The NACCHO Profile Study Dashboard: Empowering Local Public Health With Data-Driven Insights

In the evolving landscape of public health, effective decision-making relies on timely access to actionable data. Dashboards – which synthesize complex data into digestible visualizations – have emerged as powerful tools for improving public health surveillance, resource allocation, and policymaking.1-3 However, their effectiveness depends heavily on their design. For example, interactive features that allow users to explore data from multiple perspectives can be particularly valuable in local public health contexts, as large variability among local health departments (LHDs) in their governance, infrastructure, and capacity necessitates nuanced analyses. Storytelling approaches can amplify the impact of data by making findings accessible to non-technical audiences, including lawmakers.4 Furthermore, user-friendly interfaces, simple and consistent design elements, and the ability to drill down into specific data points are critical for engaging diverse public health leaders across federal, state, and local agencies.5-7 Overview of the NACCHO Profile Study Dashboard Against this background, the National Association of County and City Health Officials (NACCHO), in partnership with the Association of State and Territorial Health Officials (ASTHO), built the NACCHO Profile Study Dashboard (naccho.shinyapps.io/nacchoProfile). This tool displays data from NACCHO’s National Profile of Local Health Departments (Profile) Study, which is conducted every three years to describe LHD infrastructure and practice at the national level. As the largest and most reliable data source on LHDs in the United States, the study provides a complete and accurate overview of LHD funding, staffing, activities, and partnerships. The most recent study was conducted in 2022 with 2512 LHDs nationwide. A total of 942 LHDs responded, representing a 38% response rate. National estimates for all LHDs in the study population are computed using survey weights. The dashboard presents both point-in-time national estimates from 2022, as well as longitudinal trends dating back to 2008. To inform the development of the dashboard, ASTHO conducted a collaborative discovery process to understand different public health stakeholders’ potential use of the dashboard and related data needs. During the discovery process, ASTHO interviewed nine NACCHO staff, seven Centers for Disease Control and Prevention (CDC) employees, two state association of county and city health official (SACCHO) leaders, and one LHD director. Across all groups, feedback emphasized the importance of five dashboard capabilities aligned with their needs (Table 1). TABLE 1 - Aspects Users Identified as Important for the NACCHO Profile Study Dashboard Aspect Purpose Example Quote Data storytelling Help users make sense of and apply the data “I think data stories are important because generally people understand the importance of data, but they don’t always know what that mean.” Easy-to-access key findings Allow users share the data with their stakeholders “I’m looking for infographics, percentages – those are both really impactful with lawmakers.” Options to cross tabulate Align with the ways users are already exploring the data “[I] will cross [data] with other variables like governance, finance, sharing of systems, systems development.” Comprehensive filters Enable users to drill down and compare groups of LHDs to another group (e.g., rural to non-rural) “I think [filtering] enhances the accessibility to a variety of readers or technical readers can get detail if they want it.” Novel yet consistent design Catch users’ attention and support ease in finding pertinent information “NACCHO is very creative in its charts, and I think that’s the kind of thing we need to kind of continue … in the dashboard you are developing – especially the charts that are kind of unusual or provocative.” In addition to these features, users prioritized the National Profile Study data that offer the most utility (Table 2). The most important domains included agency and leadership structures, workforce, finance, and services. Some user groups also found data on informatics, access to health care, policy and advocacy activities, public health planning, and partnerships to be integral to their work. For each topic, the dashboard offers several data visualization options, depending on the availability of data. Users may view 2022 analyses as a column chart or a table, as well as longitudinal trends as a line graph. In addition to multiple views, users can dive deeper into the findings using a comprehensive set of filters based on LHD characteristics, including rurality, agency governance, population size served, and U.S. region. Although some of these filtered analyses are presented in the comprehensive National Profile Study report, the interactive dashboard allows users to view filtered data not shown in the report (eg, proportions by rurality are available for nearly every data visualization in the dashboard but not the report). Lastly, to support users in communicating about public health insights to their stakeholders, every visualization can be downloaded as either a PDF document or vector image, while the results displayed within each visualization can be downloaded as either a .CSV or .XLS file. TABLE 2 - Domains and Topics Included in the NACCHO Profile Study Dashboard Domain Topic(s) Agency & Leadership Agency Characteristics Executive Characteristics Workforce Full-Time Equivalents Employees Jobs Lost & Added Occupational Classifications Finance Expenditures Revenues Budget Changes Services Services Provided Service Changes Other Topics Informatics Access to Health Care Policy & Advocacy Planning & QI Partnerships NACCHO Profile Study Dashboard Example Use-Cases The dashboard has practical applications across various levels of public health. National public health organizations can make sense of study findings with the data stories. These stories weave data from a variety of research efforts and narrative together to contextualize National Profile Study findings within the broader public health landscape. As such, data stories help advance advocacy and awareness efforts. For example, one data story places the experiences of harassment among local health officials during the COVID-19 pandemic in the context of broader public health workforce capacity limitations. NACCHO has shared this story with a variety of audiences to raise awareness about the challenges faced by public health practitioners, as well as to identify opportunities for capacity building initiatives supporting the mental wellbeing of LHD leaders and staff. Federal agencies can use the key findings – which synthesize the complex data into high-level takeaways – to advise policy recommendations. These findings offer an at-a-glance view of LHD capacity trends relevant to timely public health topics. For example, National Profile Study data showed an underinvestment in the public health staffing, resulting in $7.6 billion in the American Rescue Plan to strengthen the workforce during the COVID-19 pandemic. In 2022, the LHD workforce grew by 19% during the pandemic, but this growth was driven by a 175% increase in contract workers. This key finding highlights the likely influence of the temporary federal funding and can guide future resource distribution. SACCHO and LHD leaders can cross tabulate and filter the data to map strengths and gaps to specific subsets of LHD populations to advocate for targeted resources. For example, one local health official used the National Profile Study to compare LHD data in their state to national averages, leading to a promise of $2.5 million from the state to bolster local infectious disease activities. The dashboard will now make this kind of work easier by generating customized yet simple data visualizations using the dashboard’s filters, which can then be downloaded for sharing with policymakers and other non-technical audiences. The NACCHO Profile Study Dashboard exemplifies the power of data-driven tools in advancing public health. By integrating novel data visualizations with user-centric design, the dashboard empowers public health leaders at all levels – federal, state, and local – to make informed decisions, advocate for resources, and craft evidence-based policies that strengthen the nation’s local health departments.