1. Findings from the 2008 National Profile of Local Health Departments Study Big City Local Health Departments

2. National Profile of Local Health Departments Study The National Profile of Local Health Departments is a survey of local health department (LHD) infrastructure and activities NACCHO sends the Profile questionnaire to every LHD in the U.S. – Completed by 83% of all LHDs in 2008 Data are self-reported by LHDs and not independently verified by NACCHO Source of all data in this presentation is from 2008 findings

3. Big City Local Health Departments Defined for the purpose of this report as LHDs that serve a city of 350,000 or more – Based on 2008 Census estimates 49 LHDs meet the Big City definition – 47 Big City LHDs included in this analysis – 1 Big City LHD did not respond to the 2008 Profile questionnaire – District of Columbia omitted because of unique status Big City LHDs serve a variety of jurisdictions – 36% serve combined city-county jurisdictions – 34% serve county jurisdictions – 28% serve city jurisdictions – 2% serve multi-county, district or regional jurisdictions Many Big City LHDs (62%) have a Local Board of Health

4. Big City LHDs Included in Analysis Alameda County Public Health Department (Oakland) El Paso County Department of Health and Environment (Colorado Springs) New York City Department of Health and Mental Hygiene Austin/Travis County Health and Human Services Fresno County Department of Public HealthOklahoma City-County Health Department Baltimore City Health DepartmentFulton County Department of Health and Wellness (Atlanta) Philadelphia Department of Public Health Boston Public Health CommissionHouston Department of Health and Human Services Pima County Health Department (Tucson) Chicago Department of Public HealthKansas City Health DepartmentPublic Health - Seattle and King County City of Cleveland Department of Public HealthLong Beach Department of Health and Human Services Sacramento County Department of Health and Human Services City of El Paso Department of Public HealthLouisville Metro Department of Public Health and Wellness San Antonio Metropolitan Health District City of Milwaukee Health DepartmentMaricopa County Department of Public Health (Phoenix & Mesa) San Francisco Department of Public Health City of Saint Louis Department of HealthMarion County Health Department (Indianapolis) Santa Clara County Public Health Department (San Jose) Columbus Public HealthMecklenburg County Health Department (Charlotte) Sedgwick County Health Department (Wichita) County of Los Angeles Department of Public Health Memphis and Shelby County Health Department Southern Nevada Health District (Las Vegas) County of San Diego Health and Human Services Agency, Public Health Services Metro Public Health Department (Nashville)Tarrant County Public Health Department (Fort Worth & Arlington) Denver Department of Environmental Health and Denver Public Health Miami-Dade County Health DepartmentTulsa City-County Health Department Detroit Department of Health and Wellness Promotion Minneapolis Department Health and Family Support Virginia Beach Department of Public Health Douglas County Health Department (Omaha)Multnomah County Health Department (Portland) Wake County Human Services (Raleigh) Duval County Health Department (Jacksonville)New Mexico Department of Health, Albuquerque and Las Cruces Districts (Albuquerque)

5. Distribution of Big City LHDs by Size of Population Served

6. Distribution of Big City LHDs by Total Annual Expenditures

7. Big City LHDs: Mean and Median LHD Expenditures by Size of Population Served Size of Population ServedMeanMedian 350,000 – 499,999$27,900,000$21,700,000 500,000 – 749,999$54,100,000$27,700,000 750,000 – 999,999$167,000,000$54,500,000 1,000,000 – 1,999,999$158,000,000$87,800,000 2,000,000+$384,000,000$105,000,000

8. Mean Percentage of Total LHD Revenues: Big City and Nationally from Various Sources *List does not represent all sources of revenue

9. Mean and Median Per Capita Revenues: Big City and Nationally from Selected Sources MeanMedian Source of Revenue Big CityNationalBig CityNational All revenues$105$66$51$37 Local revenues$31$15$13$7 State direct revenues$14$11$4$6 Federal pass-through revenues $10$8 $5 Federal direct revenues $12$2$4$0

