Examining Value, Process and Outcomes of Nuisance Inspection and Abatement Conducted by Local Health Departments

Purpose: Investigate conduct and nature of nuisance inspection and abatement through direct observation. Identify differences among Ohio Local Health Departments (LHDs) in nuisance inspection and abatement through factors associated with variation of service delivery across diverse community and organizational structures. Background: Nuisance abatement is an essential, mandated, unfunded public health service conducted by environmental health specialist in LHDs. However, there has been no formal effort to quantify, categorize, or standardize nuisance abatement efforts. Methods: This comparative case study utilized mixed methods including survey, interview, direct observation, and data abstraction. Original data documenting the process of nuisance abatement was produced from an observational protocol administered by trained observers at 6 diverse LHDs (n=167). A survey profile of participating Environmental Health Workers helps understand process variation (n=27). Data also includes abstraction of routinely collected nuisance abatement services data (n=509). Results: The top nuisance complaints were: property (32%); animal (28%); air (18%); water (18%); and solid waste/garbage (17%). Complaints were most often came from residents (64%), anonymous or unknown (22%), and government employees (14%); and were most often were directed toward residential (63%); commercial (12%); and public (3%) property. Complaints were received most often through phone calls (73%) and email (15%). The LHDs jurisdictional size, setting, population and resource allocation were related to the process of managing nuisance complaints. At the conclusion of the inspection, Environmental Health Worker checkout included clear feedback and assessment (91%); a plan for remediation (78%); and environmental health education (62%). Inspection outcomes included immediate remediation (58%), written orders (18%), citation (15%), and verbal warnings (11%). Conclusion:  Nuisance inspection and abatement represent a mandated, unfunded environmental public health service that has not been subjected to research scrutiny. Understanding factors that influence performance of these services will allow reduction of harmful, wasteful, and inequitable variation.