Performance and Priorities: A Cross-sectional Study of Local Health Department Approaches to Essential Public Health Services

Objectives: Despite a push for increased local public health capacity, no clear baseline for performance of local health departments (LHDs) exists. The objectives of this study were to quantify the self-reported performance of LHDs on the 10 Essential Public Health Services (EPHSs) and describe the relationships between performance and characteristics of LHDs. Methods: We used data on 2000 LHDs from the 2013 National Profile of Local Health Departments survey to develop principal components analysis–based scores to evaluate each LHD on the performance of EPHSs. Scores ranged from 0 to 100. LHDs that performed no activities within an EPHS had a score of 0, and LHDs that performed all activities within an EPHS had a score of 100. We explored the relationships between EPHS scores and LHD characteristics by using multivariate linear regression and cluster analysis. Results: Performance scores varied greatly by LHDs and EPHSs; however, LHDs typically scored <50, indicating that they perform