Local Health Departments’ Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction?

CONTEXT Health disparities are among the critical public health challenges. OBJECTIVES To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs' performing those activities since 2005, and factors associated with variation in such engagement. METHODS We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities. RESULTS About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four activities. LHD characteristics significantly associated (p≤0.05) with the increased likelihood of performing activities to address health disparities were: recent completion of community health assessment, community health improvement plan and agency wide strategic plan. Other significant positive impacts on such activities included per capita expenditures, local governance, having one or more local boards of health, larger population size and metropolitan status of the LHD jurisdiction. CONCLUSIONS Reduced infrastructural capacity of LHDs has resulted in fewer LHDs addressing health disparities in their jurisdictions. LHD characteristics associated with higher performance of activities for health disparity reduction identified by this research have important policy implications.