving a multi-county area, or any other
or remediation of problems arrangement that has governmental authority
affecting the public’s health, and and is responsible for public health functions
provide expertise to those at the local level.
interventions that need 2
For the purposes of this document, “health
improvement. disparities” refer to differences in populations’
health status that are avoidable and can be
10 Contribute to and apply the
evidence base of public
changed. These differences can result from
social and/or economic conditions, as well as
public policy. Examples include situations
health.
whereby hazardous waste sites are located in
a. When researchers approach the poor communities, there is a lack of
LHD to engage in research affordable housing, and there is limited or no
activities that benefit the health of access to transportation. These and other
factors adversely affect population health.
the community,
3
i. Identify appropriate The standards are framed around the Ten
populations, geographic areas, Essential Public Health Services, which have
been reworded to more accurately reflect the
and partners;
specific LHD roles and responsibilities related
ii. Work with them to actively
to each category. In addition, these standards
involve the community in all are consistent with the National Public Health
phases of research; Performance Standards Program (NPHPSP),
iii. Provide data and expertise to serving to specify the role of governmental
support research; and, LHDs while the NPHPSP addresses the public
iv. Facilitate their efforts to share health system as a whole.
research findings with the 4
This includes those from local health
community, governing bodies, departments, local boards of health, state
and policymakers. health departments, and federal public health
b. Share results of research, program agencies; as well as county commissioners,
mayors, state legislators, and gubernatorial
evaluations, and best practices
health advisors.
with other public health
5
practitioners and academics. www.exploringaccreditation.org
6
c. Apply evidence-based programs NACCHO Resolution 04-06 further describes
and best practices where possible. NACCHO’s stance on accreditation.
7
As defined by the Core Public Health
Competencies developed by the Council on
Linkages between Academia and Public
Health Practice.
Operational Definition of a Functional Local Health Department • November 2005 9
o p e r a t i o n a l d e f i n i t i o n o f a
f u n c t i o n a l l o c a l h e a l t h d e p a r t m e n t
P
ublic health professionals and WHAT ARE NACCHO’S
the communities they serve NEXT STEPS?
deserve a common set of
NACCHO’s first step is education and
expectations about local health communication about the definition
departments (LHDs). More than 600 with LHDs, local boards of health,
governmental public health state health departments, federal
professionals and local and state public health agenices, and local and
officials representing 30 different state elected officials. Metrics will be
states contributed to this definition, developed to allow LHDs to measure
which will be a living document. their progress in achieving the
standards.
By describing the functions of LHDs,
the definition will help citizens and NACCHO will also gather examples of
how LHDs use the definition. The
residents understand what they can
Exploring Accreditation project will
reasonably expect from governmental
examine the use of the standards as
public health in their communities.
the basis for a voluntary national
The definition also will be useful to
accreditation system for LHDs of all
elected officials, who need to sizes and structures.
understand what LHDs do and how
to hold them accountable. And, the
definition will aid LHDs in obtaining WHAT ACTION STEPS CAN
their fair share of resources. YOU TAKE?
LHDs can use the definition and
standards to assess local efforts,
measure performance, expand
functions, enhance activities, and
communicate about the role of local
public health to their governing
bodies, elected officials, and
community.
NACCHO has developed a set of three
fact sheets describing the role of local
public health and a communications
toolkit as part of this project. Both
the toolkit and the fact sheets are
available on NACCHO’s Web site (see
the following column). We encourage
NACCHO NATIONAL LHDs to download the fact sheets and
ASSOCIATION OF
COUNTY & CITY
HEALTH OFFICIALS
communications toolkit.
10
NACCHO
Finally, your experiences with the
definition will inform and help shape
the implementation phase of this
effort. Please submit examples of
how LHDs have met the definition
(particularly those involving the
development of shared capacity and/
or resources), applied the tools in the
communications toolkit, or otherwise
used the definition or related
materials.
You can find additional materials and For more information about this
submit examples online at: project, please contact
NACCHO at (202) 783-5550
www.naccho.org/topics/ and ask to speak with the
infrastructure/ Operational Definition program
operationaldefinition.cfm. manager, or e-mail
operationaldefinition@naccho.org.
NACCHO thanks the following organizations for their contributions to the development
of the operational definition: the Association of State and Territorial Health Officials,
the Association of State and Territorial Local Health Liaison Officials, the Centers for
Disease Control and Prevention, the Health Resources and Services Administration, the
National Association of Counties, the National Association of Local Boards of Health,
the National Conference of State Legislatures, the National Governors Association, the
National League of Cities, and the U.S. Conference of Mayors.
Funding for this project was provided by
the Robert Wood Johnson Foundation and
the Centers for Disease Control and
Prevention (under cooperative agreement
U50/CCU302718). The contents of this
document are solely the responsibility of
the authors and do not necessarily
represent the official views of the sponsors.
Operational Definition of a Functional Local Health Department • November 2005 11
National Association of
County and City
Health Officials
1100 17th Street, NW
Second Floor
Washington, DC 20036
(202) 783-5550 Phone
(202) 783-1583 Fax
www.naccho.org
NACCHO NATIONAL
ASSOCIATION OF
COUNTY & CITY
HEALTH OFFICIALS
12
