Key Findings from 2022











How to Use the Dashboard

Learn how to navigate the dashboard by reading the sections below.



The Profile of State and Territorial Public Health (Profile) survey is a census conducted by the Association of State and Territorial Health Officials (ASTHO) to gather information on state, territorial, and freely associated state public health agencies (S/THAs) and their activities, structure, and resources. The Profile aims to define the scope of S/THA services, identify variations in practice among public health agencies, and contribute to the development of best practices in governmental public health. The Profile began in 2007 and was fielded on average every three years between 2007 and 2022.

The Profile is the most comprehensive data source about S/THAs in the United States. The data collected through the Profile represent the breadth of work overseen by health agencies and shows how the public health field has shifted in response to societal changes and emergent needs. Data also reflect the structural nuances and limitations in which agencies conduct their work. ASTHO launched its new Profile dashboard in December 2023. This new tool allows users to explore Profile data collected from 2012 – 2022. The Profile Dashboard was created using R Shiny.

The National Association of County Health Officials (NACCHO) publishes the National Profile of Local Health Departments, which complements the state and island area level data produced by ASTHO.

When you see the globe icon, select it to see data visualized in a map.

The chart icon shows data through a bar chart, cluster chart, or drill down chart.

The line graph shows data trended over time.

This icon indicates the ability to download a graphic or data visualization.

This icon allows you to explore data through more unique visualization types.

The information icon appears on the footer of every page and provides additional context and information.

You will see this icon on the footer of every page. Select it if you have a question.

Study Design and Survey Questionnaires: Between 2012 and 2022, the Profile was administered to all 50 states, Washington, D.C., and eight island areas (i.e., five U.S. territories and three freely associated states). The development of the Profile survey instrument is overseen by a panel of subject matter experts—the Profile Advisory Workgroup—which is comprised of state and territorial health agency staff, federal agency staff, non-profit organization partners, and academic researchers. The survey instrument varies by year, and the full questionnaire for each of the survey years included in the Profile Dashboard are linked below:

While ASTHO’s Profile aims to serve as a census of state, territorial, and freely associated state health agencies health agencies, not all agencies participate or complete the survey in its entity. The Profile survey response rate was 91.5% in 2012 and 98.5% in 2016, 2019, and 2022. The Profile Dashboard indicates cases where agency-level data are missing (i.e., “Data not available”) or suppressed (i.e., “Masked”) and includes sample size counts for multi-agency totals.

Data Validation and Verification Process: ASTHO ensures Profile data are valid and correct through a multi-step process. Health agencies enter Profile data into an online survey tool that validates data as it’s entered. After agencies have completed data entry, the ASTHO Research Team verifies reported data through review and follow-up. In cases where data appear inconsistent with prior reporting or have seemingly erroneous values, ASTHO provides feedback to agencies and asks that values either be confirmed or corrected through a secondary data collection. Once agencies have verified data, ASTHO performs additional quality processes to ensure multi-agency summary statistics are generalizable. Given that the ASTHO Profile population is small—59 agencies in total—extreme values can skew summary and trend data. To reduce the impact of outliers on summary and trend data, ASTHO has developed a suppression methodology that excludes values in cases where an agency-level value significantly skews the national total or where agency-level multi-year trends are 2.5 deviations or more from the mean percent change for the trend.

Data Recoding and Transposing: Profile data is collected in a single year; however, some data elements relate to retrospective time periods (e.g., past fiscal or calendar years) or forecast future circumstances (e.g., projected retirement rates). Survey respondents can also add open-ended clarifications to multiple-choice and continuous value fields, or specify when their response should be classified as a category other than those listed. Further, some questions ask for similar data to be broken out in differing ways (e.g., expenditures by category and by funding source). In each of these circumstances, data may need to be transposed, recoded, or recalculated for ease and accuracy in analysis and interpretation.

Interpretation: Resources on how to use data and information presented in this dashboard are primarily available within the stories (located in the stories tab). We have agency-specific pages in the profiles tab, which includes agency-level information that may be helpful in orienting users to the many differences across state and island area public health agencies. We highly recommend that all users refer to the stories on governance in the stories tab, as governance and structure influence expenditures, activities, workforce, and more. If you use these data for any purpose, please use our recommended citation, below.

