P-03503 (12/2023)
Local Health Department Annual Reports
Best Practices Guide
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Table of Contents
Introduction .................................................................................................................................................................. 3
Local requirements and needs ................................................................................................................................ 3
How to use this resource ........................................................................................................................................ 3
Legal ............................................................................................................................................................................... 4
Board of health ......................................................................................................................................................... 4
Department of Health Services ............................................................................................................................. 4
Local jurisdiction ...................................................................................................................................................... 4
Audience ........................................................................................................................................................................ 5
Document type ............................................................................................................................................................. 6
Content .......................................................................................................................................................................... 7
Title ............................................................................................................................................................................ 7
Organization ............................................................................................................................................................. 7
Accessibility .............................................................................................................................................................. 8
Language accessibility ......................................................................................................................................... 8
Visual accessibility ............................................................................................................................................... 8
Other accessibility considerations ..................................................................................................................... 9
Credibility (trust and transparency) ....................................................................................................................... 9
Impact ...................................................................................................................................................................... 10
Communications ........................................................................................................................................................ 11
Considerations ........................................................................................................................................................ 11
Annual report examples ............................................................................................................................................ 12
Connections to national models ............................................................................................................................... 13
Resources ..................................................................................................................................................................... 15
Legal ......................................................................................................................................................................... 15
Audience.................................................................................................................................................................. 15
Content .................................................................................................................................................................... 15
Communications .................................................................................................................................................... 15
Other resources ...................................................................................................................................................... 15
Note on language: When this guide references board of health (BOH) this term encompasses any
type of local governing body the health department may interact with when submitting their annual
report. This includes, but is not limited to, a health and human services board, county board, and city
council.
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Introduction
Annual reports play an important role in providing information to a local governing entity and the public.
In many sectors, annual reports provide an opportunity to communicate the success of your health
department and its financials in a clear, balanced, honest, and visual way. The annual report is an essential
tool used by organizations to:
•
Build trust through transparency.
•
Expand the understanding of health.
•
Mobilize people and resources.
•
Paint a picture of accomplishments toward the agency’s mission, vision, values, and goals.
The Wisconsin Department of Health Services (DHS) does not prescribe the content or format for local
health department annual reports. This document outlines best practices observed in annual reports from
diverse jurisdictions across Wisconsin. Examples have been chosen because they display characteristics
that include transparency, accountability, accessibility, and visual presentation of information. Local health
departments (LHDs) may want to consider these examples when developing their annual reports.
Local requirements and needs
Ultimately, your agency will decide…
Therefore, you may want to ask…
The purpose of your annual report.
Is it a tool to communicate the value of the
health department?
Is it an internal document to report to the
governing body?
Does it serve as a budget justification
resource?
To whom you want or need to communicate and
how you will communicate the information.
Can the report serve multiple functions and be
shared with multiple audiences?
Do you create a few different reports with
varying levels of detail based on the audience?
The best document type to share your health
department’s impact.
How does your board of health want to see the
information?
How does the community want to see the
information?
The value your LHD generates from the work to create and share your annual report is more important
than conforming to a specific template or normative requirement. The suggestions below are only helpful
if they generate value and are allowable based on jurisdictional requirements and needs.
How to use this resource
Best practice characteristics are organized by topic. Click on a topic to find suggestions, considerations,
and examples to use in developing your annual report. These best practices were developed from national
resources, subject matter expertise, and what other Wisconsin health departments are doing.
If you would like to suggest further examples of best practice in LHD annual reports, please contact
Matthew M. Collie (matthew.collie@dhs.wisconsin.gov).
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Legal
There are various submission requirements in Wisconsin regarding annual reports.
Board of health
Wisconsin Stat. § 251.06(3)(h) states what is required of annual reports: “… The local health officer shall
submit an annual report of the administration of the local health department to the local board of health.”
