NALSYS Frequently Asked Questions

The National Longitudinal Survey of Public Health Systems, or NALSYS for short, is a unique survey that has followed a national cohort of local public health systems over six waves to date beginning in 1998, followed up in 2006, 2012, 2014, 2016, and most recently in 2018. This cohort was defined initially by identifying all local health departments in the U.S. that served a jurisdiction containing at least 100,000 residents using data from the NACCHO Profile survey and U.S. Census data, and sampling 100 percent of these jurisdictions. These jurisdictions represent approximately 17 percent of all local public health jurisdictions in the U.S., but serve approximately 70% of the U.S. population.


The NALSYS is a unique survey that captures the implementation of 20 recommended public health activities and involvement of local organizations and social services within public health jurisdictions in the U.S. It is a validated survey instrument that measures the following attributes:

  • Recommended Public Health Activities: Community needs assessment, prioritization of community needs, determination of priority populations, community health action plan, allocation and deployment of resources, implementation of community health initiatives, provision of or linkage to appropriate services for priority health needs, behavioral risk factors, investigations of adverse health events, laboratory services, preventative and screening services, professional health communication network, decision-making support of public officials around public health, community health issue updates to the media and public, organizational assessment of local public health agency, evaluations and monitoring of the effect of public health services, and implementation of mandated public health programs.
  • Organizational Contributions: There are 16 pre-defined organizations that may participate in recommended public health activities within a specific public health jurisdiction. Examples include a local hospital or local K-12 school. There are an additional 17 pre-defined social services in the public health jurisdiction that may also participate. Examples include services for Veterans or those with disabilities. To understand the total contribution of an organization or social service, its proportion of participation in each of the 20 recommended public health activities can be measured.
  • Local Agency Effort: For each activity, a five-point Likert scale is used to measure total effort contributed by the local public health agency.
  • Perceived effectiveness: A Likert scale is used to measure the agency's perception of how effectively each activity is carried out by all participating organizations and social services in the jurisdiction.
  • Health Equity and Disparities: A Likert scale is used to measure the agency's perception of how much of each activity is focused on addressing health inequity and disparities.

A series of analyses, publications, and presentations have used the data, including analyses of how recent economic and policy changes are influencing the structure and function of local public health delivery systems, and how these systems-level changes impact population health.

All local public health officials who have responded to the survey have received a customized report of results that examines how their own jurisdiction’s public health delivery system has changed over time and how it compares with other communities across the U.S. and among “peer-groups” of similar communities defined based on demographic and socioeconomic characteristics. This report is intended for use by local officials and their community partners for a variety of purposes including strategic planning, systems development and evaluation, policy development and analysis, and quality improvement.


For your convenience, a de-identified public-use version of the NALSYS is available for download at the Inter-University Consortium for Political and Social Research (ICPSR) website. Please check back on this website for updates.

If you require restricted NALSYS data for your proposed study, you can email Please provide your IRB determination and explain the data you need. The Systems for Action National Coordinating Center staff will review your request, and if approved, will contact you directly to discuss the Data Use Agreement (DUA). The DUA will be signed by both the data requesting individual or entity and by an official representative of S4A and shall ensure proper use of the NALSYS data.

Please note that release of the NALSYS data file from the S4A National Program Office is contingent upon securing an IRB determination of the proposed study. Please contact the S4A National Program Office for more details.