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Scientific Data Documentation

National Profile Of National Health Departments, July 1990

ABSTRACT

                                Supported by:

                         CENTERS FOR DISEASE CONTROL
                    Public Health Practice Program Office

                                Prepared by:

               NATIONAL ASSOCIATION OF COUNTY HEALTH OFFICIALS
                            440 First Street N.W.
                           Washington, D.C.  20001
                               (202) 783-5550
FOREWORD

 On behalf of the National Association of County Health Officials (NACHO), I am
 pleased to present the first findings from the National Profile of Local
 Health Departments.  This project was established as an adjunct study to the
 Assessment Protocol for Excellence In Public Health (APEX/PH).  The National
 Profile was developed to provide the public health community with a current
 and comprehensive description of the nation's local health departments.  The
 following report presents a detailed portrait of the important role local
 health departments play in our public health system.

 This study was made possible through the participation of each of the local
 health departments described within.  I would like to thank all of the local
 health officials and their staffs who participated in this project and made
 this study possible.  Further, all local health officials can and should take
 pride in their contributions to public health, which are so clearly depicted
 in the pages which follow.

 It is anticipated that this report will serve to do more than simply provide a
 long-overdue description of local public health.  Local, state and federal
 public health practitioners will find a variety of uses for the data.  Local
 health officials will be able to enhance their program analyses by using a
 national database, including staffing, expenditure and services data, as a
 reference point.

 Those involved with local public health recommendations and policy decisions
 will have an accurate depiction of the resources, abilities, and contributions
 of local health departments nationwide.  This report details the sizable role
 local health departments play in health assessment, policy development, and
 assurance, i.e., the core activities outlined in the Institute of Medicine's
 report, The Future of Public Health.  It also shows the great extent to which
 local health departments provide health care in our communities through
 prevention activities and the delivery of personal health services.

 In follow-up to this report, NACHO is performing more in-depth analyses of the
 database, and is researching specific local health issues that are of national
 interest.  NACHO also has the potential to use this profile to launch
 additional research projects, perhaps using a sampling frame, and to monitor
 trends in local health programs and operations.  With this in mind, we are
 looking forward to presenting many more reports from the National Profile of
 Local Health Departments.

 Your suggestions and comments on this report are invited.  Please address your
 communications to the National Association of County Health Officials, 440
 First Street, N.W., Suite 500, Washington, D.C.  20001.


                    Martin P. Wasserman, M.D., J.D.
                    President, National Association of County Health Officials
                    Director, Montgomery County Health Department, Maryland
ACKNOWLEDGEMENTS

 Special thanks are due to all of the local health officials who participated
 in this project and made this report possible.  It is our sincere wish that
 the results of the National Profile will be of great use to them.

 The development of the National Profile of Local Health Departments has been
 directed by the APEX/PH Registry Committee and the NACHO Review Board.

 The APEX/PH Registry Committee members are:

      Arthur P. Liang, M.D., M.P.H., Assistant Director for Surveillance and
                 Epidemiology, Public Health Practice Program Office, Centers
                 for Disease Control, Chairperson;
      Larry M. Belmont, M.P.H., M.P.A., Director of the Panhandle Health
                 District, Idaho;
      Beverly C. Flynn, R.N., Ph.D., F.A.A.N., Professor and Director, Healthy
                 Cities Indiana, Department of Community Health Nursing,
                 Indiana University;
      Gary Gurian, M.D., Director of the Allentown Bureau of Health,
                 Pennsylvania;
      William Shonick, Ph.D., Professor of Health Services, UCLA School of
                 Public Health;
      Pomeroy Sinnock, Ph.D., Centers for Disease Control, was Chairperson of
                 the APEX/PH Registry Committee from its inception in 1988 to
                 April 1990.

 The NACHO Review Board members are:

      James Giuffre', M.P.H., Director, North Central District Health
                 Department, Idaho;
      David Gurule', M.P.H., Chief Health Planning Officer, Department of
                 Health and Hospitals, City of St. Louis, Missouri;
      Mary Luth, M.P.H., M.P.A., Director, Washington County Public Health
                 Department, Minnesota;
      Bruce Parsons, M.P.A., Director, Gaston County Health Department, North
                 Carolina.

 This project was made possible by the following individuals who noted the need
 for such a profile and guided its progress at all stages:

      Robert G. Harmon, M.D., M.P.H., Administrator, Health Resources and
                 Services Administration, who served as the Chairperson of the
                 APEX/PH Steering Committee from July 1987 to February 1990:
      Joel Nitzkin, M.D., D.P.A., Medical Director, Louisiana Office of Health
                 and Hospitals, Louisiana, who served as Chairperson of the
                 APEX/PH Work from July 1987 to September 1989;
      William Dyal, Director, Division of Public Health Systems, Public Health
                 Practice Program Office, CDC;
      Charles Bacon, Project Officer APEX/PH, Public Health Advisor, Public
                 Health Practice Program Office, CDC;
                 C. Joseph Webb, former Project Officer APEX/PH, Public Health
                 Advisor, Public Health Practice Program Office, CDC.


 This project is also indebted to the members of the APEX/PH Steering Committee
 and the APEX/PH Work Group (Appendix 3).

 The contributions of the following are also appreciated:

      the U.S. Conference of Local Health Officers;
      the State Health Agencies and their staffs;
      the Association of State and Territorial Local Health Liaison Officials;
      the statewide associations of local health officials.

 This project is supported by the Public Health Practice Program Office,
 Centers for Disease Control.

 This report was prepared by the following staff of the National Association of
 County Health Officials:

      Jani Bigelson, M.P.H., Assistant Director;
      John Grasse, M.P.H., Research Assistant;
      Clark Greene, M.A., Research Associate;
      Nancy Rawding, M.P.H., Executive Director.

 Special thanks to Clark Greene, whose diligence, organization and unflappable
 calm made possible the development of the National Profile of Local Health
 Departments.


LIST OF FIGURES

Local Health Department Overview

 Figure 1   Number of Local Health Departments by State

 Figure 2   Populations of Local Health Department Jurisdictions

Local Health Officers

 Figure 3   Degrees of Local Health Officers

 Figure 4   Degrees of Local Health Officers by Jurisdiction

 Figure 5   Percent of Local Health Departments with a Full Time
               Health Officer by Jurisdiction Population

 Figure 6   Tenure of Local Health Officers

 Figure 7   Mean and Median Local Health Officer Tenure by
               Jurisdiction Population

Local Health Department Jurisdictions

 Figure 8   Local Health Department Jurisdictions

 Figure 9   Local Health Departments with Boards of Health within
               Jurisdiction

 Figure 10  Percent of Local Health Departments with Boards of
               Health within Jurisdiction by Jurisdiction Population

Local Health Department Budgets and Selected Sources of Revenue

 Figure 11  Local Health Department Annual Expenditures

 Figure 12  Local Health Department Mean and Median Annual
               Expenditures by Jurisdiction Population

 Figure 13  Percent of Local Health Departments that Charge for
               Personal Health Services by Jurisdiction Population

 Figure 14  Percent of Local Health Departments that Accept Medicaid
               Reimbursement by Jurisdiction Population

Local Health Department Staff

 Figure 15  Local Health Department Number of Full Time Employees

 Figure 16  Local Health Department Mean and Median Number of Full
               Time Employees by Jurisdiction

Local Health Department Functions and Services

 Figure 17  Percent of Local Health Departments that Reported Select
               Staff Full and/or Part Time

 Figure 18  Percent of Local Health Departments that Reported Select
               Staff Full and/or Part Time Jurisdiction Population

 Figure 19  Percent of Local Health Departments that Reported Being
               Active in Assessment Functions and Services

 Figure 20  Percent of Local Health Departments that Reported Being
               Active in Assessment Functions and Services by
               Jurisdiction Population

 Figure 21  Percent of Local Health Departments that Reported Being
               Active in Policy Development Functions and Services

 Figure 22  Percent of Local Health Departments that Reported Being
               Active in Policy Development Functions and Services
               by Jurisdiction Population

 Figure 23  Percent of Local Health Departments that Reported Being
               Active in Selected Assurance Functions and Services

 Figure 24  Percent of Local Health Departments that Reported Being
               Active in Selected Assurance Functions and Services by
               Jurisdiction Population

 Figure 25  Percent of Local Health Departments that Reported Being
               Active in Environmental Health Assurance Functions and
               Services

