National Longitudinal Survey of Public Health Systems (NALSYS), [United States], 1998-2018

Obtaining a better understanding of the organizational and operational attributes of public health delivery systems is a critical step in elucidating pathways for improving public health services. This survey of local governmental public health agencies was conducted to that end, as part of a larger study designed to classify the structural characteristics of local public health delivery systems and to examine variation and change in these characteristics over time. In 1998 and again in 2006, 2012, 2014, 2016 and 2018, local governmental public health agencies serving populations of 100,000 residents or more were surveyed about 20 core public health activities devoted to public health assessment, policy development, and assurance. For each activity, the survey instrument asked agency directors to report whether the activity was performed at all in the agency's jurisdiction and if so, which types of organizations were involved in performing the activity. Response options for the second item consisted of a pre-defined list of organization types, including hospitals, physician practices, health insurers, community health centers, educational institutions, community-based and faith-based organizations, state and local government agencies, and private businesses/employers. The instrument also asked what proportion of the total community effort for each activity was contributed by the local public health agency and asked how effectively the activity was performed.