Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study

Abstract Background The Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships. Methods We used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships. Results Stronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03). Conclusions Stronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.

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Does Collaboration Between Local Health Departments and Nonprofit Hospitals Foster Community Health?

Academy of Management Proceedings ◽

10.5465/ambpp.2020.14116abstract ◽

2020 ◽

Vol 2020 (1) ◽

pp. 14116

Author(s):

Geri Cramer ◽

Gary J Young ◽

Jean Mcguire ◽

Simone Singh ◽

Daniel Kim

Keyword(s):

Community Health ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Nonprofit Hospitals

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Local Health Departments’ Role in Nonprofit Hospitals’ Community Health Needs Assessment

American Journal of Public Health ◽

10.2105/ajph.2018.304382 ◽

2018 ◽

Vol 108 (5) ◽

pp. 595-597 ◽

Cited By ~ 3

Author(s):

Gulzar H. Shah

Keyword(s):

Needs Assessment ◽

Community Health ◽

Health Needs ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Health Needs Assessment ◽

Nonprofit Hospitals ◽

Community Health Needs Assessment

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Does Federal Assistance to Health Departments for Bioterrorism Preparedness Improve Local Public Health Activity? An Empirical Evaluation Using the 2005 NACCHO Profile of Local Health Departments

Journal of Homeland Security and Emergency Management ◽

10.2202/1547-7355.1630 ◽

2010 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

George H Avery ◽

Tim Wright

Keyword(s):

Public Health ◽

Empirical Evaluation ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Local Public Health ◽

Public Health Activity ◽

Federal Assistance

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Performance and Priorities: A Cross-sectional Study of Local Health Department Approaches to Essential Public Health Services

Public Health Reports ◽

10.1177/0033354919890862 ◽

2019 ◽

Vol 135 (1) ◽

pp. 97-106 ◽

Cited By ~ 1

Author(s):

Megan Wallace ◽

Joshua Sharfstein ◽

Justin Lessler

Keyword(s):

Public Health ◽

Health Services ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Public Health Services ◽

Cross Sectional ◽

Local Public Health ◽

Essential Public Health Services ◽

Per Capita

Objectives: Despite a push for increased local public health capacity, no clear baseline for performance of local health departments (LHDs) exists. The objectives of this study were to quantify the self-reported performance of LHDs on the 10 Essential Public Health Services (EPHSs) and describe the relationships between performance and characteristics of LHDs. Methods: We used data on 2000 LHDs from the 2013 National Profile of Local Health Departments survey to develop principal components analysis–based scores to evaluate each LHD on the performance of EPHSs. Scores ranged from 0 to 100. LHDs that performed no activities within an EPHS had a score of 0, and LHDs that performed all activities within an EPHS had a score of 100. We explored the relationships between EPHS scores and LHD characteristics by using multivariate linear regression and cluster analysis. Results: Performance scores varied greatly by LHDs and EPHSs; however, LHDs typically scored <50, indicating that they performed fewer than half of the activities evaluated. LHDs that served larger populations (vs smaller populations) and LHDs that had higher per-capita funding (vs lower per-capita funding) had higher EPHS scores. We identified 6 EPHS performance score–based LHD clusters, which suggests similarities in which EPHSs LHDs focused on. Conclusions: Our results suggest weaknesses in many LHDs’ fulfillment of the EPHSs, particularly in low-population and low-funding settings. LHDs should be given the resources to increase capacity and ensure the EPHSs are met in communities.

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Snow Storms and Vulnerable Populations: Local Public Health Activities in Response to the 2014-2015 Severe Winter Weather

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.81 ◽

2018 ◽

Vol 13 (03) ◽

pp. 647-649

Author(s):

Dorothy Bernard ◽

Souleymane Konate ◽

Elena Savoia

Keyword(s):

Public Health ◽

Vulnerable Populations ◽

Winter Season ◽

Severe Weather ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Public Health Services ◽

Local Public Health ◽

The Impact

ABSTRACTThe Northeastern United States experienced some of its coldest and snowiest conditions ever recorded during the winter of 2014-2015. The snowfall and extreme temperatures created significant challenges for local health departments attempting to continue critical services and respond to storm-related needs of the community. This report from the field aims to describe the impact of the severe weather on local health departments’ operations, to examine the disruption to public health services, and to document public health support provided to vulnerable populations during the 2014-2015 winter season. Our findings show that the severe weather exposed major challenges in continuity of public health operations across health departments of various sizes and highlighted some key issues as well as effective strategies, such as collaborations with community-based organizations, to identify and address the needs of the most vulnerable during the winter storms. (Disaster Med Public Health Preparedness. 2019;13:647-649)

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Collaboration Among Missouri Nonprofit Hospitals and Local Health Departments: Content Analysis of Community Health Needs Assessments

American Journal of Public Health ◽

10.2105/ajph.2014.302488 ◽

2015 ◽

Vol 105 (S2) ◽

pp. S337-S344 ◽

Cited By ~ 30

Author(s):

Kate E. Beatty ◽

Kristin D. Wilson ◽

Amanda Ciecior ◽

Lisa Stringer

Keyword(s):

Content Analysis ◽

Community Health ◽

Health Needs ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Nonprofit Hospitals ◽

Needs Assessments

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Patterns of Cross-Sector Collaboration in Local Health Departments: A Cluster Analysis

Health Promotion Practice ◽

10.1177/1524839920972982 ◽

2020 ◽

pp. 152483992097298

Author(s):