 Figure 26  Percent of Local Health Departments that Reported Being
               Active in Environmental Health Assurance Functions and
               Services by Jurisdiction Population

 Figure 27  Percent of Local Health Departments that Reported Being
               Active in Personal Health Assurance Functions and
               Services

 Figure 28  Percent of Local Health Departments that Reported Being
               Active in Personal Health Assurance Functions and
               Services (Cont'd)

 Figure 29  Percent of Local Health Departments that Reported Being
               Active in Personal Health Assurance Functions and
               Services by Jurisdiction Population

 Figure 30  Percent of Local Health Departments that Reported Being
               Active in Personal Health Assurance Functions and
               Services by Jurisdiction Population (Cont'd)

 Figure 31  Percent of Local Health Departments that Reported Being
               Active in Selected Functions and Services by Reported
               Number of Full Time Employees

 Figure 32  Percent of Local Health Departments that Reported Being
               Active in Selected Functions and Services by
               Respondent's Public Health Service Region
INTRODUCTION

 The National Profile of Local Departments was conceived in 1987 as an adjunct
 project to the Assessment Protocol for Excellence in Public Health (APEX/PH).
 The goal of APEX/PH, a collaborative effort of public health organizations*,
 is the development of a self-assessment process to assist local health
 departments to better meet the needs of their communities.  The resulting
 APEX/PH workbook is a manual for local health departments to use in assessing
 and improving their organizational capacity, assessing the health status of
 the community, and involving the community in a more effective pursuit of
 public health objectives.  The National Profile was developed to learn more
 about the current capacities of local health departments and to therefore
 shape the development of the APEX/PH Workbook so that it would be as useful as
 possible to all local health departments.

 Beyond its use in the development of the APEX/PH Workbook, the National
 Profile serves to additional purposes, First, it provides a much-needed
 description of the nation's local health departments; and second, it provides
 a sampling frame for future studies of the contributions of local health
 departments to the nation's public health.  The National Profile is an
 extensive compilation of information on local health departments.  The
 information was obtained from 2,269 local health departments that reported on
 their staffing size and patterns, budget expenditures, public health
 activities, and other characteristics.

 A brief review of the literature shows the importance of local health research
 and points to the timeliness of the National Profile.  The earliest efforts
 were undertaken in 1923 by the American Public Health Association's Committee
 on Administrative Practice (CAP)(1).  Data were collected from 83 city health
 departments on their expenditures, organization and public health practices.
 The committee continued to focus on local health services through the
 development of "Appraisal Forms" that were used to collect information on
 public health practices and provide feedback to the health officer.  In 1943,
 the committee published the report entitled "Health Practice Indices," which
 contained data on 178 local health departments in 31 states and 4 Canadian
 provinces(2).

 In 1945, Haven Emerson, M.D., Chairman of the CAP, released the milestone
 report Local Health Units for the Nation, in which he extensively described
 the existing local health system and made recommendations for an ideal local
 health system(3).  This included the recommendation that local health services
 be provided in units (departments) serving no less than 50,000 people.  This
 was though to represent the smallest population for which a department would
 be able to provide efficient and effective public health services.  He
 suggested that, for the existing population to be served effectively, a total
 of 1,197 health units would be needed.

 Terris and Kramer studied local health departments in 1947 to measure the
 level of medical care being provided by these departments(4).  At that time,
 they reported a total of 1,385 full time departments (including state health
 districts).  This work demonstrated that local health departments were moving
 beyond the heretofore traditional boundaries of preventive services and into
 the provision of therapeutic services.

 Joseph Mountin, in 1953, published the Guide to Health Organization in the
 United States, which gave a detailed accounting of the nation's health system
 on the federal, state and local levels(5).  He described the percent of the
 population served by local health service sin the various regions of the
 country, and outlined sample budgets for health departments serving various
 sized populations.  He reported a total of 1,239 local health departments (963
 county and 276 city units).

 The next major study, initiated by the Public Health Service in 1964 and
 published in 1968, again focused on the medical activities local health
 departments were providing(6).  At that time, the Public Health Service
 maintained a directory** of local health units that identified 1,703 local
 health units, all of which were polled as to their responsibilities, services,
 relation to other providers, and role in assuring quality of care in its
 jurisdiction.  The results, using the earlier data from Terris and Kramer's
 study as a baseline, indicated local health departments were becoming
 increasingly involved in medical care.

 C. Arden Miller's study in the mid-70's identified approximately 1,980 local
 health departments(7).  This study provided the public community with summary
 data concerning the jurisdictions, organization, finance, functions, and
 staffing of local health departments.  This extensive work also provided
 information on local health officer's training and salaries.  Miller concluded
 that local health departments were extensively involved in rendering health
 services, including direct personal health services.

 More recent estimates of the numbers and functions of local health departments
 have been done.  An unpublished study by Mullan and Smith(8) (The Johns Hopkins
 University) was conducted by polling the state health departments and resulted
 in a count of 3,233 local health departments.  The Public Health Foundation,
 responsible for maintaining the Association of State and Territorial Health
 Officials (ASTHO) Reporting System, reported that, as of 1989, "nearly 3,000
 local health departments"(9) existed.  Both reports relied primarily on the
 states for their estimates.

 The need for current and detailed local health department data has been widely
 cited.  This was most recently emphasized in the Institute of Medicine's
 report The Future of Public Health, which included the frank admission that,
 "..data on the activities of local health departments are hard to come by."(10)

 The National Profile is a response to this problem.  It provides current,
 detailed, primary source data on our nation's local health departments.
 _________________________
    *  The participating organizations are:  The American Public Health
 Association (APHA); the Association of Schools of Public Health (ASPH); the
 Association of State and Territorial Health Officials (ASTHO); the center for
 Disease Control (CDC); the National Association of County Health Officials
 (NACHO); the U.S. Conference of Local Health Officers (USCLHO).

    ** This directory was discontinued after 1971.
OVERVIEW

Data Source

 The study population for this profile is all local health departments in the
 United States.  Three sources were used to insure that all possible local
 health departments were identified.  The U.S. Conference of Local Health
 Officers (USCLHO) and NACHO both contributed their member mailing lists.
 Additionally, each state health agency were contacted, and the names and
 addresses of the local health departments in their states were obtained from
 them.  After eliminating duplicates, 3,241 local health entities were
 identified as the initial study population.

Definition

 One of the challenges of this and similar projects has been the development of
 a standard "case definition" for a local health department.  A great diversity
 exists among the public health units at the local level; this makes it
 difficult to arrive at a single definition. For the purpose of this study, a
 local health department was defined as:

 an administrative or service unit of local or state government, concerned with
 health, and carrying some responsibility for the health of a jurisdiction
 smaller than the state.

 This definition is adapted from the one used by C.  Arden Miller in 1974* and
 the one used by ASTHO**.  This definition is less restrictive than either, both
 of which included one or more full time employee(s).  The ASTHO definition
 further restricts this by adding that it be a public health employee.  In this
 analysis responses received from units with fewer than one full time employee,
 units that operate on a part time basis, and independently operating nursing
 and environmental units were included.
 __________________________
      *  Miller's operational definition of a local health department:"...an
 administrative and service unit of local or state government, concerned with
 health, employing at least one full time person, and carrying some
 responsibility for the health of a jurisdiction smaller than the state."

      ** The ASTHO definition of a local health department:  An official
 (governmental) public health agency which is, in whole or part, responsible to
 a substate governmental entity or entities.  An entity may be a city, county,
 city-county, federation of counties, borough, township, or any other type of
 substate governmental entity.  A local health department must:  have a staff
 of one or more full-time professional public health employees (e.g., public
 health nurse, sanitarian); deliver public health services; serve a definable
 geographic area; have identifiable expenditures and/or budget in the political
 subdivision (s) it serves.

 Responses received from the following entities were excluded from the
 analysis:

 sub-units or satellite offices of local health departments;

 district units providing support for independent local health
 units (such as the district offices in Alabama, Georgia,
 Louisiana, Mississippi, New Mexico, South Carolina, Tennessee, and
 Virginia.  However, the independent local health units from these
 states were included.);

 sub-state extensions of the state that were not considered by the
 state to be local health departments (such as the units in
 Delaware, Hawaii, Rhode Island, Vermont, and many in
 Pennsylvania);

 non-governmental agencies (such as those in Alaska, which for the
 most part provide local health services through nonprofit
 corporations.)

 By applying these parameters, eliminating duplicates, and removing units that
 not longer existed (noted as miscellaneous below), the study population was
 adjusted to 2,932.  Table 2 details the exclusions that were made.

