Using the National Public Health Performance Standards program to define the role of the local health department

In preparing for a national accreditation initiative, public health officials feel that evaluating public health agencies on their capacities to achieve certain standards will lead to improved service quality, consistency of public health roles nationally, and a greater understanding of those roles among the general population. However, rural agencies expressed concerns that inadequate fiscal and human resources would be barriers to their becoming accredited. In response to these concerns, this study introduces a concept for expanding the utility of the National Public Health Performance Standards Program, through which the role of the local health department will be more specifically defined. The concept divides the 10 essential public health services into two practical components: the Discovery component, consisting of essential services 1, 2, 9, and 10; and the Action component, consisting of essential services 3 through 8. The study examines the extent to which Action capacity is dependent on Discovery capacity. The results were supportive, as Discovery capacity (combined capacity for essential services 1, 2, 9, and 10) was able to explain as much as 75% of the variability in Action capacity (combined variability of the capacity for essential services 3 through 8). The study concluded that although health departments have a responsibility to coordinate activities associated with all 10 essential services, their active, measurable responsibility should be to collect and share health-status information, diagnose and investigate local disease activity, evaluate public health effectiveness, and work with local institutions of higher education to research innovative solutions to address public health issues.