Population size is one of the strongest predictors of the performance of a local public health system.
There were significant advances in public health research during the 1990s. The National Association of City and County Health Organizations (NACCHO) gathered data describing the nearly 3,000 local health departments in the United States. Also, the Centers for Disease Control and Prevention (CDC) created standards for the work of state and local public health systems. Two separate studies linked the descriptive NACCHO data with the CDC measures of performance. The studies identified specific characteristics of local health care systems that influenced performance. However, there were glaring limitations to that research, including that the data sets were from different time periods.
This study addressed the limitations of the previous research, using data sets from a single time period. Like the two previous studies, the research presented here assessed 10 essential public health services (EPHS). Each local health agency received an overall performance score and a score for each EPHS.
During the 1990s, public health systems and services research (PHSSR) emerged as a new branch of the public health profession. This study tested the findings of two previous studies of local public health system performance.