 _____________________________________________________________________________
                                    TABLE 1
                               STUDY POPULATION

 Initial Study Population                                         3,241

 Exclusions
            Corporate Agencies                                      15
            Districts                                               90
            Duplicates                                              28
            State Agency Extensions                                 84
            Sub-units, Satellite Offices                            60
            Miscellaneous                                           32

 Final Study Population                                           2,932
 _____________________________________________________________________________

Response Rate

 Completed data collection instruments were received from 2,269 local health
 departments that fit the above definition, and they were from all 46 states
 which have local health departments.  The overall response rate was 77%.
 Thirty states had response rates over 80%; of these, eight states had 100%
 response rates.  Five states had response rates under 50%, and no state had a
 response rate lower than 30%.

Strengths

 The response rate has been described above, but it is important to note that
 this is one of the highest response rates reported in the literature.  Only
 the PHS study in 1966 achieved a higher response rate (78.1%); however, the
 study population was smaller (1,703).  The response rate for this study lends
 confidence to the results.

 This is the most extensive data set on local health departments available
 since the mid-seventies.  The database addresses a wide array of local health
 department issues, including:

 local health department assessment, policy development and
 assurance activities;
 local health officer degrees, licensure, tenure, and full or part
 time status;'
 the presence or absence of a local board of health'
 numbers and types of employees;
 annual expenditures.

 Equally important is the fact that these data are primary source data only,
 i.e. the database contains reported directly from local health officials.

 The data were tested for reliability, with good results.  A random sample of
 five percent of the respondents were retested, using telephone interviews, on
 20 of the variables.  Matching responses were give 82% of the time.

 A great strength of the National Profile is that it will allow for specific
 research of a representative sample of health departments.  The ability to
 generate representative samples of local health departments is a new capacity
 for the public health system.  Scientific analyses that could not have been
 completed before may now be carried out quickly and efficiently.

Limitations

 As previously discussed, it is difficult to derive a case definition for local
 health departments that captures the diversity that exists across the nation.
 This has clearly been an issue for other studies, as evidenced by the variance
 in the number of local health departments reported.  Lack of a common
 definition limits the ability to directly compare the results of this analysis
 to previous studies.

 A second limitation is the effect of the non-respondents.  In an effort to
 learn something about the health departments which did not respond, population
 data of the jurisdictions that they served were obtained from the U.S. Census
 Bureau(11) and added to the database.  Analyzing these data showed that the
 response rate was significantly lower for local health departments serving
 smaller jurisdiction populations than for those serving larger jurisdiction
 populations (Table 2).  Additionally, of the 663 non-respondents, 23% of them
 were from two New England states, sand 47% of the non-respondents were from 12
 Southern states.  Therefore, the data are skewed against local health
 departments in those regions that serve less populated jurisdictions.
 ______________________________________________________________________________
                                   TABLE 2
                   RESPONSE RATE BY JURISDICTION POPULATION

 Population                               Response Rate                   N

 0 To 24,999                                   71%                      1,337
 25,000 To 49,999                              81%                        649
 50,000 To 99,999                              85%                        448
 100,000 To 499,999                            90%                        357
 500,000 +                                     99%                         84

 Totals                                        79%*                     2,875

 *The overall response rate for this analysis is higher than the response rate
 mentioned above (77%).  This is due to the exclusion from this analysis of 57
 non-respondents for which population data was unavailable.
 ______________________________________________________________________________

 A  third limitation involves terminology.  The data collection instrument may
 have been interpreted differently by the respondents, for example:  board of
 health; health planning; and primary care could have been interpreted
 differently.  Definitions were not provided for the phrases or terms used, and
 the interpretation was left to the respondent.

 Similarly, respondents were asked to review a list of local health department
 functions and services, and to indicate which of them they were "active in."
 No definition was provided for the term "active in".  Therefore they could
 respond affirmatively if they provided the actual service, if they provided
 referrals only, or if the service was contracted out.
RESULTS

 These descriptive results provide an excellent overview of this nation's local
 public health system.  These data represent the initial findings of the
 National Profile of Local Health Departments.  The continuing analysis of the
 database has and will produce more in-depth results pertaining to specific
 local health issues, much of which will be released in future reports.

 The highlights of the descriptive findings are:

 there are 2,932 local health departments in 46 states nationwide;

 65% of the respondents serve jurisdictions of less than 50,000
 population, and 4% service populations of 500,000 or more;

 67% of the departments report having a full time health officer,
 and 54% of the health officers report having held their present
 position for at least five years;

 70% of the respondents report having a board of health within
 their jurisdiction;

 76% of all local health departments serve a county, multi-county,
 or city/county jurisdiction;

 18% report annual expenditures of less than $100,000, and 28%
 report annual expenditures in excess of $1,000,000;

 75% of all respondents charge for services, and 76% accept
 Medicaid reimbursement;

 46% of the respondents report having fewer than 10 full time
 employees, and 10% had 100 or greater;

 90% of all local health departments report employing a full and/or
 part time registered nurse (either directly or though contracted
 services), and 62% report the same for a physician.

 The National Profile also provides information on the extent to which local
 health departments are assessing the health of their communities, developing
 policies to promote public health, and assuring the public's health through
 direct or indirect service provision.  It is important to note that localities
 nationwide have developed unique systems for providing health services.  These
 systems rely on public, private and volunteer participation.  Therefore,
 instances in this study where local health departments do not report being
 active in specific functions or services may not indicate a lack of services.
 In many instances these functions and services are provided elsewhere within
 the community.

 For assessment functions and services:

            87% are active in reportable disease data collection and analysis;

            92% report being active in communicable disease epidemiology and
            surveillance.

 For policy development activities:

            52% are active in priority setting;

            57% are active in health planning;

            59% are active in health code development and enforcement.

 For assurance activities:

            72% of the respondents report being active in some inspection
            activity;

            72% of the respondents report being active in some licensing
            activity.

            74% report being active in health education activities.

 In environmental health assurance:

            46% are active in hazardous waste management;

            55% are active in solid waste management;

            60% report being active in water pollution;

            68% report being active in public water supply safety;

            70% are active in vector and animal control;

            77% are active in individual water supply safety;

            79% report being active in the sewage disposal systems area.

 In personal health assurance services:

            43% report laboratory services;

            47% report activities assisting handicapped children;

            50% are active in home health care;

            57% report being active in Acquired Immune Deficiency Syndrome
            (AIDS) resting and counseling;

            59% report being active in prenatal care;

            60% report being active in family planning;

            69% report being active in the prevention of chronic diseases;

            73% report activity in the control of sexually transmitted
            diseases;

            81% are active in the control of tuberculosis;

            84% are active inn child health;

            92% are active in immunization programs.

 There recent Institute of Medicine report labeled local health departments,

      "...the critical components of the public health system that directly
      deliver public health services to citizens."(12)

 The National Profile of Local Health Departments demonstrates the truth of
 this statement by describing the multitude of activities that local health
 departments conduct, both in protecting and promoting the public's health, and
 through providing direct health care delivery.
DISCUSSION

 The National Profile is an excellent resource for local health department data
 and has met its primary goal of providing a description of local health
 departments.

 It is clear from this description that local health departments contribute
 greatly to the nation's health through assessment, policy development, and
 assurance.  Whereas the approximately 100 units that existed in the early part
 of this century were primarily assessment-oriented, local health departments
 are now very active in community assessment, communicable disease
 surveillance, personal services, environmental epidemiology, and other
 emerging environmental health areas.  These data demonstrate how local health
 departments have responded to new and perhaps more difficult public health
 challenges.

 Problems involving AIDS, the environment, the indigent care have emerged at a
 time when the federal government is returning much of the responsibility for
 health to the states, and the states must turn to local health agencies.  This
 added responsibility is particularly problematic for those at the local level
 who are trying to respond to the increasing demand for services without the
 added economic base from which to pay for these services.

 The increased understanding of the functions of local health departments, the
 constraints within which they operate, and their fit within the framework of
 all services in the community is one of the most beneficial aspects of this
 study.  The information from the Profile can also be used to obtain a better
 understanding of the totality of public health and personal health services
 available in a community.  Taken together with information on the presence of
 community health centers, hospitals, and private physicians, one gets a more
 accurate impression of the services actually available in a community.

 Information contained in this Profile also provides the opportunity to better
 support these important community institutions.  Using the data in the
 Profile, technical assistance, professional courses, and other support
 services can be tailored to meet the particular needs of local health
 departments.

