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Analyses conducted for public health systems and services research (PHSSR) frequently include a variable that represents the relationship between state and local health departments (i.e., a governance category) in their analyses, either as an explanatory variable or a control variable. A number of organizations and researchers has categorized states according to governance, but the categorizations have been inconsistent across studies. This lack of agreement regarding governance category has been problematic for PHSSR.

The Association of State and Territorial Health Officials (ASTHO) in conjunction with NORC at the University of Chicago and with input from the National Association of County and City Health Officials (NACCHO) conducted a study to systematically categorize state health agencies by their governance relationships with their local health departments (LHDs), using specific criteria. Based on a literature review, expert opinion, a survey, and follow-up telephone interviews in selected states, the relationships that exist between state and local health departments in each state were classified into four core categories: centralized, decentralized, shared and mixed. States’ systems were further classified based on a determination of what percentage of a state's population is served by LHDs of each governance type, creating additional categories of largely centralized, largely decentralized and largely shared for those states where more than 75 percent of the population is served by that predominant governance structure. The classification system for LHDs developed by NACCHO defines the governance relationship of each LHD with the state health agency as local, state or shared.

The presentation will include a map showing the classification of each state. A second map, developed using ARCGIS, will show the classification of each local health department based on NACCHO’s classification system. These new governance categories will be included in the data sets from ASTHO’s Profile survey and NACCHO’s Profile survey. These newly standardized state and local public health agency governance categorizations should help PHSSR by providing greater uniformity and validity across research studies.


Reproduced with permission of the National Coordinating Center for PHSSR and the Robert Wood Johnson Foundation, Princeton, N.J. Presentation obtained from the Keeneland Conference site.


2011 Keeneland Conference on Public Health Systems and Services Research