The language is light on standards. As such, it is suggested LHDs create annual reports that meet the needs
of their department or community. Completing an annual report to meet a standard creates a report that
likely will not be used. Completing a report that has a purpose for the LHD, BOH, and/or the local
community better fulfills the requirement.
Department of Health Services
Local health departments are required to submit their annual reports to DHS by May 1. The following
wording of Wis. Admin. Code § DHS 140.04(2)(a) has prompted questions from LHDs: “…By May 1, a
copy of the annual report submitted by the local health officer during the previous year…” The wording
could be read such that “during the previous year” means the annual report provided to the BOH during
the previous calendar year. If a LHD does not start working on their 2023 annual report until after January
1, 2024, then the report sent to the BOH in calendar year 2023 is likely the report regarding the activities
of calendar year 2022.
Completing an annual report for the preceding calendar year (for example, 2023) after May 1 (for example,
2024) potentially diminishes the benefit of an annual report to the BOH and the community. DHS advises
LHDs that it better serves LHDs, BOHs, DHS, and the local community if LHDs target to complete the
previous calendar year’s annual report before May 1. In other words, target completing the 2023 annual
report before May 1, 2024. Then submit to DHS that annual report after it has been submitted to the local
governing body.
Local jurisdiction
Consider whether there are additional jurisdictional requirements beyond what is required in Wisconsin
state statute and administrative code.
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Audience
The audience for your annual report is the people or groups you want to read and use the report. Knowing
your target audience before creating your report is vital since every audience has different levels of public
health knowledge, interest in the work of the health department, and learning styles. Your annual report
may have one or multiple audiences with one or a few different versions of the annual report. An annual
report focused on a specific audience may help you communicate and build a relationship with that
audience(s).
The Public Health Communications Collaborative has created a communications tool on writing in plain
language, about public health, that provides a quick two-page primer on how to define your audience and
goals. See pages three through five of “Plain Language for Public Health.”
Some audiences to consider:
Wisconsin Statutes requires the submission of an annual report to the
local board of health, so at least one of your audiences will likely be the
BOH.
What information does your BOH want?
What information do they need?
What format best suits their learning styles?
Do stakeholders or partners request or need particular information from
your health department? Would they benefit from an annual report that
highlights your interactions with them?
The annual report could serve as a useful historical or reference
document for the health department itself. Health department staff
often need and understand public health information on a more
technical level. Consider whether creating a separate, more
comprehensive report might be useful to the health department while
avoiding unnecessary or difficult to understand information in the main
report.
Would the annual report serve as a resource for working with and
communicating with the public? The public may need information at a
higher concept level (10,000-foot view) and at a lower reading level than
public health experts or stakeholders.
Audiences that do not need to be considered:
While Wis. Admin. Code requires you to submit to your annual report
to DHS, DHS does not recommend that you consider DHS an audience
when creating your annual report. An annual report that meets the
needs of the BOH, the LHD, and/or the local community, will provide
information useful to DHS.
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Document type
Consider what format works best for your health department to tell the story of the past year. You might
choose multiple formats depending on your target audience(s) and communication plan.
Infographic
•
Often intended as a “one-pager,” an effective way of communicating complicated information
•
Easy to share on social media and mass distribute
•
Mostly intended for public consumption
Report
•
A written, multi-page document
•
More typical for a governing body than the general public
Report and executive summary
•
For lengthy reports, an executive summary that highlights the main messages may be included.
•
For lengthy reports where the executive summary may be multiple pages, consider the executive
summary a separate stand-alone report or combine with an infographic.
Section of a larger health and human services report
•
How can the public health and human services sections of a combined report support and
reference the work and accomplishments of the other?
•
Would the public health division benefit from a standalone annual report that addresses additional
items or topics more in depth?
Website
•
Allows for more dynamic content
•
Requires website expertise
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Content
The content of the annual report is the most important consideration after determining the audience. The
content included will be directed by the audience you are trying to inform and restrained by the time
available to spend on developing the report.
