Slides for CPH 950 with Dr. Scutchfield - Spring 2011 Prepared by: Kristina Rabarison

1. ASTHO and NACCHO Profiles
Feb. 11 2010
CPH 950
F.D. Scutchfield, M.D.
Peter P. Bosomworth Professor of
Health Services Research and Policy
University of Kentucky
Center for Public Health Systems & Services Research

2. Association of State and Territorial
Health Officials (ASTHO)
• ASTHO Profile of State Public Health, Volume One
(2009) (pdf)
• With support from the Robert Wood Johnson
Foundation and the Centers for Disease Control
and Prevention, ASTHO surveyed state and
territorial health agencies about their
responsibilities, organization and structure,
planning and quality improvement activities,
workforce, and much more. All 50 states and the
District of Columbia completed the survey.

3. ASTHO – Vision and Mission
VISION:
• Healthy people thriving in a nation free of
preventable illness and Injury
MISSION:
• To transform public health within states and
territories to help members dramatically
improve health and wellness

4. State public health is the focal point for
population health activities in states, public
health system oversight, management of
federal funds targeted to unmet needs, state
health surveillance, and is the final arbiter of
health policy in states.

5. 4 Main Sections of ASTHO Profile
1. Public Health Responsibilities
2. Organization and Structure
3. State Health Planning and Quality
Improvement
4. State Health Agency Workforce

6. 1. Public Health Responsibilities
• Wellness
• Policy Development
• Vital Statistics
• Prevention Services
• Immunization Services
• Preparedness
• Access to Care
• Registry Maintenance
• Maternal and Child Health Services
• Epidemiology and Surveillance
• Regulation, Inspection and Licensing
• Environmental Health
• Professional Licensing

7. State Health Agency (SHA) Top Activities
• Leadership development
• Adoption of National Public Health
• Performance Standards
• Implementation of the Public Health
• Improvement Project
• Workforce development / core
competencies
• Coordination with partners in the
public health system
• Support for local public health
agencies
• Data driven management.

8. 2. Organization and Structure
This section looks at issues
such as the influence of
state legislatures on
SHAs and the
relationships between
SHAs and other entities,
such as local public
health agencies and
private organizations.

9. 3. State Health Planning and Quality
Improvement
To varying degrees, SHAs have drawn from several tools
developed to help them achieve higher standards in their
organizations and programs. Among the most prominent:
• Turning Point, a network of 23 state partners and five
National Excellence Collaboratives initiated by the Robert
Wood Johnson Foundation to strengthen the public health
system in the U.S.
• National Public Health Performance Standards Program
(NPHPSP), a CDC National Partnership initiative that sets
forth standards for state and local public health systems.

10. SHA Health Improvement Plan QI and Performance Management

11. 4. State Health Agency Workforce
Although a majority of state health officials hold a medical doctor
degree, others have earned degrees in a variety of disciplines.
About a third hold a master’s in public health degree.

12. State Health Agency Staff
Number of Full-time Equivalents (FTEs) Number and Type of SHA Employees
Employed by SHAs

14. National Association of County and
City Health Officials (NACCHO)
NACCHO is the national organization
representing local health departments.
NACCHO support efforts that protect and
improve the health of all people and all
communities by promoting national policy,
developing resources and programs, seeking
health equity, and supporting effective local
public health practice and systems.

15. Purpose of National Profile of LHDs
To advance and support the development of a database
for LHDs to describe and understand their structure,
function, and capacities.

