Characteristics of Local Health Department Leadership and Their Impact on Service Provisions

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Background: The future of public health is leading towards local health departments (LHDs) focusing more on core public health functions and less on clinical service offerings. While it has been recognized that organizational characteristics and population demographics have an impact on service provision, the characteristics of the top executive also may influence LHD’s service provisions.

Purpose: This study examines LHD top executive characteristics and the extent to which these characteristics impact the level of service delivery change within each program area.

Methods: Data from the National Association of County and City Health Officials’ 2016 Profile of LHDs were used to perform Chi-square analyses of changes in the level of program area service delivery by characteristics of the top executive.

Results: Being a first time executives was strongly associated with service delivery changes in all program areas. First time executives were significantly more likely (p<0.001) to reduce immunization (16% of LHDs) and obesity prevention services (7.1%); while expanding tobacco, alcohol, or other drug prevention (24.5%) and diabetes screening services (15.3%). The gender of the top executive was significantly associated with changes in 10 of the 11 program areas. Female executives were more likely to expand immunization (18.9%) and communicable disease screening or treatment (23.5%) services; while male executives expanded screening services for high blood pressure (11.2%) and diabetes (18.4%). Among other executive characteristics, LHDs with Hispanic/Latino executives were more likely to expand maternal and child health services than non-Hispanic/Latino executives (23.5% v 11.9%; p<0.001); while non-Caucasian executives were more likely to expand epidemiology and surveillance services than Caucasian executives (18% vs. 9.8%; p<0.001).

Conclusion: The top executive characteristics of a LHD appear to have a significant relationship with the impact on service provisions and should be considered an important factor for service provision priorities.


American Public Health Association Annual Meeting (APHA)


San Diego, CA