 The development and maintenance of the Profile will provide the capacity to
 monitor trends in the functions, activities and other characteristics of local
 health departments.  Changes in staffing patterns, the educational levels or
 tenure of local health officials, budget expenditures, services provided,
 etc., can be followed.  It will be possible to analyze some hypotheses already
 set forth in the public health literature.  For example, as previously stated,
 1945 Emerson(13) recommended that local health departments should serve
 populations of no less than 50,000.  Many experts have debated the merits of
 this.  By following the overall development of local health departments, it
 will be possible to see if there is a natural progression toward this.
 Further study on this and other related issues is warranted, and the National
 Profile will facilitate such research.

 The National Profile of Local Health Departments helps to make visible the
 important role of local health departments in the nation's health system.


FIGURES

Introduction

 The data in the following figures are presented as overall
 frequency percents, and in relation to the size of the population
 of the respondent's jurisdiction.  This is done to show the
 variations that exist among local health departments, and to
 provide a framework in which local health officials may compare
 themselves to departments in jurisdictions of similar size.  The
 population variable was used for this analysis because of its
 relatively high predictive value in relation to the other
 variables.  Select variables are also shown in relation to the
 respondent's staff size, and by U.S. Public Health Service
 Region (Appendix 2).

 Please note, the population or "N" for each analysis varies
 slightly due to the fact that not all respondents answered each
 item on the data collection instrument.

21. Number of Local Health Departments (LHD) by State

 This table displays the definition of a local health department as
 stated in this report.  The total number of local health
 departments nationwide was determined to be 2,932.  Due to the
 variations that exist among local health departments, the number
 in a state is not an indication of the level of local public health
 services.

 None:         VT, DE, RI, HI

 1 to 24:      ME, NH, PA, MD, IA, ND, SD, NE, WY, ID, NV, UT, AZ, AK

 25 to 49:     WV, SC, MI, MN, WA, OR, NM

 50 to 99:     MT, CA, CO, KS, OK, TX, AR, LA, MS, AL, TN, IL, IN,
               KY, NC, FL, NY

 100 or more:  MA, CT, VA, OH, GA, MO, WI, NJ

22. Populations of Local Health Department Jurisdictions

 This table shows the distribution of the local health departments
 by the reported population of their jurisdiction.

                   POPULATION        PERCENTAGE

                  0    to 24,999        42%
               25,000  to 49,999        23%
               50,000  to 99,999        17%
               100,000 to 499,999       14%
               500,000 +                 4%

                                     N = 2,263
23. Degrees of Local Health Officers

 This table shows the distribution of the responding local health
 officers according to the degrees that they reported to hold.  All
 degrees and combinations of degrees reported are collapsed into the
 five categories shown.  The results show that 51% of the
 respondents reported holding medical degrees, and 23% reported
 holding graduate public health degrees.

               DEGREES REPORTED       PERCENTAGE

                Medical Degree            36%
                MD + Graduate Public
                      Health Degree       14%
                MD + Other Graduate
                      Degree               1%
                Graduate Public Health
                 Degree Only               9%
                Other Graduate Degree     13%
                Other Non-Graduate
                      Degree              27%

                                       N = 2,193
24. Degrees of Local Health Officers by Jurisdiction Population

 This cross-tabulation table displays the distribution of the
 responding local health officers according to their reported
 degrees and according to the reported population of their
 jurisdictions.  The table should be read column-wise to determine
 the total distribution of local health officers by their reported
 degrees for each population group.  (See Figure 3 for overall
 data.)

 DEGREES-           0 to     25,000 to   50,000 to   100,000   500,000+
                    24,999   49,999      99,999      499,999

 Medical Degree       41%     38%         31%          27%       18%

 MD + Graduate
  Public Health
  Degree               9%     10%         12%          30%       52%

 MD + Other Grad.
  Degree               0%      1%          1%           2%        6%

 Graduate Public
  Health Degree
  Only                 3%     10%         15%          20%        4%

 Other Graduate
  Degree               9%     16%         19%          13%       10%

 Other Non-Graduate
  Degree              38%     25%         22%           8%       10%

 Column Total        100%    100%        100%         100%      100%

 N =                  913     511         372          315        82

 5. % of LHD w/ a Full Time Health Officer by Jurisdiction Pop.

 This table shows the percent of responding health depts that
 reported having a full time health officer for each of the five
 population groups.  Overall, 67% reported a full time health
 officer (N = 2,124).

      0 to       25,000 to   50,000 to   100,000 to     500,000+
      24,999     49,999      99,999      499,999

       57%         62%         75%            86%            99%

 N =   872         495         363            312            82

 6. Tenure of Local Health Officers (Years as of 12/89)

 This table displays the distribution of the responding local health
 officers according to their reported years of service in their
 present position as of December 1989.

                Tenure                           Percent

      Less than 2 years                            18%
      2 to 4.9 years                               28%
      5 to 9.9 years                               23%
      10 to 19.9 years                             24%
      20 years or more                              7%

      N = 1,965

 7. Mean & Median Local Health Officer Tenure by Jurisdiction Pop.
    (Years as of 12/89)

 This table shows the mean and median reported tenure for the local
 health officers in each of the population groups.  Overall, the
 mean tenure was 8.0 years, and the median tenure was 5.8 years (N = 1,965).

                             MEAN           MEDIAN

      0 to 24,999             8.1             5
      (N = 790)

      25,000 to
       49,999                 8.4            6.1
      (N = 460)

      50,000 to
       99,999                 8              6.2
      (N = 340)

      100,000 to
       499,999                8              6.5
      (N = 300)

      500,000 +               5.7            3.5
      (N = 75)

 8. Local Health Department Jurisdictions

 This table shows the distribution of the local health departments
 by their reported jurisdictions.

                Jurisdiction           Percent

                County                   49%
                City/County              20%
                Multi-County              7%
                City                     10%
                Town-Township            13%
                Other                     1%

 9. Local Health Depts. w/ Boards of Health within Jurisdiction

 This table shows the percent of the responding local health
 departments that reported having a board of health within their
 jurisdiction, and those that reported not having a board of health.

                Has Board of Health 70%
                No Board of Health  30%

                             N = 2,211
 10. % of LHD w/ Boards of Health within Jurisdiction

 This table shows the percent of responding local health departments
 that reported having boards of health for each population group.
 (See Figure 9 for overall data.)

                                   N =           Percent

      0 to 24,999                  920             67%

      25,000 to 49,999             514             75%

      50,000 to 99,999             376             77%

      100,000 to 499,999           319             72%

      500,000 +                     82             49%
 
 11. Local Health Department Annual Expenditures

 This table displays the distribution of the respondents according
 to their reported annual expenditures.  The fiscal years that were
 reported for were mostly FY88 and FY89.  In a few instances data
 were submitted by FYs 87 and 86.  These data were used without
 adjustment.

                Expenditures ($)             Percent

                0 to 99,999                    18%

                100,000 to 249,999             21%

                250,000 to 499,999             19%

                500,000 to 999,999             14%

                1,000,000 +                    28%

                N = 1,960

 12. Local Health Dept. Mean & Median Annual Expenditures

 This table shows the mean and median reported annual expenditures
 for the local health departments in each of the population groups.
 The axis indicating annual expenditures is scaled logarithmical to
 display the great disparity of annual expenditures among local
 health departments serving different populations.  Overall, the
 reported mean annual expenditure was $2,734,540, and the median was
 $364,436 (N = 1,960).

 Annual Expenditures ($)
 1 to 1,000,000,000                      Mean        Median

      0 to 24,999                      197,431      131,273
      (N = 758)

      25,000 to 49,999                 499,898      375,000
      (N = 467)

      50,000 to 99,999               1,079,206      860,000
      (N = 359)

      100,000 to 499,999             3,629,878    2,588,965
      (N = 295)

      500,000 +                     43,602,004   16,100,000
      (N = 81)

 13. % of LHD that Charge for Personal Health Services

 This table indicates the percent of local health departments that
 reported charging for services for each of the population groups.
 Overall, 75% reported charging for services (N = 2,105).

                                        N =   Percent

                0 to 24,999             838     67%

                25,000 to 49,999        509     75%

                50,000 to 99,999        366     79%

                100,000 to 499,999      311     88%

                500,000 +                81     95%

 14. % of Local Health Depts. that Accept Medicaid Reimbursement

 This table indicates the percent of local health departments that
 reported accepting Medicaid reimbursement for each of the
 population groups.  Overall, 76% reported accepting Medicaid
 reimbursement (N = 1,951).

