By Crystal D. Swann
October 9, 2006

The standards of the Operational Definition are intended to: Assure that regardless of their different size, structure and governance, America’s 3,000 LHDs all provide a consistent level of quality and core services to their communities. Increase accountability to community leaders and the public. Enhance the visibility of public health and its role in safeguarding community health. Further define the relationship between local governmental public health and other community organizations that contribute to the public’s health.

For many Americans, the local health department is an agency that moves back and forth from obscurity to prominence in seemingly random fashion. Long periods of time can elapse when they receive little public notice. But then something happens—an outbreak of West Nile virus or a surge of concern about a flu pandemic—and all attention is suddenly riveted on the local health department as people wonder: is our health in jeopardy and if it is what is being done to keep us safe?

Despite a general understanding that health departments focus on health hazards, few people understand what health departments do on a daily basis, much less whether their performance is adequate to address the many challenges that confront them.

Recently, the National Association of County and City Health Officials (NACCHO) has endeavored to develop specific standards that define the essential functions of local health departments or LHDs. In that process, NACCHO solicited the help of elected officials and others to assist in developing the definition. Representing the Conference of Mayors, Children, Health and Human Services Committee Chair Richmond (CA) Mayor Irma Anderson served on the Operational Definition Project Task Force.

Anderson summed it up this way: “Whether there are more health threats today or just a greater awareness of them, mayors should realize that health departments are a front-line defense and we should be just as clear about what we expect from them as we are about the local police and fire departments.”

The result of this effort is summed up in the Operational Definition of a Functional Local Health Department or the Operational Definition. The document is the outcome of an unprecedented two-year collaboration among more than 600 public health professionals and local and state officials representing 30 different states. It provides standards for key mission-critical functions, such as diagnosing and investigating health problems or hazards, formulating policies and plans that support community health, enforcing public health laws, educating the public about healthy choices, and maintaining a strong public health staff.

The goal is to bring America’s local health departments closer to the communities they serve through a process that clearly defines what constitutes a quality public health infrastructure while instituting greater accountability for maintaining it.

At the end of the day, the individual performance of each LHD must add up to a nationwide network of protection. But in reality, LHDs operate as independent entities whose responsibilities, staffing, structure and capabilities can vary widely from community to community.

“We should look to the standards contained in the definition as a way to seek greater consistency of quality because the threats we are dealing with, unlike our health departments, do not respect jurisdictional boundaries,” Anderson said. “As a mayor interested in health threats to my constituents, I want to know that the department in the next county or the next state is operating from the same playbook we are and that’s something this definition can provide. It offers a framework for boosting regional and national cooperation among local health professionals.”

The Operational Definition is intended to challenge LHDs to review and enhance their performance. NACCHO also believes that the effort to bring programs in line with the new standards will encourage constructive dialogue amongst our nation’s LHD’s, which can vary considerably in size and resources. NACCHO intends to facilitate these exchanges by collecting examples of how agencies in different parts of the country use the definition as a tool to improve services.

The purpose of the definition is to provide the tools required to maintain a public health infrastructure ready to face current and future threats to America’s health. Rather than wait until we are in the midst of something dramatic like a flu pandemic, or watch while less sensational but still insidious threats like obesity and diabetes erode the health gains of the past decade, we can act proactively to improve the foundation for securing a healthy future for our country.

At the city level, mayors should be focusing on public health capabilities with the same routine and regularity with which they examine public safety and public works capacities. To that end, the definition can help mayors better understand what LHDs do, gauge the resources their departments need, and hold them accountable for ensuring that an investment in public health services is money well spent.

The National Association of County and City Health Officers is an affiliate organization of The U. S. Conference of Mayors. For more information, or to download or order a copy of the Operational Definition, visit www.naccho.org and click on Operational Definition or call 202-783-5550.