Comparison of Local Public Health Departments Highlights Social Inequities Interview with:

Megan Wallace, DrPH Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland

Dr. Wallace

Megan Wallace, DrPH
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland What is the background for this study? What are the main findings?

Response: Local health departments are often evaluated on a nationwide or statewide basis, however, given diversity among counties that exists even at the state level, we felt there might be a better way to group health departments for evaluation.

In this study, we created county-level clusters using local characteristics most associated with the outcomes of interest, which were smoking, motor vehicle crash deaths, and obesity. We then compared county-level percentile rankings for the outcomes within sociodemographic peer clusters vs nationwide rankings. We identified 8 groups of counties with similar local characteristics.

Percentile ranks for the outcomes of interest often differed when counties were compared within their peer groups in comparison with a nationwide scale. What should readers take away from your report? 

Response: Comparing counties on a statewide or nationwide basis fails to adequately account for the diversity that exists. Providing counties with peer groups may be useful for progress comparisons and the sharing of best practices. What recommendations do you have for future research as a result of this work?

Response: Local health departments serve as the front lines of public health practice in the United States, therefore continued research on mechanisms and best practices to aide in the important work they do is essential. Is there anything else you would like to add?

Response: This method provides an important mechanism to evaluate local health department performance, but it should be considered a supplement to, not a replacement of, current methods. The current methodologies are useful for highlighting the social inequities of health, or demonstrating how legislation impacts counties across a state, all of which are important to creating a robust understanding of health within a given county.

We have no disclosures. ​


Wallace M, Sharfstein JM, Kaminsky J, Lessler J. Comparison of US County-Level Public Health Performance Rankings With County Cluster and National Rankings: Assessment Based on Prevalence Rates of Smoking and Obesity and Motor Vehicle Crash Death Rates. JAMA Netw Open. 2019;2(1):e186816. doi:10.1001/jamanetworkopen.2018.681 





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