Center for Outbreak Preparedness Insights
Local Public Health Resources Index
DASHBOARD
In chart view, the bar direction indicates if the value of the selected indicator or domain is above (right) or below (left) the average score across all four states.
KEY TAKEAWAYS
- California local health departments had higher per capita expenditures on average, with more than 2.5 times the median per capita expenditures of LHDs in Arizona and Utah, and more than 1.5 times the median per capita expenditures of Nevada LHDs. Note that there is a wide range of per capita expenditures within each state, underscoring the importance of local-level data like those made available in the LPHRI.
- Public health workforce per capita staffing levels tended to be higher in jurisdictions with small populations and lower in jurisdictions serving large populations, though the levels varied widely by state and type of staffing. For example, California had the lowest epidemiology staffing levels but the highest nurse staffing levels.
- Clinical lab and pharmacy workforce staffing levels were highest in more populated counties and lowest in less populated counties.
- Wastewater surveillance adoption was uneven: while 49% of counties reported no testing being done in 2023, approximately 4 in 10 counties reported conducting wastewater surveillance testing an average of more than 340 days each year in 2023.
KEY TAKEAWAYS
- California local health departments had higher per capita expenditures on average, with more than 2.5 times the median per capita expenditures of LHDs in Arizona and Utah, and more than 1.5 times the median per capita expenditures of Nevada LHDs. Note that there is a wide range of per capita expenditures within each state, underscoring the importance of local-level data like those made available in the LPHRI.
- Public health workforce per capita staffing levels tended to be higher in jurisdictions with small populations and lower in jurisdictions serving large populations, though the levels varied widely by state and type of staffing. For example, California had the lowest epidemiology staffing levels but the highest nurse staffing levels.
- Clinical lab and pharmacy workforce staffing levels were highest in more populated counties and lowest in less populated counties.
- Wastewater surveillance adoption was uneven: while 49% of counties reported no testing being done in 2023, approximately 4 in 10 counties reported conducting wastewater surveillance testing an average of more than 340 days each year in 2023.
The LPHRI provides a unique opportunity to compare resource levels across local jurisdictions, which may be used to inform program planning decisions. For example, the public health workforce data could help planners identify nearby jurisdictions with higher staffing levels that could assist during an emergency, such as through a memorandum of understanding. Data on expenditure levels could also provide insights into overall public health investment trends across different geographies or health department sizes.
While the tool displays local resource levels relative to the other jurisdictions across the 4 states, it does not assess capabilities of those resources, such as whether the staff available have the appropriate training to perform the duties effectively. Additionally, since no widely accepted “standards” for optimal resource levels exist, the LPHRI cannot be used to draw conclusions about optimal resource levels. Finally, the LPHRI is not meant to predict where outbreaks will occur or what health outcomes may result. For example, in correlation analyses, we did not find an association between the domain scores and certain health outcomes, such as influenza vaccination rates or age-adjusted premature mortality. Despite these caveats, the LPHRI is a valuable tool that allows public health leaders to access data for resource comparisons at the local level.
The dashboard below allows users to explore the data in the LPHRI, which can be displayed by county or by local health department. For a complete description of the methods and data sources used to develop the index, the Technical Notes are available below.
METHODOLOGY
The LPHRI is organized based on key categories of public health resources that are foundational to preparedness activities at the local level. Domains and indicators were selected and organized based on information from the scientific literature and feedback from technical advisors. Using data compiled from several publicly available sources, we applied statistical methods to aggregate the indicators into domains and conducted analysis on the data. For more details on the methods data sources used to develop the LPHRI, please see the Technical Notes available below.