10. Characteristics of LHDs Top Executives: Big City and Nationally CharacteristicBig CityNational Full-time position 100%86% Less than two years in position 28%21% Ten or more years in position 21%35% % Race White 70%94% % Hispanic 11%2% % Female 40%56% Holds graduate degree 98%62% Holds public health degree 53%21% Holds medical degree (MD) 47%14% Holds registered nurse (RN) licensure 20%39%

11. Percentage of Big City LHDs Employing Selected Occupations

12. FTEs * Employed by Big City LHDs: Median and Median per 100,000 Population for All Staff and Selected Occupations Occupation Median (FTEs) Median FTE per 100,000 population Total FTEs436.553.7 Clerical staff84.69 Nurse625.4 Environmental health professional** 334.7 Manager/Director202.6 *FTE=Full-time Equivalent **Environmental health professional includes EH specialists (Sanitarian) and Other EH scientists

13. FTEs Employed by Big City LHDs: Median and Median per 100,000 Population for Selected Occupations OccupationMedian Median per 100,000 population Nutritionist111.3 Behavioral health professional 9.51.3 Health educator91 Information systems specialist 40.6 Epidemiologist30.5 Physician50.4 Public information specialist10.2 Emergency preparedness coordinator 10.2

14. Top Activities & Services Provided by Big City LHDs Activity or ServicePercent of LHDs Communicable/Infectious disease surveillance98% Adult Immunization96% Child Immunization96% Tuberculosis screening96% Population-based nutrition services96% Tuberculosis treatment94% HIV/AIDS screening94% Maternal and child health surveillance91% STD treatment91%

15. Activities & Services Provided More Frequently by Big City LHDs Compared Nationally Activity or Service Big City LHDs National Difference (Big City - National) Laboratory services83%25%58% Syndromic surveillance89%40%50% Asthma prevention and/or management 64%26%38% STD treatment91%57%35% Vital records84%50%35% HIV/AIDS screening94%59%34% Oral health services62%29%33% Maternal and child health surveillance 91%61%30%

16. Activities & Services Provided Less Frequently in Big City LHDs Compared Nationally Activity or Service Big City LHDs National Difference (Big City - National) Children's camps regulation23%48%-25% Home health care7%25%-18% Campgrounds/ Recreational vehicles regulation 24%42%-18% Septic systems regulation50%68%-18% Private drinking water regulation47%59%-12% High blood pressure screening58%68%-10% Groundwater protection33%41%-8% Solid waste haulers regulation22%29%-7% Mobile homes regulation24%30%-6%

17. Emergency Preparedness Activities in Big City LHDs Activity Percent of LHDs Participated in tabletop drills or exercises98% Developed or updated pandemic flu preparedness plans96% Updated a written emergency response plan based on recommendations from an exercise After Action Report (AAR) 96% Participated in functional drills or exercises96% Provided emergency preparedness training to staff on NIMS compliance 91% Reviewed relevant legal authorities to isolate and/or quarantine individuals, groups, facilities, animals, food products 87% Participated in full-scale drills or exercise81% Assessed emergency preparedness competencies of staff based on the nine core Emergency Preparedness Competencies and the agencys all-hazard response plan 57%

18. Addressing Health Disparities in Big City LHDs Activity Percent of LHDs Supported community efforts to change the causes of health disparities 96% Described health disparities in jurisdiction using data96% Prioritized resources and programs specifically for the reduction in health disparities 85% Educated elected or appointed officials about health disparities and their causes 83% Trained workforce on health disparities and their causes81% Recruited workforce from communities adversely impacted by health disparities 68% Took public policy positions on health disparities64% Conducted original research that links health disparities to difference in social or environmental conditions 47%

19. Percentage of Big City LHDs Performing Community Health Assessment and Improvement Planning in Past Three Years

20. For more information, email: ProfileTeam@naccho.org The 2008 Profile was made possible through funding from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. Mission The mission of the National Association of County and City Health Officials is to be a leader, catalyst, and voice for local health departments in order to ensure the conditions that promote health and equity, combat disease, and improve the quality and length of all lives.