When adding information to your annual report, pause and ask yourself, “Why does it matter that the
target audience know this about the health department?” Keep asking yourself why until you can connect
the information to your community health improvement plan, your strategic plan, a relevant population-
level reason, or a social determinant of health.
The following best practice characteristics were identified after review of content in a diverse sample of
Wisconsin LHD annual reports and then grouped into themes. Along with including these characteristics,
ensure all local accountability and disclosure requirements are met.
Title
Title the report based on the year it covers and not when it was released. A report discussing the local
health department’s work in 2021 and released in February 2022 should be titled as 2021, not 2022.
Organization
Ways to structure the report:
•
Accreditation domains (PHAB)
•
Foundational Public Health Services (capabilities and areas), (PHNCI)
•
Prevent, Promote, Protect: National public health identity
•
Program area or department
•
10 Essential Public Health Services (CDC)
Universal standards of practice to include (consider regardless of the structure you choose):
•
Your health department logo to create a consistent, identifiable brand
o
City of Appleton includes logo on cover page and name in document footer
o
Racine County includes logo on cover page and in document footer
•
The agency’s vision, mission, and value statements
•
A financial chart or graph
•
An organizational chart
•
A letter or statement from the health officer with a brief reflection on the year, appreciation for
partnerships, introduction to the document, and/or vision for the future
•
A section describing the work, resolutions, or accomplishments of the board of health
•
Visually distinguishing sections for easy reference, such as color-coding with corresponding
symbols
Organization is the structure or flow of your annual report. Use a structure that helps you highlight the
strengths of your health department.
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Accessibility
Meet people where they are in terms of readability to enhance comprehension. In other words, try to
create content usable by everyone.
Language accessibility
•
Consider adding more visuals (for example, icons, images, maps, photos of program activities, etc.)
to decrease the amount of text in the report. See ‘Visual accessibility’ below for more information
on visual content.
•
Use active language.
•
Use clear and easy to understand language, so the report can be understood quickly, easily, and
completely by your audience. Crawford County’s 2021 annual report uses clear and relatable
language.
•
Write with health literacy in mind and at the level of your target audience. For example, the general
public reads at a third to fifth grade level. Many reports are written at a very high level.
Visual accessibility
•
Use visuals (for example, icons, images, maps, photos of program activities, charts, etc.) to
highlight key information about program activities and outcomes.
o
Consider adding a description or caption directly under the image of what is depicted.
o
When using visuals, add “alt text” to images and graphs in your report. Alt text is used to
convey the “why” and what of the image as it relates to the content of a document or
webpage. You can do this in multiple languages.
Alt text is read aloud to users by screen reader software (technology used by
readers with visual impairment) and is indexed by search engines. It also displays on
a webpage if the image fails to load.
This resource will help you learn to write good alt text: Alt Text for Images (UNC
School of Medicine).
o
Ensure the pictures and graphics reflect various populations in the LHD’s jurisdiction.
•
Use shapes and other distinguishing features in a chart or graph to help decipher information for
people who cannot differentiate colors.
o
When you need to use color, be aware of the Web Content Accessibility Guidelines
(WCAG) color contrast standards. Use a tool, like this Color Contrast Checker website, to
ensure your design is accessible.
o
The minimum WCAG standard is 4.5:1. At DHS, all content is required to meet the Level
AAA minimum contrast ratio of 7:1 to ensure its accessibility whether increased or
decreased in size. Check with a communications team or expert in your jurisdiction to learn
about specific requirements.
•
Use an accessibility checker (Microsoft Word has a “check accessibility” feature) to ensure the
document follows accessibility best practices.
The following are guidelines for improving the accessibility of documents, however, this is not a
substitute for formal training on accessibility. One place to begin is the online resource WebAIM
which has an independent-study online training for creating more accessible documents.
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•
Consider avoiding callouts.
o
Many reports use these distinct “boxes” for small blocks of featured content or
information. While callouts increase visibility of specific content and make it easier for
visual readers to find information, callouts are not always accessible by screen readers.
