National Longitudinal Survey of Public Health Systems (NLSPHS)

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The choropleth map shown below displays transitions in the percentages of population served by a comprehensive public health system over time in each state. The map also displays states that are significantly above or below the national average in the percentage of the population served by a Comprehensive Public Health Delivery System.


The National Longitudinal Survey of Public Health Systems (NLSPHS) is the only national, longitudinal source of information on the implementation and impact of multi-sector population health activities of local public health systems and how they have evolved and changed over time. Specifically, the NLSPHS collects information on a set of twenty population health activities recommended by national guidelines and federal consensus panels for implementation in state and local practice settings in order to monitor, protect, and improve health outcomes at the population level.

Over the last eighteen years, the NLSPHS has followed a cohort of local governmental public health agencies in 490 U.S. metropolitan communities in all states that serve jurisdictions with a population of at least 100,000 residents. Using survey data initially collected in 1998, and again in 2006, 2012, 2014, and 2016, the cohort of communities in the NLSPHS represent around 17 percent of all local public health jurisdictions but contain approximately 70 percent of the U.S. population. Beginning with the 2014 wave of the NLSPHS, the survey expanded to include an additional 550 public health jurisdictions having a population of less than 100,000 residents. Originally conducted with support from the Centers for Disease Control and Prevention, the NLSPHS follow-up surveys (2006 through 2016) were completed with support from the Robert Wood Johnson Foundation. 

The NLSPHS can be linked with many other national data sources to study how the delivery systems for population health improvement activities vary across communities, how they change over time, and what impact they have on important health and economic outcomes. A bibliography of studies that have used NLSPHS data is available here.

The survey captures information on the constellation of organizations in each community – both governmental agencies and private institutions—that participate in implementing these activities, along with measure of the perceived quality of implementation. These descriptions define each jurisdiction’s type of population health delivery system.

The NLSPHS results are used to monitor the percentage of the U.S. population that is served by a Comprehensive Population Health Delivery System. Communities are characterized as having a comprehensive population health system when they reflect a broad scope of population health activities supported through a densely connected network of multi-organizational and multi-sector relationships. This measure of access to public health is included in the Robert Wood Johnson Foundation’s set of core metrics for monitoring progress in the Culture of Health Action Framework.