                                        N =   Percent

                0 to 24,999             762     70%

                25,000 to 49,999        462     75%

                50,000 to 99,999        347     78%

                100,000 to 499,999      300     87%

                500,000 +                80     95%

 15. Local Health Dept. Number of Full Time Employees

 This table shows the distribution of the responding local health
 departments by the number of full time employees that they
 reported.

                No. of Full Time
                   Employees           Percent

                     0 - 4                26%

                     5 - 9                20%

                    10 - 24               22%

                    25 - 99               22%

                    100 +                 10%

                    N = 2,137

 16. Local Health Dept. Mean & Median # of Full Time Employees

 This table shows the mean and median number of full time employees
 reported by the respondents for each of the population sets.  The
 axis indicating number of employees is scaled logarithmical.
 Overall, the mean number of full time employees is 61.1, and the
 median is 11 (N = 2,137).

                              Mean           Median

      0 to 24,999              6.3              4
      (N = 857)

      25,000 to 49,999        15.4             11
      (N = 513)

      50,000 to 99,999        33.5             29
      (N = 375)

      100,000 to 499,999      96.1             72
      (N = 310)

      500,000 +              914.9            800
      (N = 82)
 
 17. % of LHD that Reported Select Staff Full and/or Part Time

 This table shows the percents of the responding local health
 departments that reported employing the listed personnel, either
 directly or through contracted services, in a full and/or part time
 capacity.

      Staff Positions                              Percent

 Clerical/Secretarial                                94%
 Dentist                                             17%
 Engineer/Sanitarian                                 77%
 Epidemiologist/Statistician                         11%
 Health Educator                                     37%
 Licensed Practical Nurse                            33%
 Nutritionist/Dietician                              51%
 Physician                                           62%
 Planner/Analyst                                      8%
 Public Information Specialist                        6%
 Registered Nurse                                    90%
 Social Worker                                       27%
 Toxicologist/Environmental Specialist               18%

                                                   N = 2,263

 18. Figure 17 by Jurisdiction Population

 This table shows the percents of the responding local health
 departments in each of the population groups that reported
 employing the list personnel, either directly or through contracted
 services, in a full and/or part time capacity.  (See Figure 17 for
 overall data).

                       Jurisdiction Population
 Staff
 Positions         0 to     25,000 to   50,000 to   100,000 to   500,000+
                   24,999   49,999      99,999      499,999

 Clerical/
 Secretarial        89%      97%         98%          99%          100%

 Dentist             7%      14%         18%          36%           73%

 Engineer/
 Sanitarian         65%      80%         87%          92%           93%

 Epidemiologist/
 Statistician        4%       3%          8%          33%           87%

 Health
 Educator           17%      31%         54%          71%           95%

 Licensed
 Practical
 Nurse              23%      28%         39%          54%           72%

 Nutritionist/
 Dietician          33%      49%         67%          78%           93%

 Physician          44%      65%         75%          88%           99%

 Planner/
 Analyst             2%       2%          5%          21%           71%

 Public Information
 Specialist          2%       2%          5%          14%           52%
 Registered
 Nurse              83%      93%         98%          96%           99%

 Social Worker      13%      24%         35%          52%           68%

 Toxicologist/
 Environmental
 Specialist         10%      14%         18%          37%           59%

 N =                954      526         380          320           83

 19. % of LHD Active in Assessment Functions & Services

 Percent of Local Health Departments that Reported Being Active in
 Assessment Functions and Services

 This table shows the percent of respondents that reported being
 active in the listed assessment functions and services.

        Data Collection and Analysis                        Percent

                Behavioral Risk Assessment                    33%

                Morbidity Data                                49%

                Reportable Diseases                           87%

                Vital Records and Statistics                  64%

        Epidemiology and Surveillance

                Chronic Disease                               55%

                Communicable Disease                          92%

                                                           N = 2,263

 20. Figure 19 by Jurisdiction Population

 Percent of Local Health Departments that Reported Being Active in
 Assessment Functions and Services by Jurisdiction Population

 This table shows the percent of respondents that reported being
 active in the listed assessment functions and services for each of
 the population groups.  (See Figure 19 for overall data.)

 Jurisdiction
 Population    0 to    25,000 to   50,000 to   100,000 to  500,000+
               24,999  49,999      99,999      499,999

 Functions & Services

 Data Collection and Analysis Activities
 Behavioral Risk
  Assessment     25%    33%         42%          43%         51%

 Morbidity
  Data           39%    50%         58%          63%         76%

 Reportable
  Diseases       81%    90%         92%          93%         95%

 Vital Records
  & Statistics   53%    67%         69%          75%         89%

 Epidemiology and Surveillance Activities

 Chronic
  Disease        48%    59%          58%         59%         65%

 Communicable
  Disease        87%    94%          95%         96%         98%

 N =             954    526          380         320         83

 21. % of LHD Active in Policy Development Functions and Services

 Percent of Local Health Departments that Reported Being Active in
 Policy Development Functions and Services

 This table shows the percent of respondents that reported being
 active in the listed policy development functions and services.

      Functions and Services                        Percent

 Health Code Development and
  Enforcement                                         59%

 Health Planning                                      57%

 Priority Setting                                     52%

                                                   N = 2,263

 22. Figure 21 by Jurisdiction Population

 Percent of Local Health Depts. that Reported Being Active in Policy
 Development Functions and Services by Jurisdiction Population

 This table shows the percent of respondents that reported being
 active in the listed policy development functions and services for
 each of the population groups.  (See Figure 21 for overall data.)

 Functions &
  Services      0 to    25,000 to   50,000 to   100,000 to   500,00+
                24,999  49,999      99,999      499,999

 Health Code
  Development and
  Enforcement    47%      58%         71%         73%          84%
 Health
  Planning       47%      57%         66%         71%          83%

 Priority
  Setting        37%      52%         63%         74%          84%

 N =             954      526         380         320          83

 23. % of LHD Active in Selected Assurance Functions and Services

 Percent of Local Health Departments that Reported Being Active
 in Selected Assurance Functions and Services

 This table shows the percent of respondents that reported being
 active in assurance functions and services, in the inspection,
 licensing and health education areas.

 Functions and Services                          Percent

      Inspection Activities

        Food and Milk Control                      72%

        Health Facility Safety/Quality             47%

        Recreational Facility Safety/Quality       54%

        Other Facility Safety/Quality              32%

      Licensing Activities

        Health Facility                            22%

        Other Facility                             72%

        Health Education                           74%

                                                N = 2,263

 24. Figure 23 by Jurisdiction Population

 Percent of Local Health Departments that Reported Being Active
 in Selected Assurance Functions and Services

 This table shows the percent of respondents that reported being
 active in the listed assurance functions and services, in the
 inspection, licensing and health education areas, for each of the
 population groups.  (See Figure 23 for overall data.)

 Functions &   0 to    25,000 to   50,000 to   100,000 to   500,000+
  Services     24,999  49,999      99,999      499,999

 Inspection Activities

 Food & Milk
  Control         65%     74%         77%          84%         80%

 Health Facility
  Safety/
  Quality         43%     49%         48%          49%         55%



 Recreational
  Facility Safety/
  Quality         45%     57%         61%          65%         68%

 Other Facility
  Safety/
  Quality         25%     33%         34%          40%         58%

 Licensing Activities

 Health
  Facilities      24%     20%         16%          22%         29%

 Other
  Facilities      63%     74%         77%          83%         78%

 Health
 Education        66%     74%         80%          88%         95%

 N =              954     526         380          320         83

 25. % of LHD Active in Enviro. Health Assurance Func. & Serv.

 Percent of Local Health Departments that Reported Being Active
 in Environmental Health Assurance Functions and Services

 This table shows the percent of respondents that reported being
 active in environmental health assurance functions and services.

 Functions and Services                            Percent

   Air Quality                                       33%

   Hazardous Waste Management                        46%

   Individual Water Supply Safety                    77%

   Noise Pollution                                   20%

   Occupational Health and Safety                    23%

   Public Water Supply Safety                        58%

   Radiation Control                                 21%

   Sewage Disposal Systems                           79%

   Solid Waste Management                            55%

   Vector and Animal Control                         70%

   Water Pollution                                   60%

                                                   N = 2,263

 26. Figure 25 by Jurisdiction Population

 Percent of Local Health Departments that Reported Being Active
 in Environmental Health Assurance Functions and Services
 By Jurisdiction Population

 This table shows the percent of respondents that reported being
 active in the listed environmental health assurance functions and
 services for each of the population groups.  (See Figure 25 for
 overall data.)

