Local health departments (LHDs) can play pivotal roles in U.S. communities by helping to link people with medical services and assuring access to care when it is otherwise unavailable. However, a new study in the American Journal of Preventive Medicine finds that many LHDs aren’t able to meet these goals, which could spell trouble for the uninsured and underinsured.
“Our report shows that in 2010, about 28 percent of LHDs had not conducted any of the three targeted activities in our study,” which looked at how LHDs assessed gaps in care, increased access to health services and used strategies to meet the health needs of the underserved, said lead author Huabin Luo, Ph.D, former research fellow with the Centers for Disease Control and Prevention and assistant professor in the department of public health at the Brody School of Medicine at East Carolina University.
In recent years, deep funding cuts have impacted local health departments. For example, between 2008 and 2009 alone, over 23,000 LHD jobs were eliminated. This combined with an increase in demand for health care services can mean an increase in health disparities for those who rely on community health care.
The study found that LHDs with larger budgets in bigger population centers were more likely to provide access to health services compared to smaller LHDs with fewer financial resources, where they may be needed more.
Laura Hanen, chief of government and public affairs at the National Association of County and City Health Officials (NACCHO), says that assuring access to care is complex and often out of the hands of LHDs in terms of the availability of providers and financial resources to care for uninsured. She explained LHDs do not receive sufficient resources to consistently carry out their core functions. “They are primarily supported through categorical disease funding, leaving them to support essential public services on the margins.”
Luo said the study may shine a light on what is needed to improve LHD services. “More support is needed for small local health departments with fewer financial resources to bridge the gap in providing access to care. If people cannot get proper care on time, their health conditions may get worse, they may end up in ERs and hospitalization will cost more.”
Hanen noted that as health insurance coverage becomes more widespread, LHDs will continue to identify and link people without health insurance to programs that provide health care services. “It cannot be overstated enough that poor housing, education, low income, unemployment and lack of transportation in a neighborhood are all interconnected and are all factors that determine health.”
- Huabin Luo, Sergey Sotnikov, Gulzar Shah. Local Health Department Activities to Ensure Access to Care. American Journal of Preventive Medicine, 2013; 45 (6): 720 DOI: 10.1016/j.amepre.2013.07.010
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