16. 10 Essential Public Health Services

17. Operational Definition of
a Functional Local Health Department

18. Total Number of LHDs in Study
Population, Number of LHDs
Completing
Questionnaire, and Response Rates,
for All LHDs and by State

19. Main Sections of NACCHO Profile
1. Jurisdiction and Governance
2. Financing
3. LHD Leaders
4. LHD Workforce
5. Emergency Preparedness
6. LHD Activies
7. Community Health and Health Disparities
8. Quality Improvement and Accreditation
9. Information Technology and Management

20. 1. Jurisdiction and Governance
LHD Governance Type, by State

21. Local Boards of Health Functions
• adopting public health
regulations,
• setting and imposing fees,
• approving the LHD budget
• hiring or firing the top
agency administrator
• requesting a public health
levy

22. 2. Financing
• What Were LHD Total Annual
Expenditures?
• What Were the Average Expenditures
of LHDs?
• What Were per Capita Expenditures
for LHDs?
• Did LHD per Capita Expenditures
Differ by State?
• What Were the Sources of LHD
Revenues?
• Did Revenue Sources Vary by the Size
of the Population Served
• by the LHD?
• What Were the LHD Revenue Sources
for Each State?

23. LHD Total Annual Expenditures
Forty-two percent had
expenditures of less than
$1 million, 30 percent had
expenditures of $1 to
$4.9 million, and 17
percent had expenditures
of $5 million or more.
Data on this item were
unreported for 11 percent
of LHDs.

24. 3. LHD Leaders
• What Were the Demographic
Characteristics of LHD
• Top Agency Executives?
• Did Characteristics of Top
Executives Change Between
2005 and 2008?
• How Old Were Most LHD Top
Executives?
• What Was the Education Level
of LHD Top Executives?
• How Long Have Top Executives
Worked at LHDs?
• Were New Top Executives
Different from Experienced Top
Executives?

25. Percentage of Top Agency Distribution of Top Agency Executives,
Executives by Selected Characteristics by Highest Degree Obtained

26. 4. LHD Workforce
• How Many FTE Positions Were
Employed by LHDs?
• Did the Average Numbers of
Employees and FTEs Vary by Size
• of the Population Served by the
LHD?
• What Were the Demographic
Characteristics of LHD Staff?
• What Kinds of Job Functions
Were Most Often Included at
LHDs?

27. LHD Workforce
• Did Occupations at the LHD
Vary by the Size of the
Population Served?
• What Were the Average
Numbers of Staff Persons at
LHDs?
• What Were the Typical
Staffing Patterns of LHDs?
• Has the Workforce Size and
Composition Changed
Between 2005 and 2008?
• What Was the Overall
Distribution of the LHD
Workforce?

28. Distribution of FTE Positions at Distribution of Occupations in
LHDs the LHD Workforce

29. The Demographic Characteristics of LHD Staff

30. 5. Emergency Preparedness
• What Kinds of Centers for Disease Control and Prevention (CDC) Funding
• Did LHDs Receive for Emergency Preparedness Activities?
• Did Funding Vary by the Size of the Population Served by the LHD?
• What Was the Funding per Capita for Emergency Preparedness Activities
• in LHD Jurisdictions?
• What Were the per Capita Levels of CDC Funding to LHDs for Emergency
• Preparedness by State?
• How Many LHDs Had Staff Salaries Paid with Emergency
• Preparedness Funding?
• What Kinds of Emergency Preparedness Planning Activities Were
• Conducted by LHDs?
• What Were the Reasons for Activating an Emergency Operations
• Center (EOC)?
• What Percentage of LHDs Responded to Specific Emergency Events?

31. Kinds of Emergency Preparedness Planning
Activities Were Conducted by LHDs

32. 6. LHD Activities
10 Most Frequent Activities
and Services Available
Through LHDs Directly

33. 7. Community Health and Health
Disparities • Did LHDs Participate in Community Health
Planning Activities?
• What Roles Did LHDs Have in the
Development of Community
• Health Assessments?
• Did Community Health Assessments and
Community Health Improvement
• Planning Activities Differ According to the
Size of the Population Served
• by the LHD?
• What Resources Did LHDs Use for CHAs and
CHIP?