 Functions &   0 to       25,000 to   50,000 to   100,000 to   500,000+
 Services      24,999     49,999      99,999      499,999

  Air Quality    24%         37%        37%          41%          52%

  Hazardous
  Waste Mgmt     39%         46%        48%          57%          76%

  Individual
  Water Supply
  Safety         70%         81%        80%          86%          75%

  Noise
  Pollution      16%         21%        24%          24%          40%

  Occupational
  Health and
  Safety         19%         22%        26%          27%          53%

  Public Water
  Supply Safety  52%         58%        62%          64%          71%

  Radiation
  Control        16%         20%        24%          26%          43%

  Sewage Disposal
  Systems        72%         84%        81%          87%          82%

  Solid Waste
  Management     48%         59%        57%          66%          64%

  Vector and
  Animal
  Control        58%         76%        78%          83%          78%

  Water
  Pollution      52%         63%        67%          68%          71%

  N =            954         526        380          320          83

 27. % of LHD Active in Personal Health Assurance Func. & Serv.

 Percent of Local Health Departments that Reported Being Active
 in Personal Health Assurance Functions and Services

 This graph shows the percent of respondents that reported being active in
 assurance functions and services in the personal health services area.

 Functions and Services                        Percent

  Aids Testing and Counseling                    57%

  Alcohol Abuse                                  16%

  Child Health                                   84%

  Chronic Disease                                69%

  Dental Health                                  38%

  Drug Abuse                                     17%

  Emergency Medical Services                     13%

  Family Planning                                60%

  Handicapped Children                           47%

  Home Health Care                               50%

  Hospitals                                      50%

                                              N = 2,263

 28. Figure 27 continued

 Percent of Local Health Departments that Reported Being Active
 in Personal Health Assurance Functions and Services (Cont'd)

 This table shows the percent of respondents that reported being
 active in assurance functions and services in the personal health
 services area.

 Functions and Services                        Percent

  Immunizations                                  92%

  Laboratory Services                            43%

  Long Term Care Facilities                       6%

  Mental Health                                  14%

  Obstetrical Care                               20%

  Prenatal Care                                  59%

  Primary Care                                   22%

  Sexually Transmitted Diseases                  73%

  Tuberculosis                                   81%

  WIC                                            69%

                                              N = 2,263

 29. Figures 27 and 28 by Jurisdiction Population

 Percent of Local Health Departments that Reported Being Active
 in Personal Health Assurance Functions and Services
 by Jurisdiction Population

 This table shows the percent of respondents that reported being
 active in the listed personal health assurance function and
 services for each of the population groups.  (See Figure 27 for
 overall data.)

 Functions &       0 to     25,000 to   50,000 to   100,000 to   500,000+
 Services          24,999   49,999      99,999      499,999

 Aids Testing
 and Counseling     44%      47%         70%          88%          96%

 Alcohol Abuse      13%      12%         16%          20%          43%

 Child Health       74%      87%         92%          95%          99%

 Chronic Disease    62%      71%         76%          76%          89%

 Dental Health      27%      36%         41%          55%          80%

 Drug Abuse         17%      15%         17%          18%          40%

 Emergency Medical
 Services            9%      11%         15%          18%          39%

 Family Planning    53%      59%         64%          67%          87%

 Handicapped
 Children           39%      49%         55%          55%          63%

 Home Health
 Care               49%      55%         54%          44%          42%

 Hospitals           2%       2%          4%           3%          15%

 N =                954      526         380          320          83

 30. Figure 29 continued

 This table shows the percent of respondents that reported being
 active in the listed personal health assurance function and
 services for each of the population groups.  (See Figure 27 for
 overall data.)

 Functions &       0 to     25,000 to   50,000 to   100,000 to   500,000+
 Services          24,999   49,999      99,999      499,999

 Immunizations      86%      95%          98%         98%         100%

 Laboratory
 Services           36%      38%          45%         65%          83%

 Long Term Care
 Facilities          4%       6%          10%          8%          17%

 Mental Health      14%      13%          13%         12%          34%

 Obstetrical
 Care               15%      19%          22%         31%          39%

 Prenatal Care      49%      59%          67%         73%          83%

 Primary Care       16%      18%          25%         34%          59%

 Sexually Transmitted
 Diseases           61%      72%          85%         93%          95%

 Tuberculosis       69%      86%          91%         92%          95%

 WIC                63%      67%          75%         80%          89%

 N =                954      526          380         320          83

 31. % of LHD Active in Functions & Services by # of Employees

 Percent of Local Health Departments that Reported Being Active in Selected
 Functions and Services by Reported Number of Full Time Employees

 This table shows the percent of respondents that reported being
 active in the listed function and services with the respondents
 distributed into 5 separate groups based upon their reported number
 of full time employees.  (See Figure 19, 21, 23, 25, 27 and 28 for
 overall data.)

 Functions                     Number of Employees
 & Services          0 to 4     5 to 9     10 to 24     25 to 100     100+

 Reportable Disease
 Data Collection      79%        88%         91%          95%         98%

 Health Planning      46%        55%         59%          68%         81%

 Food and Milk
 Control              58%        70%         78%          83%         82%

 Health Education     63%        74%         77%          84%         94%

 Hazardous Waste
 Management           42%        41%         44%          51%         69%

 Individual Water
 Supply Safety        63%        80%         81%          87%         84%

 Vector and Animal
 Control              55%        69%         76%          83%         84%

 Aids Testing and
 Counseling           27%        53%         62%          85%         96%

 Child Health         66%        87%         93%          97%         99%

 Family Planning      35%        61%         70%          74%         85%

 Immunizations        84%        95%         98%          99%        100%

 Prenatal Care        35%        55%         71%          77%         85%

 Sexually Transmitted
 Diseases             44%        73%         86%          93%         97%

 Tuberculosis         60%        85%         90%          95%         96%

 N =                  547        433         478          475         205

 32. % of LHD Active in Functions & Services by Service Region

 Percent of Local Health Departments that Reported Being Active in Selected
 Functions and Services by Respondent's Public Health Service Region

 This table shows the percent of respondents that reported being
 active in the listed function and services with the respondents
 distributed by their U.S. Public Health Service Region.  (The
 regions are described in appendix 3, see figures 19, 21, 23, 25, 27
 and 28 for overall data.)

 PHS REGION           1    2    3    4    5    6    7    8    9    10

 Functions &
 Services

 Reportable Disease
 Data Collection     75%  92%  97%  94%  87%  88%  80%  77%  96%  96%

 Health Planning     39%  80%  62%  55%  64%  49%  51%  58%  74%  78%

 Food and Milk
 Control             83%  82%  94%  81%  66%  73%  42%  49%  73%  70%

 Health Education    47%  90%  84%  79%  77%  75%  74%  71%  83%  81%

 Hazardous Waste
 Management          60%  70%  40%  36%  42%  47%  23%  42%  70%  66%

 Individual Water
 Supply Safety       66%  79%  93%  89%  76%  80%  62%  60%  73%  80%
 Vector and Animal
 Control             57%  85%  81%  77%  77%  70%  41%  57%  77%  72%

 Aids Testing and
 Counseling          12%  41%  86%  94%  41%  62%  45%  56%  93%  99%

 Child Health        35%  96%  92%  99%  86%  94%  89%  83%  91%  93%

 Family Planning      6%  29%  92%  98%  44%  82%  58%  55%  86%  74%

 Immunizations       61%  98% 100% 100%  96%  98%  96%  85%  97% 100%

 Sexually Transmitted
 Diseases            20%  77%  97%  99%  68%  92%  55%  63%  99%  95%

 Tuberculosis        40%  83%  98%  99%  78%  96%  74%  60%  97% 100%

 N =                 327  158  124  478  486  239  206  108   69   74


APPENDIXES

 Appendix 1

                NATIONAL PROFILE OF LOCAL HEALTH DEPARTMENTS
                         DATA COLLECTION INSTRUMENT

                                   APEX/PH
               NATIONAL ASSOCIATION OF COUNTY HEALTH OFFICIALS
                National Profile of Local Health Departments


 I.  LOCAL HEALTH DEPARTMENT

  A.  Agency Name_______________________________________________________________

  B.  MailingAddress___________________________________________________________

  C.  City______________________________________________________________________

  D.  State_____________________________________________________________________

  E.  Zip Code__________________________________________________________________

  F.  County____________________________________________________________________

  G.  Telephone Number__________________________________________________________

  H.  Facsimile (FAX) Telephone Number__________________________________________


 II. LOCAL HEALTH OFFICER

  The person legally appointed or otherwise designated to serve as the
  official health officer of the local health department.

