Elements Of Local Public Health Infrastructure that Correlate with Best Practice Activities: A Preliminary Analysis

Public health infrastructure (PHI) serves as the core foundation for essential public health and its services. However, the U.S. PHI has been weakened by understaffing, underfunding, limited resources and partnerships, and outdated data and information systems over the past few decades. The recent COVID-19 pandemic exacerbated its vulnerability and weakened nature, resulting in increased health disparities and worse health outcomes in general for the nation. The goal of this study was to identify elements of local PHI that are associated with the completion of 20 key public health activities while adjusting for state differences. Cross-sectional secondary data were acquired and linked from two national surveys of local health departments, the National Profile of Local Health Departments survey and the National Longitudinal Survey of Public Health Systems. In total, 20 multivariable logistic regression models were created to analyze the relationships between variables. State fixed effects were used in multivariable models to control for state differences. It was found that state differences affected the correlations of infrastructure variables. Several staffing elements, abilities to provide certain services, and participation in certain types of actions were strongly correlated with the completion of best practice activities. These findings will add to the discussion of what the minimum necessary elements of PHI may be.