Examining the Priorities of Local Health Departments in California: A Mixed Methods Study

Area of Science:

• Public Health Policy
• Health Services Research
• Community Health Planning

Background:

• Local health departments (LHDs) are crucial for community health.
• Prioritization is a key function for LHDs in resource allocation.
• Community Health Needs Assessments (CHNA) and Community Health Improvement Plans (CHIP) are vital planning documents.

Purpose of the Study:

• To examine the alignment between priorities identified in CHNAs and those in CHIPs.
• To identify factors influencing priority setting and alignment in LHDs.
• To understand barriers and facilitators in the public health prioritization process.

Main Methods:

• Mixed-methods study design.
• Analysis of CHNA and CHIP documents from 58 California counties.
• Thematic analysis of interviews with 19 public health officials.

Main Results:

• A 35% alignment rate was observed between CHNA-identified needs and CHIP-targeted priorities.
• Misalignment drivers include addressing unaddressable needs, political influences, and funding/capacity limitations.
• Rural LHDs often prioritized based on available state/federal funding due to limited discretionary funds.

Conclusions:

• LHDs encounter significant challenges in aligning CHNA and CHIP priorities.
• Adopting formal, transparent, and evidence-based prioritization methods is recommended.
• Further research should develop appropriate decision-making processes for local public health.