Environmental Research Foundation, 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.
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."