The Landscape of Local Public Health Preparedness: Findings from the 2018 Preparedness Profile Assessment

The National Association of County and City Health Officials (NACCHO) has released the 2018 Preparedness Profile assessment describing the landscape of public health emergency preparedness across the United States. The assessment gathers information about preparedness trends and emerging issues at local health departments (LHDs) to provide an evidentiary foundation for future public health preparedness initiatives. Results of the 2018 Preparedness Profile highlight strengths, gaps, and opportunities for improving public health preparedness at the local, state, and national levels.

A statistically representative sample of 910 preparedness coordinators, stratified by jurisdiction population size, was asked to complete the 2018 Preparedness Profile via Qualtrics Survey Software™ between January and March 2018. Preparedness coordinators are individuals identified by LHDs as having a significant responsibility for leading or coordinating an LHD’s disaster/emergency preparedness planning and response activities. LHDs serving large jurisdictions (population of 500,000+) were oversampled, and results were weighted to adjust for both oversampling and non-response.

Preparedness coordinators were asked to respond to 26 questions about their LHD’s preparedness workforce, planning, partnerships and activities. A total of 387 preparedness coordinators completed the assessment for a response rate of 43 percent. During the analysis phase, NACCHO took into account the results of this assessment and qualitative information provided by our membership through workgroups and programmatic activities. Some of the highlights of the results and recommendations of this assessment include:

  • Preparedness Workforce: The Preparedness Profile identified variability in experience among preparedness coordinators at the local level. NACCHO recommends prioritizing investments in training and workforce development opportunities targeted to different skills level.
  • Partnerships and Coalitions: The Preparedness Profile identified strong relationships public health and many partner organizations (e.g., healthcare, emergency management); however, there is opportunity to strengthen relationships with pharmacies, intelligence/security organizations, and the mental/behavioral health community. To increase community resilience at the local level, NACCHO recommends that national partners explore additional avenues that may provide a framework or roadmap for enhancing engagement between public health and these sectors.
  • Administrative Preparedness: The results of the Preparedness Profile identified improvements in administrative preparedness procedures at the local level, however a lack of awareness among some health departments and dedicated resources remains a common barrier. NACCHO recommends working with national partners representing state and local stakeholders to identify common barriers and priorities and to continue to look for opportunities to raise awareness among LHD leadership of good administrative preparedness practice and available resources.
  • Preparedness Planning: The Preparedness Profile identified that preparedness programs are concerned about emerging threats, such as opioid abuse and active shooter incidents, but feel unprepared to respond to such events. NACCHO recommends increased funding to build sustainable preparedness capacity and capability at the local level in order to be able to adapt preparedness infrastructure and processes to address these and other emerging public health threats.
  • Preparedness Activities: The Preparedness Profile identified that LHDs conduct minimal activities related to terrorism, critical infrastructure protection, and cybersecurity. NACCHO recommends that national, state and local organizations work together to clarify the role of public health and LHDs in addressing these 21st century health security threats.

This assessment represents a significant contribution by preparedness coordinators to the knowledge base of the overall state of preparedness personnel, infrastructure, and practice at LHDs. Through this research, NACCHO will continue to strive to be the voice for LHDs around the nation by educating and advocating to policymakers the importance of reliable and sustained sources of funding for preparedness activities and response, and by promoting the work of LHDs towards ensuring the health, safety, and resilience of their communities.

For more information about the assessment results and NACCHO’s specific recommendations, please refer to the full report. If you have any questions, please e-mail

About Katie Dwyer

Katie Schemm Dwyer is a Director in NACCHO's Preparedness Division. Her work focuses on supporting local health departments strengthen public health preparedness systems through governance, coordination and liaison with federal preparedness organizations, policy, and program management.

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