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 uses a validated survey instrument administered to the local public health official in each sampled community to measure the following attributes:

Availability of recommended activities: Whether or not each of 20 recommended public health activities is performed in the community. These 20 activities are based on the Institute of Medicine’s Core Public Health Functions definitions and reflect high-value practices recommended by a series of expert panels convened by the U.S. Centers for Disease Control and Prevention. These activities are closely aligned with the federal government’s Essential Public Health Services Framework and a more recently developed set of Foundational Public Health Capabilities called for by the Institute of Medicine in its 2012 consensus report.

  • Organizational contributions: Which types of organizations in the community contribute to performing each of the 20 recommended public health activities. For each activity, a pre-defined check-list of 15 types of organizations is used, along with open-ended response options. For each type of organization, a contribution measure is constructed that indicates the proportion of the 20 recommended activities to which the organization contributes in each community. These measures are further grouped into one of four sectors based on organization type.
  • Local Agency Effort: What proportion of the total effort used to perform each activity is contributed by the local public health agency in the community. For each activity, a five-point Likert scale is used to measure effort.
  • Perceived effectiveness: How effectively is each activity carried out in the community, using a fivepoint Likert scale.

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 ICPSR website. Please check back on this website for updates. If you are interested in creating a longitudinal version of the NALSYS data file for use in your proposed study, click here to submit a data request form.

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. Upon approval of your data request, a unique link 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.