local health departments, performance standards, public health infrastructure



  1. Kennedy, Virginia C.


In summer 2001, 47 local public health agencies in Texas evaluated their public health systems using a modified version of the Local Public Health System Performance Assessment Instrument. A concurrent investigation sought to describe the performance of these systems in the aggregate and identify local health agency characteristics and other factors associated with system performance. High system performance was associated with larger community size, higher community socioeconomic status, greater public health agency capacity, and agency contribution to system performance. These findings raise questions concerning the expectation that all local public health systems, regardless of the core agency's capacity, should be able to attain the performance standards.