  A.  Name_____________________________________________________________________
               Last                   First               Middle Initial

  B.  Title____________________________________________________________________

  C.  Degrees/Licenses (Please check those that apply.)


      1.  DEGREES                          2.  PROFESSIONAL LICENSES
     __          __                          __
    |__| MD     |__| DO                     |__| MD
     __          __                          __
    |__| DrPH   |__| PhD                    |__| RN
     __          __                          __
    |__| MPH    |__| MBA                    |__| RS
     __          __                          __
    |__| DVM    |__| MS                     |__| RD
     __                                      __
    |__| Other________________              |__| Other________________
              (Please specify)                        (Please specify)

  D.  Month and year local health officer was appointed to present position:

             Month____________________ Year____________________

  E.  The Health Officer position is:
                       __                             __
            Full Time |__|                 Part Time |__|

  F.  Does the local health officer serve as Administrator/Director for the
  local health department?
                 __                            __
            Yes |__|                       No |__|

       If "No" please give name and title of the Administrator/Director.

       Name_____________________________________________________________
                Last               First               Middle Initial

       Title____________________________________________________________

       The position of the Administrator/Director is:
                        __                            __
             Full Time |__|                Part Time |__|


 III.  JURISDICTION OF LOCAL HEALTH DEPARTMENT

  A.  What is the geographic jurisdiction served by your local health
      department?  (Please check appropriate response.)
              __
             |__| City
              __
             |__| County
              __
             |__| City/County
              __
             |__| Multi-County District or Region
                       (Please list names of all counties)

                  _____________________________________________________________

                  _____________________________________________________________
              __
             |__| Town/Township
              __
             |__| State
              __
             |__| Other____________________________
                      (Please specify)

  B.  Are there any other local health departments operating within your
  jurisdiction?
                  __                           __
             Yes |__|                      No |__|

             If "yes" please list names of all other health departments.

             ___________________________________________________________

             ___________________________________________________________

             ___________________________________________________________

  C.  Are you part of a regional/district health agency?
                  __                           __
             Yes |__|                      No |__|

             If "yes" please give the name of the regional/district health
             agency.

  D.  Is there a local Board of Health within your jurisdiction?
                  __                           __
             Yes |__|                      No |__|

  E.  Estimated 1988 total population of jurisdiction served by local health
      department is:

             __________________________________________________________________

  F.  Which best describes the status of your local health department in
      relation to the state health agency?  (Please check appropriate response.)
              __
             |__| Independent
                  (Local government operates the local health department
                   independent of state health agency.)
              __
             |__| Shared/Combined State - Local
                  (Local government operates the local health department in
                  conjunction with the state health agency.)
              __
             |__| Local Unit of State Health Agency
                  (Local health department is operated by the state health
                  agency.)
              __
             |__| Local Unit of Regional/District Health Agency
                  (Local Health department is operated by a regional/district
                  office of the state health agency.)
              __
             |__| Other (Please specify.)_____________________________________


 IV.  STAFF

  A.   The total number of persons employed full time by the local health
       department is:___________________________________________________________

  B.   The total number of authorized full time equivalents (FTE's) in the local
       health department is:____________________________________________________

  C.  Which of the following does your local health department employ on a full
  time and or part time basis (either directly or through contracted services)?
             (Please check all appropriate responses.)
                                                     Full Time     Part Time
                                                       __              __
             Clerical/Secretarial                     |__|            |__|
                                                       __              __
             Dentists                                 |__|            |__|
                                                       __              __
             Engineers/Sanitarians                    |__|            |__|
                                                       __              __
             Epidemiologist/Statisticians             |__|            |__|
                                                       __              __
             Health Educators                         |__|            |__|
                                                       __              __
             Licensed Practical Nurses                |__|            |__|
                                                       __              __
             Nutritionists/Dieticians                 |__|            |__|
                                                       __              __
             Physicians                               |__|            |__|
                                                       __              __
             Planners/Analysts                        |__|            |__|
                                                       __              __
             Public Information Specialists           |__|            |__|
                                                       __              __
             Registered Nurses                        |__|            |__|
                                                       __              __
             Social Workers                           |__|            |__|
                                                       __              __
             Toxicologists/Environmental Specialists  |__|            |__|

  D.  Which type of employee do you consider the majority of your local health
  department staff to be?  (Please check appropriate response.)
              __
             |__| Local government employee
              __
             |__| State government employee
              __
             |__| Other________________________________________________________
                       (Please specify.)
 V.  BUDGET

  A.  Please give total expenditures for your local health department for the
  most recent fiscal year available. $__________________________________________

  B.  Please indicate the fiscal year in which these expenditures occurred.
  (e.g.) 1985, 1986, 1987):_____________________________________________________

  C.  Does your local health department charge patients for any personal health
  services it provides?       __           __           __
                         Yes |__|      No |__|     N/A |__|

  D.  Does your local health department accept Medicaid reimbursement for any
  personal health services it provides?    __           __            __
                                      Yes |__|      No |__|      N/A |__|


 VI.  FUNCTIONS/SERVICES

  Please indicate which of the following function and or service areas your
  local health department is active in.  (Please note; this is not intended to
  be a complete listing of all health department functions and services.

       Step I.   Please mark an "X" by all appropriate responses.
       Step II.  Place a second "X" by the five which are most important.

        ____ A.  ASSESSMENT ACTIVITIES
       |____|1.  Data Collection/Analysis
       |____|a.  Behavioral Risk Assessment
       |____|b.  Morbidity Data
       |____|c.  Reportable Diseases
       |____|d.  Vital Records and Statistics
       |____|e.  Other___________________________________
                      (Please specify.)

        ____ 2.  Epidemiology/Surveillance
       |____|a.  Chronic Disease
       |____|b.  Communicable Disease
       |____|c.  Other___________________________________
                      (Please specify.)

        ____ B.  POLICY DEVELOPMENT
       |____|1.  Health Code Development and Enforcement
       |____|2.  Health Planning
       |____|3.  Priority Setting


                                        SECTION VI continued on next page
                         C.  ASSURANCE ACTIVITIES
        ____ 1.  Inspection
       |____|a.  Food and Milk control
       |____|b.  Health Facility Safety/Quality
       |____|c.  Recreational Facility/Safety/Quality
       |____|d.  Other Facility Safety/Quality (Beauty Parlors, Pet Shops etc.)

        ____ 2.  Licensing
       |____|a.  Health Facilities
       |____|b.  Other Services/Facilities (Restaurants, Beauty Shops, etc.)

             3.  Health Education

        ____ 4.  Environmental
       |____|a.  Air Quality
       |____|b.  Hazardous Waste Management
       |____|c.  Individual Water Supply Safety
       |____|d.  Noise Pollution
       |____|e.  Occupational Health and Safety
       |____|f.  Public Water Supply Safety
       |____|g.  Radiation Control
       |____|h.  Sewage Disposal Systems
       |____|i.  Solid Waste Management
       |____|j.  Vector and Animal Control
       |____|k.  Water Pollution

        ____ 5.  Personal Health Services
       |____|a.  AIDS Testing and Counseling
       |____|b.  Alcohol Abuse
       |____|c.  Child Health
       |____|d.  Chronic Disease
       |____|e.  Dental Health
       |____|f.  Drug Abuse
       |____|g.  Environmental
       |____|h.  Family Planning
       |____|i.  Handicapped Children
       |____|j.  Home Health Care
       |____|k.  Hospitals
       |____|l.  Immunizations
       |____|m.  Laboratory Services
       |____|n.  Long Term Care Facilities
       |____|o.  Mental Health
       |____|p.  Obstetrical Care
       |____|q.  Prenatal Care
       |____|r.  Primary Care
       |____|s.  Sexually Transmitted Diseases
       |____|t.  Tuberculosis
       |____|u.  WIC

  Name of person completing profile_____________________________________________
  Title_________________________________________________________________________
  Telephone number______________________________________________________________
  Date__________________________________________________________________________

                       THANK YOU FOR YOUR TIME AND EFFORT


                       PLEASE RETURN COMPLETED PROFILE TO,
                     OR DIRECT ANY COMMENTS OR QUESTIONS TO:


                                  Clark Greene
                               Research Associate
                                 Project APEX/PH
                 National Association of County Health Officials
                              440 First Street N.W.
                             Washington, D.C. 20001
                                 (202) 783-5550


 Appendix 2

                     U.S. PUBLIC HEALTH SERVICE REGIONS

 Region 1   Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island*,
            Vermont*

 Region 2   New Jersey, New York, Puerto Rico**, Virgin Islands**

 Region 3   Delaware*, District of Columbia, Maryland, Pennsylvania,
            Virginia, West Virginia

 Region 4   Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
            South Carolina, Tennessee

 Region 5   Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin

 Region 6   Arkansas, Louisiana, New Mexico, Oklahoma, Texas

 Region 7   Iowa, Kansas, Missouri, Nebraska

 Region 8   Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

 Region 9   American Samoa**, Arizona, California, Guam**, Hawaii*, Nevada,
            N. Mariana Islands**, Trust Territories**

 Region 10  Alaska, Idaho, Oregon, Washington

 *Delaware, Hawaii, Rhode Island, and Vermont have no local health departments
 as defined in this report.

