National Longitudinal Survey of Public Health Systems



Since 1998, researchers have followed a nationally representative cohort of U.S. communities to examine the types of public health activities performed within the community, the range of organizations contributing to each activity, and the perceived effectiveness of each activity in addressing community needs. This information, obtained through a validated survey of local public health officials, provides an in-depth view of the structure and function of local public health delivery systems and how these systems evolve over time. Originally conducted with support from the U.S. Centers for Disease Control and Prevention, the National Longitudinal Survey of Public Health Systems (NLSPHS) was fielded for the first time in 1998, with a follow-up survey conducted in 2006 as part of a Robert Wood Johnson Foundation-funded project to develop an evidence-based typology of local public health delivery systems.

Each wave of the survey has been linked with data on local health departments collected from the prior year’s National Profile of Local Health Departments survey conducted by the National Association of County and City Health Officials (NACCHO), allowing for an in-depth view of how local health departments relate to the multi-organizational delivery systems in which they operate.  These data, linked with still other data sources on community demographic, health, and economic characteristics, have supported a wide array of studies regardign the organization, financing, and delivery of public health services and provided considerable insight into policy and administrative mechanisms for improving the practice of public health.

A third wave of the NLSPHS was conducted in 2012 and data was linked with the 2010 NACCHO Profile Survey as well as the 2010 Survey of State Health Agencies conducted by the Association of State and Territorial Health Officials (ASTHO). An additional 2014 wave used the 2012 survey instrument and included a supplementary sample of small and rural nonmetropolitan communities last surveyed in 2006.

The resulting data (available from the Inter-University Consortium for Political and Social Research) is useful for tracking public health services status in light of environmental conditions such as the budget shortfalls and economic rescission and implementation of the Affordable Care Act (ACA). Local public health agencies and the PBRN networks use the data and measures for local analyses, particularly to construct a national comparison group used in comparative analyses of public health practice variation and using the survey instruments for state-focused analyses.

Recent Findings

The survey collects data on organizational partnerships and communications, enabling social network analysis to examine the types of partnerships associated with successful health outcomes, and to determine the most effective approach to communications within a specific network. Significant 2012 survey results were:

  • Economic constraints, when other factors were controlled, did not impact public health system partnership networks. Other factors such as population size and the existence of a board of health had a greater impact on the centrality of the networks, having implications for network development strategies and public health system communications.
  • Reductions in the public health activities provided fell by nearly 5% in the average community between 2006 and 2012, and most sharply among communities experiencing the largest increases in unemployment and the largest reductions in governmental public health spending.
  • Since federal resources and private sector contributions were not successful in providing continuous local public health service levels during the recession, new financing mechanisms may be necessary to ensure equitable public health protections during economic downturns.

Findings from the 2014 survey include:

  • Comprehensive and highly-integrated public health systems appear to offer considerable health and economic benefits over time, with larger reductions in rates of infant mortality and deaths due to cardiovascular disease, diabetes, and cancer and 15% lower use of public health resources.
  • Low-income communities were less likely to achieve comprehensive public health system capital, as were communities without local governance structures.
  • Opportunities exist for improving population health through policy initiatives to build public health system capital, such as through the ACA’s hospital community benefit provisions and the IOM’s call for a minimum package of public health services.
  • Communities that move from non-comprehensive to comprehensive system structures over the 16-year period experience 10-40% larger reductions in preventable mortality rates compared to communities that remain non-comprehensive