34. Community Health and Health
Disparities • What Were LHD Activities Related to
Health Disparities?
• Did Activities to Address Health
Disparities Differ by the Size of
• the Population Served by the LHD?
• What Kinds of Collaborations Were
Conducted by LHDs?
• How Did LHDs Relate to Academic
Institutions?
• What Were LHD Activities Regarding
Public Health Policy?
• What Were LHD Activities Regarding
Access to Healthcare Services?

35. Community Health Assessments (CHAs)
• More than 60 percent of
respondents reported that a
CHA had been completed in
the last three years
• A lower proportion (49%)
reported that community
health improvement
planning had been
conducted in the last three
years; within this group,
more than 90 percent of all
CHIPs were based on
community health
assessments.

36. 8. Quality Improvement and
Accreditation • Did LHDs Participate in Formal Quality or
Performance Improvement Activities?
• What Were the Focus Areas for LHD
Performance Improvement Activities?
• Did LHDs Have Management with Training
in Quality Improvement?
• What Strategies or Approaches Did LHDs
Use for Quality Improvement?
• How Was the Operational Definition Used
at LHDs?
• Were Respondents Aware of the
Developing Voluntary National
• Accreditation Program?
• What Was the Interest Level in LHD
Accreditation?
• Did Interest in a Voluntary National
Accreditation Program Differ by the Size
• of the Population Served by the LHD?

37. Percentage of LHDs with Participation in a Formal Performance Improvement
Activity, for All LHDs and by Size of Population Served

38. Percentage of LHDs, by Level of Agreement with Statements on Seeking
Voluntary National Accreditation in Unspecified Time, by Size of Population
Served

39. 9. Information Technology and
Management • What Kinds of Information
Technology Did LHDs Use?
• How Were Records Kept in
Specific LHD Programs?
• What Types of Information Were
Available to LHDs?
• Did Most LHDs Have Web Sites?
• What Types of Information Were
Available on LHD Web Sites?
• What Kinds of Promotional
Strategies Were Used by LHDs?
• Did LHDs Share Resources with
Other LHDs?
• In What Types of Programs Were
LHD Resources Shared?

40. Percentage of LHDs, by Level of Implementation of Selected Information
Technologies

41. Percentage of LHDs, by Availability of Data Sources

42. Data Harmonization
• The Robert Wood Johnson Foundation
(Princeton, NJ) –Data Harmonization
• U.S. Centers for Disease Control and
Prevention –Profiles (ASTHO and NACCHO)

43. The Profiles
• ASTHO: Association of State & Territorial
Health Officials (DC)
• NACCHO: National Association of City &
County Health Officials (DC)
• NALBOH: National Association of Local Boards
of Health (Bowling Green, OH)

44. Data Harmonization Outcome: Part A
Each of the three Profiles surveys are using the
same Geographic and Demographic questions
(what we are calling Part A)

45. Data Harmonization Outcome: Part B
Each of the three Profiles surveys, however, focus on
different topics. Each survey has a distinct, different
Part B with questions of interest for each organization.
Even in these individualized Part Bs, however, there has
been a concerted effort to align questions on similar
topics by using shared or parallel language in the
questions.
Knowing what the other surveys are gathering,
associations have been able to shorten their surveys
somewhat.

46. Data Harmonization Outcome: Part C
Each of the three Profiles surveys are using the
similar cross-thematic questions addressing
key areas of focus for RWJF initiatives (what
we are calling Part C)

47. Teamwork
• Interactive colleagues in parallel positions at
all three associations
• Profiles Work Groups at all three associations
• ASTHO and NACCHO gathering information
on local boards of health to assist NALBOH

48. References:
• ASTHO - Profile of State Public Health Vol. 1
http://www.astho.org/Display/AssetDisplay.aspx?id=2882
• NACCHO – National Profile of Local Health
Departments
• The Data Harmonization Project – Jeff Jones,
PhD. Keeneland Conference, 2010

49. For more information contact:
121 Washington Avenue, Suite 212
Lexington, KY 40517
859-257-5678
www.publichealthsystems.org

50. Questions?