Availability and Perceived Effectiveness of Public Health Activities in the Nation's Most Populous Communities

We examined the availability and perceived effectiveness of 20 basic public health activities in the communities where most Americans reside. A self-administered questionnaire was mailed to the 497 directors of US local health departments serving at least 100 000 residents. On average, two thirds of the 20 public health activities were performed in the local jurisdictions surveyed, and the perceived effectiveness rating averaged 35% of the maximum possible. In multivariate models, availability of public health activities varied significantly according to population size, socioeconomic measures, local health department spending, and presence of local boards of health. Local public health capacity varies widely across the nation's most populous communities, highlighting the need for targeted improvement efforts.