assessment or policy development. In addition, performance of these practices was more extensive in larger health departments than in smaller departments. No attempt was made to compare performance in specific programmatic areas such as environmental health or maternal and child health. From the survey responses estimates were made that, in terms of the Healthy People 2000 objective, about 20–30 percent of health departments, serving about 40 percent of the population of the United States, had an “effective” level of performance. Effectiveness was defined in two ways: (1) performing 7 of the 10 public health practices listed in Table 1 or (2) from among those 10 practices, performing at least 2 of the assessment practices, 2 of the policy development practices, and 3 of the assurance practices.
In 1992 and 1994, the performance of local Illinois health departments was assessed using a set of 26 measures of public health practice (see Turnock et al., 1995). Between 1992 and 1994, the percentage of practices performed rose from an average of 55 percent to an average of 85 percent. Several changes contributed to the improved performance. Local health departments reported that the most influential was the state's requirement that they conduct assessments based on NACCHO 's APEXPH model (NACHO, 1991) or on an Illinois version called IPLAN (Illinois Plan for Local Assessment of Needs). Reports from the local health departments indicated that the Illinois Public Health Leadership Institute had its greatest impact on policy development activities. Changes in the state certification requirements, including the IPLAN process, had a broad impact across all areas of public health practice. They shifted attention away from a standard set of programmatic tasks to assessing and responding to local health needs, which is more consistent with the core functions and public health practices that are reflected in the 26 performance measures.
Implementation of the requirement for community health assessment was based on a collaboration between the state and the local health departments. For most local health departments, community health needs assessment was a new and unfamiliar task for which they had few resources and little training. The state health department provided resources in the form of orientation and training programs. It also developed a data system that could give local health departments access to essential information and provided the training and equipment needed to use the data system.