 **The scope of this report is limited to the continental United States,
 Alaska, and Hawaii.
 Appendix 3

                           APEX/PH PROJECT MEMBERS

 The APEX/PH Steering Committee:

           H. Denman Scott, M.D., M.P.H., Chairperson (ASTHO);
           Larry M. Belmont, M.P.H., M.P.A. (NACHO);
           William Bridgers, M.D. (ASPH);
           Claude A. Burnett, III, M.D., M.P.H. (NACHO)
           Joyce D. K. Essien, M.D., M.B.A. (CDC);
           Beverly C. Flynn, R.N., Ph.D., F.A.A.N. (APHA);
           Gary L. Gurian, M.A. (USCLHO);
           George E. Hardy, Jr., M.D., M.P.H. (CDC);
           Lawrence Hart, M.D., M.P.H. (USCLHO);
           Cheryl Healton, M.P.A. (ASPH);
           Joel Nitzkin, M.D., D.P.A. (At Large);
           William Shonick, Ph.D. (APHA);
           Bernard J. Turnock, M.D. (ASTHO);
           John B. Waller, Dr.P.H. (At Large).

 The APEX/PH Work Group:

           Paul Wiesner, M.D. Chairperson (NACHO);
           M. Jane Ford, M.B.A. (USCLHO);
           Joseph Latoff, M.A., M.S. (NACHO);
           Arthur P. Liang, M.D., M.P.H. (CDC);
           Jim Parker (ASTHO).

 Former APEX/PH members:

           Charles Cameron, M.D., M.P.H. (ASPH);
           Robert G. Harmon M.D., M.P.H. (ASTHO);
           Katherine Kinsman (ASTHO);
           Pomeroy Sinnock, Ph.D. (CDC);
           Rugmini Shah, M.D. (USCLHO).

 APEX/PH Project Officer:

           Charles Bacon, Public Health Advisor, Public Health Practice
                Program Office, CDC;

           C. Joseph Webb, Public Health Advisor, Public Health Practice
                Program Office, CDC, served as APEX/PH Project Officer from
                July 1987 to March 1990.

REFERENCES

 1.   Vaughan, H. (1972).  Local Health Services in the United States:  The
      Story of the CAP.  American Journal of Public Health, 62 (1), 95-111.

 2.   Halverson, W.L. (1945).  A Twenty Five Year Review of the Work of the
      Committee on Administrative Practice.  American Journal of Public
      Health, 35 (12), 1253-1259.

 3.   Emerson, H. (1945).  Local Health Units for The Nation:  A Report of
      the Subcommittee on Local Health Units, Committee on Administrative
      Practice, American Public Health Association. New York:  Commonwealth
      Fund.

 4.   Terris, M. and Kramer, N. (1949).  Medical Care activities of Full-time
      Health Departments.  American Journal of Public Health, 39 (9), 1129-
                  1135.

 5.   Mountin, J. and Flook, E. (1953).  Guide to Health Organization in the
      United States.  Washington, D.C.:  U.S. Public Health Service.

 6.   Myers, B., Steinhardt, B., Mosley, M. and Cashman, J. (1968).  The
      Medical Care Activities of Local Health Units.  Public Health Reports,
      83 (9), 757-769.

 7.   Miller, C.A., Brooks, E., DeFriese, G., Gilbert, B., Jain, S., and
      Kavaler, F. (1977).  A Survey of Local Public Health Departments and
      Their Directors.  American Journal of Public Health, 67 (10), 931-939.

 8.   Mullan, F. and Smith, J. (1988).  Characteristics of State and Local
      Health Agencies.  Johns Hopkins University School of Hygiene and Public
      Health, Baltimore, Maryland, June 1988.

 9.   Public Health Foundation. (1989).  Public Health Agencies 1989:  An
      Inventory of Programs and Block Grant Expenditures.  Washington D.C.:
      Public Health Foundation.

 10.   Institute of Medicine. (1988).  The Future of Public Health.
      Washington, D.C.:  National Academy Press.

 11.  U.S. Department of Commerce, Bureau of The Census.  (1988).  County and
      City Data Book.  Washington, D.CC.:  U.S. Government Printing Office.

 12.   Institute of Medicine. (1988).  The Future of Public Health.
      Washington, D.C.:  National Academy Press.

 13.  Emerson, H. (1945).  Local Health Units For The Nation:  A Report of
      the Subcommittee on Local Health Units, Committee on Administrative
      Practice, American Public Health Association.  New York:  Commonwealth
      Fund.

BIBLIOGRAPHY

 Brooks, E. F., and Miller, C.A. (1987).  Recent Changes inn Selected Local
 Health Departments:  Implications for Their Capacity to Guarantee Basic
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 DeFriese, G. H., Hetherington, J.S., Brooks, E.F., Miller, C.A., Jain, S.,
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 Administrative Relationships between Local Health Departments and State and
 Local Governments.  American Journal of Public Health, 71 (10), 1109-1115.

 Emerson, H. (1945).  Local Health Units For The Nation:  A Report of the
 Subcommittee on Local Health Units, Committee on Administrative Practice,
 American Public Health Association.  New York:  Commonwealth Fund.

 Halverson, W.L. (1945).  A Twenty Five Year Review of the Work of the
 Committee on Administrative Practice.  American Journal of Public Health, 35
 (12), 1253-1259.

 Institute of Medicine (1988).  The Future of Public Health. Washington, D.C.:
 National Academy Press.

 Kratz, F. W. (1942).  The Present Status of Full-Time Local Health
 Organization.  Public Health Reports, 57 (2), 194-196.

 Miller, C.D., Brooks, E., DeFriese, G., Gilbert, B., Jain, S., and Kavaler, F.
 (1977).  A Survey of Local Public Health Departments and Their Directors.
 American Journal of Public Health, 67 (10), 931-939.

 Miller, C. A., Moose, M-K.  (1981).  Local Health Departments:  Fifteen Case
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 Mountin, J. and Flook, E. (1953).  Guide to Health Organization in the United
 States.  Washington, D.C.:  U.S. Public Health Service.

 Mullan, F. and Smith, J. (1988).  Characteristics of State and Local Health
 Agencies.  Johns Hopkins University School of Hygiene and Public Health,
 Baltimore, Maryland, June 1988.

 Myers, B., Steinhardt, B., Mosley, M. and Cashman, J. (1968).  The Medical
 Care Activities of Local Health Units.  Public Health REprots, 83 (9), 757-
 769.

 Pickett, G. (1980).  The Future of Health Departments:  The Governmental
 Presence.  Annual Review of Public Health 1980, 1 (1), 297-321.

 Public Health Foundation.  (1989).  Public Health Agencies 1989:  An Inventory
 of Programs and Block Grant Expenditures.  Washington D.C.:  Public Health
 Foundation.

 Terris, M. and Kramer, N. (1949).  Medical Care  Activities of Full-time
 Health Departments.  American Journal of Public Health, 39 (9), 1129-1135.

 U.S. Department of Commerce, Bureau of The Census.  (1988).  County and City
 Data Book.  Washington, D.C.:  U.S. Government Printing Office.

 Vaughan, H. (1972).  Local Health Services in the United States:  The Story of
 the CAP.  American Journal of Public Health, 62 (1), 95-111.




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