Understanding local health department service philosophy: A latent class analysis of naccho profile data

Local health department (LHD) leaders and their community stakeholders have different philosophies on the role of the public health departments in their communities. This contributes to variation in the portfolio of services offered by an LHD. Using national data sets and LHD data compiled from Public Health Practice-Based Research Network states participating in the Public Health Activities and Services Tracking (PHAST) study, this research is focused on developing and validating a method for identifying the underlying service philosophy of LHDs and is based on available data and practitioner input. Data on the types of services offered by LHDs in the 48 states represented in the 2008 NACCHO Profile were used. Cluster analysis identified clusters of LHD services, revealing three groups of services. These clusters were used in a latent class analysis to identify classes of LHDs based on their service offerings. Input from practice experts from four PHAST study states is helping to ensure that service clusters and LHD classes match with expert knowledge of general public health systems, LHD approaches to service delivery, and the jurisdictions in their states. Preliminary findings indicate that latent classes can be identified for LHDs with different philosophies of public health services. Preliminary analyses indicate that two classes of LHDs appear most identifiable using latent class analysis: a “core services class” and a “core services plus class” that includes additional service groupings. In bivariate analyses, the core services class was associated with lower per capita expenditures than the expanded core services plus class. Ongoing expert public health practitioner review of the identified classes and preliminary findings is underway, with additional analyses of relationships between these classes and other local socio-demographic and LHD expenditures to follow, using detailed data in the PHAST database.