Minnesota Local Health Departments Findings from the 2008 National Profile of Local Health Departments Study

National Profile of Local Health Departments Study The National Profile of Local Health Departments is a survey of local health department (LHD) infrastructure and activities NACCHO sends the Profile questionnaire to every LHD in the U.S. Completed by 83% of all LHDs Completed by 100% of Minnesota LHDs Data are self-reported by LHDs and not independently verified by NACCHO Source of all data in this presentation

Minnesota Local Health Departments Most LHDs (88%) serve county or combined city-county jurisdictions 11% LHDs serve multi-county jurisdictions

Distribution of LHDs by Size of Population Served Most Minnesota health departments and health departments across the country serve very small populations (less than 25K). But in Minnesota, the second category is nearly equal – health departments that serve between 25K and 50K. In Minnesota, 71% of health departments serve populations less than 50K.

Distribution of Total Annual LHD Expenditures In Minnesota, most health departments have total annual expenditures of less than $1 million. The next highest group has expenditures of more than $2.5 million. So, our health departments fall into the smallest and largest, whereas across the country there is a more even distribution.

Median LHD Expenditures by Size of Population Served This slide combines the information from the previous two slides. It shows the median level of expenditures for health departments serving different sizes of jurisdictions in Minnesota and nationally. What you can see is that for small and medium size health departments (the first three lines), Minnesota has more expenditures that health departments across the country, but for the largest health departments, Minnesota has lower expenditures. In part, these numbers are impacted by the larger number of small health departments across the country that might only employ one part time health officer, generally focused on EH issues. Even Minnesota’s smallest jurisdictions are served by “full-service” health departments that are responsible for all of the six areas of responsibility laid out in our state law.

Percentage of Total LHD Revenues from Various Sources This slide breaks down the sources of revenue for local public health department expenditures. In a nutshell, Minnesota utilizes more Medicaid and Medicare than health departments nationwide (the dark green) and slightly more federal pass through dollars and direct federal dollars (the brightest blue and grey), which would include preparedness, MCH, and WIC. In total, these three federal sources account for 48% of Minnesota’s revenues and 34% of revenues nationally. Minnesota uses less state and local funds and “other funds” (usually fees) than health departments nationally.

Mean Per Capita LHD Revenues from Selected Sources This slide shows the mean - or average - per capita revenues for selected sources of funding. In Minnesota, our overall average per capita is lower than the national average. Our state and local funds are also lower, while our federal revenues are slightly higher.

Characteristics of LHDs’ Top Executives There’s a lot of data on this table. It shows information about our “top executives” or public health lead staff for each health department. Top executives includes CHS Administrators, public health directors and public health supervisors (in human services departments). We are above the national average in employing a full time staff person, and we have fewer new directors (14% vs. 21%) than the national average. As you can see, Minnesota’s public health directors are 100% white, and primarily female. We have fewer top executives with graduate degrees and public health degrees, and significantly more nurses.

Percentage of LHDs Employing Selected Occupations Nurse Manager/Director Clerical Staff Emergency Preparedness Coordinator Health Educator Nutritionist Environmental Health Specialist (Sanitarian) Physician Behavioral Health Professional Information Systems Specialist Epidemiologist Public Information Specialist Other Environmental Health Scientist EP=Emergency Preparedness EH=Environmental Health BH=Behavioral Health IS=Information Systems PI=Public Information The most noticeable difference on this table is that we employ significantly fewer EH specialists than the national average. In general, our public health system grew out of a “county nurse” model as opposed to a “county inspector” model.

“Typical” Staffing Patterns for Minnesota LHDs Median Full-Time Equivalents (FTEs) for Selected Population Sizes This slide shows the typical staff complement for different sized of Minnesota health departments.

Median FTEs for All Staff and Selected Occupations by Size of Population Served This slide shows the median FTEs across different jurisdiction sizes and different types of staff. A few notes – for the smaller health departments (serving fewer than 100,000 people), we tend to have more staff, significantly more nurses, and fewer EH specialists. In larger health departments (serving 100,000-500,000), we have fewer staff, equal numbers of nurses, but significantly fewer EH specialists. In the largest health departments, we have more staff again, many more nurses, and more EH specialists.

Top Activities & Services Provided by Minnesota LHDs This slide shows the programs performed by most Minnesota public health departments.

Activities & Services Provided More Frequently in Minnesota compared Nationally This slide shows program areas that Minnesota health departments perform more frequently than the national average. You can see what we do significantly more “population-based” type services than are done nationally.

Activities & Services Provided Less Frequently in Minnesota compared Nationally This slide shows activities than Minnesota health departments do far less often than health departments nationally. This list includes a number of environmental health inspection services, which tend to be done more often by our state health department and far more direct health care services, which are performed more often by the private health care system in Minnesota.

Community Health Assessment and Improvement Plan in past three years Not surprisingly, with our CHAAP process, we do more assessment and planning than health departments nationally.

For more information contact: Julie Ring, Director Local Public Health Association of MN ring@mncounties.org The 2008 Profile was made possible through funding from the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.