Table 1.

Activities, in order of importance, that best capture performance of the Essential Public Health Services^a and the combined variance in the activities used that is explained by the principal component, 2013 National Profile of Local Health Departments Survey^b

Essential Public Health Service	Activities	Variance Explained,c %
1. Monitor health status to identify and solve community health problems.	Infectious disease surveillance, injury surveillance, behavioral risk factor surveillance, chronic disease surveillance, maternal and child health surveillance, syndromic surveillance, environmental health surveillance	56.7
2. Diagnose and investigate health problems and health hazards in the community.	Screening for diabetes, cardiovascular disease, cancer, tuberculosis, high blood pressure, HIV, and blood lead; provision of laboratory services	52.2
3. Inform, educate, and empower people about health issues.	Population-based primary prevention activities for physical activity, violence, chronic disease, nutrition, tobacco, substance abuse, injury, mental illness, unintended pregnancy	57.6
4. Mobilize community partnerships to identify and solve health problems.	Collaborate with other community partners on maternal and child health, infectious disease, chronic disease, environmental health, community health assessments, food safety, tobacco, alcohol or other drugs, emergency preparedness	42.0
5. Develop policies and plans that support individual and community health efforts.	Provision of technical assistance to policy makers, regulatory groups, or advocacy groups for drafting proposed legislation, regulations, or ordinances; preparation of issue briefs on proposed policy; provision of public testimony on proposed policy; participation on a board or advisory panel responsible for public health policy	51.5
6. Enforce laws and regulations that protect health and ensure safety.	Regulation, inspection, and/or licensing of food service establishments, groundwater protection, surface water protection, private drinking water, air pollution, public drinking water, schools and daycares, indoor air quality, health facilities	45.1
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.	Provision of child immunization, family planning, sexually transmitted disease treatment, adult immunizations, tuberculosis treatment, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) food and nutrition services	41.0
8. Assure competent public and personal health care workforce.	Use of Core Competencies for Public Health Professionals5 for conducting staff performance evaluations, assessing staff training needs, developing staff training plans, writing job descriptions	67.4
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.	Performance of quality improvement (QI) activities, existence of agency-wide QI plan, QI committee, dedicated QI staff member, dedicated resources for QI, provision of QI resources and training to staff members on an ongoing basis, use of performance data to drive QI efforts	52.6
10. Research for new insights and innovative solutions to health problems.	Development of research protocols; dissemination of findings to stakeholders; collection, exchange, or report of study data; analysis and interpretation of study data; identification of research topics relevant to public health practice; recruitment of study participants; support of organizations applying research findings to practice; and application of research findings to practices within their own organization	68.5

^a Data source: Centers for Disease Control and Prevention.⁴

^b Data source: National Association of County and City Health Officials.⁶

^c Percentage of the data’s total variance explained by the principal component. For example, the principal component generated to represent Essential Public Health Service (EPHS) 1 explains 56.7% of the variability observed in all the activities categorized into EPHS 1.