Who speaks for public health agencies: assessing the core functions in local health departments.

Several large-scale studies have attempted to measure public health agency performance of core functions by interviewing health directors. Because it is not self evident that a single respondent results in a valid performance assessment, the purpose of this study was to examine the relationship between two characteristics--position in the agency and racial/ethnic identity--and perceptions of the performance of core functions. Supervisors differed from nonsupervisors and Whites differed from African Americans in their perceptions of practices reflecting assessment and policy development. Efforts to develop surveillance measures of a complex institution such as a health department should incorporate methodologies to validate the responses.