Alexis K. Grant

Keyword(s):

Public Health ◽

Cluster Analysis ◽

Determinants Of Health ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Structural Determinants ◽

Cluster Assignment ◽

Cross Sectional ◽

Top Executive

Local health departments (LHDs) are positioned to act as the community health strategist for their catchment area, which requires cross-sector collaboration. However, little research exists to understand how much and what types of cross-sector collaboration occur and its impact on LHD practice. Data from 490 LHDs who participated in the 2016 National Profile of Local Health Departments survey were analyzed to identify patterns of cross-sector collaboration among LHDs. In the survey, LHDs reported the presence of collaborative activities for each of 22 categories of organizations. Factor analysis was used to identify patterns in the types of organizations with which LHDs collaborate. Then, cluster analysis was conducted to identify patterns in the types of cross-sector collaboration, and cross-sectional analyses examined which LHD characteristics were associated with cluster assignment. LHDs collaborated most with traditional health care–oriented organizations, but less often with organizations focused on upstream determinants of health such as housing. Three distinct clusters represented collaboration patterns in LHDs: coordinators, networkers, and low-collaborators. LHDs who were low-collaborators were more likely to serve smaller populations, be unaccredited, have a smaller workforce, have a White top executive, and have a top executive without a graduate degree. These findings imply that public health practitioners should prioritize building bridges to a variety of organizations and engage in collaboration beyond information sharing. Furthermore, LHDs should prioritize accreditation and workforce development activities for supporting cross-sector collaboration. With these investments, the public health system can better address the social and structural determinants of health and promote health equity.

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Actionable lessons for the US COVID vaccine program

Israel Journal of Health Policy Research ◽

10.1186/s13584-021-00452-2 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Gary L. Freed

Keyword(s):

Public Health ◽

Local Health ◽

National Strategy ◽

Individual State ◽

Health Departments ◽

Local Health Departments ◽

Public Health Infrastructure ◽

Health Infrastructure ◽

The Us ◽

Vaccine Distribution

AbstractWhen attempting to provide lessons for other countries from the successful Israeli COVID-19 vaccine experience, it is important to distinguish between the modifiable and non-modifiable components identified in the article by Rosen, et al. Two specific modifiable components included in the Israeli program from which the US can learn are (a) a national (not individual state-based) strategy for vaccine distribution and administration and (b) a functioning public health infrastructure. As a federal government, the US maintains an often complex web of state and national authorities and responsibilities. The federal government assumed responsibility for the ordering, payment and procurement of COVID vaccine from manufacturers. In designing the subsequent steps in their COVID-19 vaccine distribution and administration plan, the Trump administration decided to rely on the states themselves to determine how best to implement guidance provided by the Centers for Disease Control and Prevention (CDC). This strategy resulted in 50 different plans and 50 different systems for the dissemination of vaccine doses, all at the level of each individual state. State health departments were neither financed, experienced nor uniformly possessed the expertise to develop and implement such plans. A national strategy for the distribution, and the workforce for the provision, of vaccine beyond the state level, similar to that which occurred in Israel, would have provided for greater efficiency and coordination across the country. The US public health infrastructure was ill-prepared and ill-staffed to take on the responsibility to deliver > 450 million doses of vaccine in an expeditious fashion, even if supply of vaccine was available. The failure to adequately invest in public health has been ubiquitous across the nation at all levels of government. Since the 2008 recession, state and local health departments have lost > 38,000 jobs and spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%. Hopefully, COVID-19 will be a wakeup call to the US with regard to the need for both a national strategy to address public health emergencies and the well-maintained infrastructure to make it happen.

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Application for Public Health Accreditation Among US Local Health Departments in 2013 to 2019: Impact of Service and Activity Mix

American Journal of Public Health ◽

10.2105/ajph.2020.306007 ◽

2020 ◽

pp. e1-e8

Author(s):

Jonathon P. Leider ◽

Jessica Kronstadt ◽

Valerie A. Yeager ◽

Kellie Hall ◽

Chelsey K. Saari ◽

...

Keyword(s):

Public Health ◽

United States ◽

Latent Class ◽

The United States ◽

Local Health ◽

Health Departments ◽

Local Health Departments ◽

Profile Data ◽

The Public ◽

Funding Support

Objectives. To examine correlates of applying for accreditation among small local health departments (LHDs) in the United States through 2019. Methods. We used administrative data from the Public Health Accreditation Board (PHAB) and 2013, 2016, and 2019 Profile data from the National Association of County and City Health Officials to examine correlates of applying for PHAB accreditation. We fit a latent class analysis (LCA) to characterize LHDs by service mix and size. We made bivariate comparisons using the t test and Pearson χ2. Results. By the end of 2019, 126 small LHDs had applied for accreditation (8%). When we compared reasons for not pursuing accreditation, we observed a difference by size for perceptions that standards exceeded LHD capacity (47% for small vs 22% for midsized [P < .001] and 0% for large [P < .001]). Conclusions. Greater funding support, considering differing standards by LHD size, and recognition that service mix might affect practicality of accreditation are all relevant considerations in attempting to increase uptake of accreditation for small LHDs. Public Health Implications. Overall, small LHDs represented about 60% of all LHDs that had not yet applied to PHAB. (Am J Public Health. Published online ahead of print December 22, 2020: e1–e8. https://doi.org/10.2105/AJPH.2020.306007 )

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