Objective: This study examined the relationship between county variation in macro contextual variables and the performance of public health practice in regional local health departments (LHDs) in Nebraska.
Design and Main Outcomes Measures: County-level data from the US Census Bureau, the Nebraska Department of Health and Human Services, and the University of Nebraska Medical Center's Health Professions Tracking Services were used to create macro context variables (eg, demographic, geographic, social, economic, population health status). The public health performance data were collected through a mail survey of the directors of regional LHDs in Nebraska in 2008. Public health performance measures were created to indicate LHD's general performance as well as core function specific performance (ie, assessment, assurance, policy development). The coefficients of variation were estimated and used to categorize each regional LHD into either a larger county variation group or a smaller county variation group for each domain of macro context variables. Statistical comparisons of public health performance measures were then made between these 2 groups for each domain.
Results: The results suggest that the county variation in macro contextual variables within a regional public health district, in general, is negatively associated with the performance of public health practice in regional LHDs. The regional LHD's performance in specific public health core function (eg, assurance) is negatively associated with the county variation in specific types of macro context factors (eg, geographic factors such as land size and population density).
Conclusions: Regional LHDs may design and implement their public health programs on the basis of the type and degree of heterogeneity among the member counties within their jurisdiction. The formation of regional LHDs, if possible, should follow geographic boundaries that minimize the heterogeneity of county composition in terms of macro contextual factors.
This study examines the relationship between county variation in macro contextual variables and the performance of public health practice in regional local health departments in Nebraska.
Department of Health Services Research and Administration (Dr Chen and Mss Xu and Jacobson) and Department of Biostatistics (Dr Yu), College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska; Bureau of Local and Rural Health (Ms Roberts), Kansas Department of Health and Environment, Topeka, Kansas; and Office of Community Health and Performance Management (Dr Palm), Nebraska Department of Health and Human Services, Lincoln, Nebraska.
Correspondence: Li-Wu Chen, MHSA, PhD, Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198 (firstname.lastname@example.org).
Support for this project was provided by a Public Health Systems Research grant from the Robert Wood Johnson Foundation.
The authors thank the directors of Nebraska's local health departments for their participation in this study. They also thank Michelle Lampman and Nicole Vanosdel for their assistance with the project and Sue Nardie for her help with editing this article.
The authors report no conflicts of interest.