ASTHO will soon make data from the Profile Survey of State and Territorial Public Health instantly available to any user upon a data use acknowledgement. Please check back in early 2024 for this update.

Please use the recommended citation below for any references to these data: Association of State and Territorial Health Officials. ASTHO Profile of State and Territorial Public Health, Volume Six. Arlington, VA: Association of State and Territorial Health Officials. 2023..

For reports related to the 2022 data or longitudinal analyses that include 2022, please visit the Stories and Profiles pages. There you will find downloadable reports on specific topics (Stories) as well as on all state, territorial, and freely associated state health agencies (Profiles). ASTHO recommends using and printing these reports.

You may also create custom reports from dashboard content by selecting the icon of three vertical lines at the top right of most figures. This icon will allow you to download the figure as a .png, .jpg, or .pdf.

For past reports from prior Profile surveys, please visit this link on ASTHO's website.

Contact us: If you have questions about the ASTHO Profile Survey of State and Territorial Public Health Agencies, please contact our team at profile@astho.org.

Report a bug: We are thrilled to bring you our new Profile dashboard and we want to make sure you had a great experience using this new tool. If you experience a bug or glitch while using this product, please share your experience below or email profile@astho.org.

Question about the data? If you have a question about the data, please make sure to check out more information on the home page. There you will find metadata, a raw data download, and general information about how we collected and report data. If you still have a question, please send an email to profile@astho.org and one of our team members will respond within 48 business hours.

Recommended citation: Association of State and Territorial Health Officials. ASTHO Profile of State and Territorial Public Health, Volume Six. Arlington, VA: Association of State and Territorial Health Officials. 2023.

The Profile of State and Territorial Public Health dashboard was made possible by many people, including health agency staff, funders, subject matter experts, and ASTHO staff. Thank you to the staff at state, territorial, and freely associated state health agencies who completed the survey. Your time is valuable and ASTHO appreciates you sharing the information that makes this work possible.

Thank you to the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation (RWJF) for providing funding support. The Profile of State and Territorial Public Health survey and dashboard was supported by funding from the CDC cooperative agreement number NU38OT000290, and Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems Grant (NE11OE000066), as well as the RWJF. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC, the Department of Health and Human Services, or the RWJF.

Subject matter experts including the Profile Advisory Workgroup and ASTHO staff provided input and guidance on questionnaire development, findings, and visual display. ASTHO staff who contributed to the research study planning, data collection, data management, analysis, dashboard development and visualization include (in alphabetical order): P'Ashe Jones, Lindsay Jorgenson, J.T. Lane, Leanne Lasher, Mad Marshall, Kristi Meadows, Miriam Naiman-Sessions, and Elizabeth Woods. ASTHO thanks Carolyn Leep for her support with data collection, verification, and her expertise and consultation on health agency governance classification. ASTHO also thanks John Coene from Opifex Sarl for his expertise and support in developing custom tools and features that are showcased on this application.











JUMP TO

DATA STORIES

Our dashboard showcases stories that connect public health data to action and support understanding of strengths and opportunities within state and island areas' public health landscape.









"As governmental public health leaders engage in efforts to transform their agencies, the Profile of State and Territorial Public Health is an important source of data to plan and measure improvements in agency functioning and capacity. Captured through a series of surveys to health agencies, the Profile allows ASTHO and its members to showcase the magnitude of work conducted by the public health workforce across all states, DC, US territories, and freely associated states in the Pacific. Data in this dashboard will inform decisions made by a broad audience of public health practitioners, policymakers, researchers, and the public."

- Michael Fraser, PhD, MS, CAE, FCPP
Chief Executive Officer, ASTHO










Explore the Data

Navigate using tabs up top or by selecting an icon below.











Funding note: The Profile of State and Territorial Public Health survey and dashboard was supported by funding from the Centers for Disease Control and Prevention cooperative agreement number NU38OT000290, and Strengthening U.S. Public Health Infrastructure, Workforce, and Data Systems Grant (NE11OE000066), as well as the Robert Wood Johnson Foundation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services or the Foundation.







