Local health departments (LHDs) across the country face a challenging task: improve health outcomes in their communities with limited resources, while navigating complex policy changes at the federal level. This work requires close collaboration with community partners, from healthcare systems to community-based organizations. As the frontline of many public health efforts, LHDs use a range of planning tools to prioritize and guide their work. In their recent study published in the Journal of Public Health Management & Practice, Sinai Urban Health Institute (SUHI) and the National Association of County and City Health Officials (NACCHO) examined three types of LHD strategic planning documents – strategic plans, community health improvement plans (CHIPs), and quality improvement plans (QIPs) – to look for best practices and trends.

In this study, a sample of 93 plans from 31 LHDs were analyzed. Given the diversity of communities, LHDs were purposely sampled by size, region, and rurality.  Findings revealed regional and size-based differences in priorities and strategies for improvement. LHDs in the West were more likely to focus on social determinants compared to those in the South. While larger departments consistently prioritized healthcare access, this focus was less common among the smallest LHDs.

Key Findings:

• Nearly all LHDs use established frameworks to develop their plans and identify areas of focus, including the 10 Essential Public Health Services and Plan-Do-Study-Act cycles.
• Behavioral health, social determinants of health, access to care, chronic disease, and nutrition and physical activity emerged as top priorities across LHDs.
• Strategies to address priorities areas included building collaborations and partnerships, advocating for policy change, increasing access to services and resources, and increasing awareness of issues.
• The different types of plans covered different topics. While CHIPs frequently incorporated social determinants of health as part of a guiding framework, QIPs focused on fostering continuous quality improvement.
• While all small and large LHDs prioritized expanding services, only about half of medium-sized LHDs included this as a strategy.

Implications and Recommendations:

• Strategic plans and CHIPs increasingly address the root causes of health and health inequities. Given the necessity of improving social conditions to advance population health, LHDs should prioritize and allocate more resources for relevant programs and policies.
• Health departments need to expand community engagement strategies to ensure plans accurately reflect the unique needs of residents and to build trust.
• Using data to drive planning can improve the effectiveness of strategies and guide adjustments over time.
• There is a need for ongoing investment in workforce development and building internal health department capacity. Spec examples include increasing the use of performance management systems and quality improvement training for public health staff.

Read the Article in JPHMP

Of note, there is an opportunity for LHDs to more meaningfully integrate equity in planning documents. In another study, published in the Journal of Racial and Ethnic Health Disparities, SUHI researchers found that health equity was not a main focus of the public health plans for most of our country’s biggest cities and only 7 of the 30 cities had health plans with specific and measurable racial equity goals. Yet cities like Chicago, Baltimore, and New York all had health equity woven into their entire health plans. Subsequent interviews identified 5 themes: (1) organizations were flexible in reallocating resources to address equity; (2) multidisciplinary teams are necessary for effective health equity plans; (3) community collaboration is required for meaningful and sustainable change; (4) there is a direct relationship between racism, structural inequities, and health outcomes; and (5) health departments have prioritized health equity plan development, but further work is required to address root causes.

To learn more about this project, check out our article, as well as the final report, Summary of Local Health Department Planning Documents: Best Practices and Trends. This project was initiated and co-conducted by the National Association of County and City Health Officials (NACCHO).

Acknowledgements:  We would like to thank the National Association of County and City Health Officials (NACCHO), as well as our colleagues who contributed to the original article: Jesus Valencia, MPH, Anna Clayon, MPH, Krishna Patel, DrPH, MPH, Joi Lee, MPP, Tim McCall, PhD, and Ashley Edminston, MPH.

Jacquelyn Jacobs, MPH, is the Director of Evaluation at Sinai Urban Health Institute. With over 15 years of experience conducting rigorous mixed-methods research and evaluations, she has led studies on chronic disease, behavioral health, and healthcare delivery.

Britney P. Smart, MPH, is the Associate Director of Health Equity Research and Evaluation at the Sinai Urban Health Institute. Britney’s research focuses on understanding the root causes of inequities and working to center the voices of those most impacted as we work to identify solutions.