A Typology to Describe Community Context and Population Health Activities in Local Public Health Delivery Systems

To develop a typology of approaches to population health activities that local health departments (LHDs) and their partners take to address community health needs, and identify associated contextual factors.

Using latent class analysis, we categorized how jurisdictions prioritize and perform 10 population health activities. With a latent class regression model (multinomial logistic regression), we examined the effect of county-level community characteristics on LHD class membership. Models include primary care provider ratio, income inequality ratio, social membership association ratio, percent non-Hispanic Black, and percent non-English speakers.

Local public health delivery systems across the US.

600 LHDs.

LHD population health approach.

Information statistics revealed a 3-class model as most appropriate for the population health approach typology-Underutilized Network (Class 1), Community Need and Implementation-Focused (Class 2), and Health Disparities, Implementation, and Evaluation-Focused (Class 3). Roughly 41% of delivery systems fell into Class 1, 39% into Class 2, and 20% into Class 3. Class 1 health departments self-reported no/poor performance on the 10 population health activities. Class 2 health departments reported variable performance (0.30 <  P ( x ) < 0.70). Class 3 health departments reported good/excellent performance for most activities (0.30 <  P ( x ) < 0.75). Regression results showed the probability of a delivery system being in Class 1 was higher among counties with a larger number of social membership associations ( P < .05). The probability of a Class 3 approach increased as the percent of non-Hispanic Black people in the community increases ( P < .05).

20% of local public health delivery systems achieve the highest level of response to community-specific health priorities. Many jurisdictions do not perform well on population health activities that can reduce health disparities overall. Those with a network of support, but without established plans and processes tailored to community-specific health needs, struggle to prioritize and perform population health activities.