Dive Deeper into Governance


Bar Graphs of Agency and Jurisdiction Characteristics

Explore how agency and jurisdiction characteristics interact. Select characteristics from the drop-down menus and explore the chart as a cluster or drill down.





Dive Deeper into Governance



Map of Agency Oversight

Explore which public health agencies/departments oversee various functions or services within their jurisdiction.




Definitions
What does it mean to have responsibility and oversight of an administrative function or service?

What does it mean to primarily direct human resource functions?


To see a list of agencies that oversee this function/service, click here.



Map of Activities Performed by Agencies

Explore which activities are performed by state and island area public health agencies.






What does it mean to...
Perform an activity?

Not perform an activity?

What is population-based primary prevention?

Dive Deeper into Activities


To see a list of agencies that performed this activity, click here.


Bar Graph of Activities

Search which activities were performed by public health agencies. Click a bar in the graph to see how many agencies performed the activities by category.









Trend Lines of Activities Over Time

View how agencies' implementation of activities has changed over time. Use the drop-down menus to select an activity.




Dive Deeper into Activities



Group and Individual Expenditure Trends

Explore grouped or agency-level expenditure trends by available fiscal year.




Definitions:
What are expenditures?

Expenditures by Funding Source

Expenditures by Expenditure Category

Federal Funds

State General Funds

Other State Funds

Other Funds

Medicaid and Medicare Funds

Masked Data

What is per capita?


Dive Deeper into Expenditures

Data Story October 2023

State public health spending grows after COVID-19

Over the past decade, the average expenditures and per capita expenditures for public health agencies have fluctuated. Sizeable increases in public health spending were observed in 2020 and 2021 as a direct response to the COVID-19 pandemic...

Read More >


Map of Expenditures by Year

Explore agencies' per capita expenditures by selecting a category to map from the drop-down menu. Use the slider to change fiscal years.




Dive Deeper into Expenditures

Data Story October 2023

State public health spending grows after COVID-19

Over the past decade, the average expenditures and per capita expenditures for public health agencies have fluctuated. Sizeable increases in public health spending were observed in 2020 and 2021 as a direct response to the COVID-19 pandemic...

Read More >


Compare Agency Expenditures to a Group

Compare an agency to a group using the selections below.






About Selected Jurisdictions




Further Exploration

Further explore public health expenditures through a bubble chart, sankey diagram, and heat map. Definitions and interpretations for each graph type is explained on the right when selected.





Definitions
Federal Funding

State General Funding

Other State Funding

Other Funding

Unspecified Funding Source

Unspecified Expenditure Category


Understanding the Figures

Interpretation October 2023

What is a Bubble Chart?

Packed bubble charts visualize data based on their size and color; in this case, the chart displays per capita spending amounts of public health agencies, grouped by your selected characteristic. For instance, if you select governance classification from the drop-down menu on the left, the bubble chart will display four colored bubble groups, where each color represents a governance classification type. Within each bubble group, you can see one bubble for each agency with that classification. The size of the bubbles corresponds to each agency’s per capita expenditures.

If you hover over an individual agency’s bubble, information on the exact expenditure amount and the fiscal year will display. You can also filter out certain groups by clicking on their label in the legend at the bottom of the chart. As an example, if you click on all the governance classifications except for “Centralized/Largely Centralized”, you can see just centralized agencies and their per capita expenditures.

If you go back to the legend and click any of the other group labels again, you can choose to compare two or more groups, or re-select them all to go back to the original bubble chart.

Interpretation October 2023

What is a Sankey Diagram?

Sankey diagrams visualize flow (often of a specific resource) and the quantities of the flows in proportion to each other. They allow us to visualize multiple perspectives in a single chart, as it breaks down categories into their associated components and shows how these different categories relate to each other.

To read the Sankey diagram, begin by looking at the left side and identifying the categories shown. In this case, the categories shown are Federal and non-Federal funding sources. You can follow the individual paths to see which funding sources constitute the two main funding categories, with the size of the path corresponding to expenditure amount.

