A Typology to Describe Community Context and Population Health Activities in Local Public Health Delivery Systems.

Objective: To develop a typology of approaches to population health activities that local health departments (LHDs) and their partners take to address community health needs, and identify associated contextual factors.

Design: Using latent class analysis, we categorized how jurisdictions prioritize and perform 10 population health activities. With a latent class regression model (multinomial logistic regression), we examined the effect of county-level community characteristics on LHD class membership. Models include primary care provider ratio, income inequality ratio, social membership association ratio, percent non-Hispanic Black, and percent non-English speakers.

Setting: Local public health delivery systems across the US.

Participants: 600 LHDs.

Main outcome measure: LHD population health approach.

Results: Information statistics revealed a 3-class model as most appropriate for the population health approach typology-Underutilized Network (Class 1), Community Need and Implementation-Focused (Class 2), and Health Disparities, Implementation, and Evaluation-Focused (Class 3). Roughly 41% of delivery systems fell into Class 1, 39% into Class 2, and 20% into Class 3. Class 1 health departments self-reported no/poor performance on the 10 population health activities. Class 2 health departments reported variable performance (0.30 < P(x) < 0.70). Class 3 health departments reported good/excellent performance for most activities (0.30 < P(x) < 0.75). Regression results showed the probability of a delivery system being in Class 1 was higher among counties with a larger number of social membership associations (P < .05). The probability of a Class 3 approach increased as the percent of non-Hispanic Black people in the community increases (P < .05).

Conclusions: 20% of local public health delivery systems achieve the highest level of response to community-specific health priorities. Many jurisdictions do not perform well on population health activities that can reduce health disparities overall. Those with a network of support, but without established plans and processes tailored to community-specific health needs, struggle to prioritize and perform population health activities.