Environmental Research Foundation  [Printer-friendly version]
April 27, 2006

A DEFINITION OF A FUNCTIONAL LOCAL HEALTH DEPARTMENT

[Rachel's introduction: Recently the National Association of County
and City Health Officials (NACCHO) published a definition of what a
local health department is supposed to do. NACCHO says the definition
of "local health department" may include a locally-governed health
department, a branch of the state health department, a state-created
district or region, a department governed by and serving a multi-
county area, or any other arrangement that has governmental authority
and is responsible for public health functions at the local level.]

By Peter Montague

There are 3000 local health departments in the U.S. They are the
first line of defense for public health -- they offer vaccinations
against infectious disease, they make sure restaurants are up to
snuff, they inspect homes for toxic lead to protect children, and many
other things. However, until recently the core functions of a local
health department had not been formally defined. Now that has changed.

The nation's 3000 local health departments are represented by the
National Association of County and City Health Officials (NACCHO --
pronounced Nay-Cho). In November 2005 NACCHO published a new
"Operational definition of a functional local health department [now
available online here." The NACCHO definition was put together with
the participation of more than 600 governmental public health
professionals and local and state officials representing 30 different
states. The NACCHO definition describes the duties, responsibilities
and vision of a local health department.

NACCHO says the definition "will help citizens and residents
understand what they can reasonably expect from governmental public
health in their communities. The definition also will be useful to
elected officials, who need to understand what LHDs [local health
departments] do and how to hold them accountable. And, the definition
will aid LHDs in obtaining their fair share of resources."

Operational definition of a functional local health department

The opening sentence reads as follows: "Governmental public health
departments are responsible for creating and maintaining conditions
that keep people healthy." This is important. Creating
conditions that make people healthy. And then maintaining those
conditions. That's a pretty powerful mandate. In contrast, the
mission of U.S. Environmental Protection Agency is "to protect human
health and the environment." EPA's mission is reactive -- protect
against threats. The public health mandate is proactive: create
conditions that keep people healthy. The difference is profound.

NACCHO goes on to describe what a "functional local health department"
does. The definition of "local health department" may include a
locally-governed health department, a branch of the state health
department, a state-created district or region, a department governed
by and serving a multi-county area, or any other arrangement that has
governmental authority and is responsible for public health functions
at the local level.

So what does a local health department do?

First a local health department "Understands the specific health
issues confronting the community, and how physical, behavioral,
environmental, social, and economic conditions affect them."

[So your health department has a mandate to concern itself with all
the conditions that affect health, including social and economic
conditions. Public health professionals call these "the social
determinants of health," and they include inequalities, social
exclusion, social isolation, pyramids of status, racism, sexism, low
income, stress, job loss, lack of control over one's circumstances,
run-down housing, and so on. There is an extensive body of
literature discussing the social determinants of health.]

** Implements health promotion programs. [In other words, a public
health department doesn't just stop bad things from happening; it
takes steps to make good things happen.]

** Develops partnerships with public and private healthcare providers
and institutions, community-based organizations, and other government
agencies (e.g., housing authority, criminal justice, education)
engaged in services that affect health to collectively identify,
alleviate, and act on the sources of public health problems. [In other
words, NACCHO expects your health department to form alliances with
community-based citizen groups, among others.]

NACCHO says "All LHDs [local health departments] exist for the common
good and are responsible for demonstrating strong leadership in the
promotion of physical, behavioral, environmental, social, and economic
conditions that improve health and well-being; prevent illness,
disease, injury, and premature death; and eliminate health
disparities." [NACCHO defines "health disparities" as "differences in
populations' health status that are avoidable and can be changed.
These differences can result from social and/or economic conditions,
as well as public policy. Examples include situations whereby
hazardous waste sites are located in poor communities, there is a lack
of affordable housing, and there is limited or no access to
transportation. These and other factors adversely affect population
health."]

[So your local health department is supposed to exercise "strong
leadership" in the promotion of environmental, social and economic
conditions that improve health and well-being, and eliminate health
disparities.]

NACCHO goes on to say that a functional health department...

** Addresses health disparities. [In other words, asks why some people
are healthy and others are not. Probing this question gets you into
the territory that many call "environmental justice."]

** Obtain and maintain data that provide information on the
community's health (e.g., immunization rates; hospital discharge data;
environmental health hazard, risk, and exposure data; community-
specific data; number of uninsured; and indicators of health
disparities such as high levels of poverty, lack of affordable
housing, limited or no access to transportation, etc.).

** Analyze data to identify trends, health problems, environmental
health hazards, and social and economic conditions that adversely
affect the public's health.

** Conduct or contribute expertise to periodic community health
assessments.

** Engage the community to identify and solve health problems.

** Advocate for policies that lessen health disparities and improve
physical, behavioral, environmental, social, and economic conditions
in the community that affect the public's health.

** Inform the community, governing bodies, and elected officials about
governmental public health services that are being provided,
improvements being made in those services, and priority health issues
not yet being adequately addressed.

Conclusion

In 1999, NACCHO formally recognized that environmental agencies and
public health agencies have overlapping missions and that
environmental protection and public health protection need to be
better integrated. No single issue illustrate this problem mmore
clearly than the issue of "cumulative risk."

NACCHO resolution 99-13, says, in part:

WHEREAS, the Institute of Medicine's 1988 Future of Public Health
Report states that "The removal of environmental health authority from
public health has led to fragmented responsibility, lack of
coordination, and inadequate attention to the public health dimensions
of environmental health issues;" and

WHEREAS, environment and health are intimately related, and
environmental health is a public health activity, yet the two fields
are often isolated and overly distinct in their current missions; and

WHEREAS, local public health agencies bring a unique, population-based
approach to environmental health issues and an emphasis on prevention
and system-wide approaches to health;

THEREFORE, BE IT RESOLVED that the National Association of County and
City Health Officials (NACCHO) advocates for resources, policies,
programs, and legislation that promote the integration of
environmental health and public health practice; and

BE IT FURTHER RESOLVED that NACCHO endorses the development and/or
enhancement of coordinated training for the environmental health
workforce in public health sciences such as epidemiology, social and
behavioral sciences, physiology and biology, and for the public health
workforce in environmental sciences such as ecology and urban
planning. [End of Resolution 99-13]

The issue of cumulative risk offers an excellent opportunity to
respond to the Institute of Medicine's concern that, "The removal of
environmental health authority from public health has led to
fragmented responsibility, lack of coordination, and inadequate
attention to the public health dimensions of environmental health
issues."