By hovering over a specific path, you highlight that path, making it easier to follow. Hovering also allows you to view additional information about the expenditures of that flow path. Once you hit the middle set of labels, you can trace the paths to see the porportion of expenditures categorized by the funding source. For instance, by hovering over USDA, you can see that expenditures in the Women, Infants, and Children category were from USDA.

By exploring the paths, we can understand relative amounts of funding support from different organizations, the proportions of types of funding supporting expenditure categories, and more.

What is a Heat Map?

Heat maps display relationships between two categories of values in a matrix, using color to display values for each combination of the axis categories. In this heatmap, the x axis shows fiscal years, the y axis displays jurisdiction agencies, and the colors show per capita agency expenditures

By using the selection drop-down on the left, you can choose whether the colors represent expenditures for all funding sources, federal funding, or state funding. By hovering over any colored cell, you can see the expenditure amounts, fiscal year, and jurisdiction. The legend at the bottom displays the color scale and the expenditure value range it represents (from $0 to $600 million).

The heatmap allows you to view general over-time trends in expenditures by looking at color gradients from left to right. For instance, you can see a distinct darkening of the colors near the right side of the chart, specifically following the vertical red line, which represents the onset of the COVID-19 pandemic. This shows that there seems to be a general increase in public health agency spending in the wake of COVID.

You can also trace specific agency trends over time by following its row of cells as labelled on the left of the chart. You might notice that New Jersey and D.C. seem to have higher spending overall, as their cells are all in the orange-red color range. Likewise, you can trace up from any of the labelled Fiscal years to look at similarities or differences between agencies in a specific year. If you trace up from 2014, you can see quite a few jurisdictions had an increase in spending compared to the prior fiscal year.




Group and Individual Workforce Trends

Explore grouped or agency-level workforce trends by available year. Data include local health agency staff if they are employees of a state health agency (centralized governance).




Definitions:
Full Time Equivalency (FTE)

Employee

Examples of FTE, Position, and Employee

Occupational Classification (Job Type)

Vacant Position and Percent Vacant

Turnover Ratio

Temporary and Contract Worker

Workforce Development Director


Dive Deeper into Workforce

Data Story October 2023

The number of state and territorial public health employees rises slightly; vacant positions rise more

Within health agencies, it can be challenging to forecast the number of workers needed given the unpredictability of public health demands. The number of non-temporary employment positions at state, territorial, and freely associated health agencies (S/THAs) relative to the size of the jurisdictions’ population increased between 2019 and 2022...

Read More >


Map of Workforce Characteristics

Use the drop-down menus to expore various workforce characteristics. Use the slider for additional years of data.




Dive Deeper into Workforce


Compare an Agency to a Group

Compare an agency to a group using the selections below.







About Selected Jurisdictions




Bubble Chart of Workforce

Explore the number of non-temporary employees and non-temporary FTEs (filled and vacant) through this bubble chart. Select other tabs (above) for additional data.





Understanding the Figure

Interpretation October 2023

The relationship between size, governance, and workforce

The larger circles within the bubble chart show values of the selected grouping, while the smaller circles represent agencies' total FTE count (including vacant and filled FTEs). When governance classification is selected as the grouping characteristic, you can see a pattern among the inner circles, where decentralized agencies tend to have smaller workforce sizes (i.e., smaller inner circles) when compared to centralized agencies (larger inner circles). Population size may mediate this relationship. If you select population size as the grouping characteristic, you can see that agencies with smaller population sizes tend to have a larger per population workforce.



Informatics at a Glance
Section New in 2022

Use the drop-down menus below to explore agencies' use of informatics strategies and activities.





Definitions:
Informatics

Career Series

Health Information Exchange (HIE)

State-designated HIE

Community/Regional HIE

Enterprise HIE

Vendor-Mediated HIE

National Health Information Network (HIN)

Dive Deeper into Informatics

Data Story October 2023

Hiring informatics staff is hard — a career series helps

Informatics positions have increased in recent years, yet agencies find recruitment and retainment of Informatics staff very challenging. A career series can help. A career series (sometimes referred to as a career path or ladder) refers to a group of hierarchical job classifications which are closely related...

Read More >



Planning and Quality Improvement

Use the drop-down menus below to explore agencies' use of various planning and quality improvement (QI) tools, as well as their accreditation status.





Definitions:
Public Health Accreditation

Use of Healthy People

Quality Improvement

Performance Standards

Performance Measures

Progress Reporting

Core Competencies for Public Health Professionals


To see a list of agencies that use this strategy, click here.


Use of Quality Improvement Activities

Use the drop-down menus below to explore agencies' use of quality improvement (QI) activities.




Connect to Resources

Connection October 2023

Want to connect to planning/QI resources?

For general support with quality improvement, you can reach out to ASTHO's Performance Improvement team for at: performanceimprovement@astho.org. For support with Healthy People 2030, please contact someone from our Chronic Disease team at: chronicdisease@astho.org.


Additional Resources are Below:



Health Equity at a Glance
Section New in 2022

Explore how many agencies engage in health equity (HE) within their public health agency, and what that work entails.




Definitions:
Equity vs. equality

Health equity

Health equity unit

Health equity director

Health equity advisory group

Topics of health equity training

Health in All Policies (HiAP)

Dive Deeper into Health Equity

Data Story October 2023

Increasing the capacity for Health Equity

Agencies with a full-time HE director are more likely to have established priorities for racial/ethnic population groups that have experienced avoidable inequities compared to agencies with a part-time HE leader....

Read More >





State and Territorial Health Agency Profiles*

*State agency profiles are currently available, while profiles for territories and freely associated states are coming soon.













About the Agency
About the Jurisdiction
Quick Stats






Expenditures














Want to add a benchmark trend to per capita expenditures? Select comparison agencies below.

















Expenditure Categories (Left): This figure shows FY2018-21 expenditures by category. When the blue dot appears to the right of the orange dot, expenditures in that category increased.

Note: Categorical expenditures can fluctuate year-to-year for numerous reasons. Agency restructuring is one common cause of shifts in categorical spending from one year to the next. When restructuring happens, another state agency may take over a department that was previously within public health. As such, spending shifts should not be interpreted to reflect overall state spending within a given category.







Workforce


There are several ways to measure workforce, and these measurements are important to distinguish when describing the public health workforce.



Full-time Equivalencies (FTEs)

FTEs are the number of full-time equivalent positions, which is different from both the number of workers and the number of positions. FTEs can include filled FTEs and vacant FTEs, which, when reported together, is a way to describe workforce capacity.

Positions

Positions are the number of actual positions (filled or vacant) within the agency/department. One position may equal one FTE, but it may not. Two half-time positions, for example, equals one FTE.

Employees

Employees are the number of people working at the agency (also called a head count). While there are instances when one position = one FTE = one employee, this is not always the case. For example, one full-time employee (1 FTE) might work in two positions, both at .5 FTE.



Click here for three examples that illustrate these differences.





















Right: Select a job category below to see the number of filled and vacant FTEs by job type within that category.

















Workforce Over Time (Below): Total FTEs (filled + vacant) are shown below since the 2012 survey fielding.








Activities



Please Note: (1) If a public health agency is not performing an activity, it may be that a separate entity within the jurisdiction, oversees that service. For example, in some jurisdictions, the public health agency oversees the implementation of Medicaid, whereas in others that work falls to an umbrella agency or a separate agency. As such, activity implementation is not a reflection of work happening within a jurisdiction, but rather work happening in the agency. (2) For some states (e.g., Idaho), Sex Education and Abstinence Only Education activities provided in community settings are only directed to parents and not students.








Find an Agency with Specific Characteristics

Use the drop downs below to find agencies that match selected characteristics. Select one or more characteristics below, and the agencies that meet those characteristics will appear on the map.



Similar Agencies

How many agencies meet these criteria?

To see a list of agencies that meet the selected criteria click here.


Find Agencies Like Yours

Select the agency you want to search. Then, make selections below to see which agencies match the selected agency on those characteristics.



What do you want to match on?


To see a list of agencies that match your agency on the selected criteria click here.


Data were last updated on December 15, 2023. Data are subject to change.
Suggested Citation: Association of State and Territorial Health Officials. ASTHO Profile of State and Territorial Public Health, Volume Six. Arlington, VA: Association of State and Territorial Health Officials. 2023.

Version: 1.0.4

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