Ensure any call outs are screen reader accessible or you may make your report more
inaccessible to the visually impaired.
Other accessibility considerations
•
Consider whether videos can be made available and created in multiple languages.
•
Ensure any videos have captions.
•
Offer the report in other formats. For example, the City of Milwaukee Health Department annual
report is available in braille and large print.
•
Select a font that is simple, familiar, and aligns with the tone, messaging, and brand of the content.
The following resources can assist your department in deciding on the best font and colors to use
for your report.
o
How to Pick a Font (WebAIM)
o
Best Fonts for Web Accessibility (Bureau of Internet Accessibility)
o
How to Design for Color Blindness (Get Feedback.com)
o
Accessibility Basics: Designing for Visual Impairment (envato tuts+)
Credibility (trust and transparency)
•
Track data over time using charts, graphs, or other appropriate graphics. The use of trend data
builds context. For clear presentation, consider:
o
Showing data clearly and consistently (for example, when using a variety of tables showing
data over multiple years check that they all ascend or descend when reading from left to
right).
o
Including clear legends.
o
Providing brief narratives to highlight what the data are telling you.
•
Include links to reports referenced in your annual report for easy access to more detailed
information.
•
Provide diverse types of data.
o
Include both quantitative and qualitative data: Multiple data types enhance the
understanding of health department activities and outcomes.
o
Aim for data that include counted things (for example, number of shots, number of
investigations, number of people served, number of radon kits distributed) or the impact
generated (for example, whether people being served are better off, how many people took
action based on an education campaign).
•
Present information in a fair and balanced manner and honestly reflect on accomplishments and
challenges.
o
City of Milwaukee Health Department annual reports include a section under each
program area for reflection on program performance (2020 and 2021).
Data are a cornerstone of public health. Use data and supporting information to demonstrate the
department’s reliability as a key source of information and expertise related to population-level health
outcomes.
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Impact
•
Describe what public health is, what it does, and why it matters. Winnebago County uses a video
on the annual report webpages (2020).
•
Describe policy impacts made by the governing body and/or highlight health policy changes
throughout the report.
•
Include clear links of accomplishments or activities to the department’s strategic plan, community
health assessment, community health improvement plan, essential public health services, and/or
foundational public health services.
•
Report impact over counts
o
Reporting counts gives numerical values to work and is useful is reporting how
much
work your health department completed. Examples: Your health department…
Employs X staff.
Administered Y vaccinations.
Distributed Z well water test kits last year.
o
Demonstrating the improved outcomes or community impact is
more
useful.
Did those staff fill an access gap in your community?
What would your community’s health look like without those vaccinations?
How many people returned their test kits and then took action?
o
Providing numbers means very little without context. Tell the health department’s story.
Good example: X groups formed to address community needs and met # times.
Even better example: X groups took actions A, B, and C to improve the
community in ways D, E, and F. This matters because G, H, and I.
•
Include information about why each program is important to the community as a whole (that is,
economy, environment, safety, connectedness, etc.).
•
Include population-level impact along with individual measures. Sharing information about how
the population and/or community is better off can be accomplished by looking at data you have
decided to include in your report and asking yourself “Why?” until you can complete the sentence
“…and this matters because…”
Wood County in their 2021 report when describing a pharmaceutical collection program,
highlighted that doing so protected groundwater and surface water, wildlife, and public health.
•
Highlight the impact of your accomplishments on the population and the places people live, work,
play, and pray.
•
Share testimony from community members. Adding the “voice of the community” helps tell the
story of your impact. Qualitative data enhances the understanding of the quantitative data reported
on in the report.
o
Use a quotation from a community member.
o
Share a community member’s story.
Expand the understanding of public health (and health) for your audience. Include the impact your health
department has made on your jurisdiction.
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Communications
A completed annual report needs to be distributed to the target audience. No one can find out about your
health department’s challenges and accomplishments or give you feedback on the report if they do not
know it exists.
If your health department has a communication procedure(s) in place, follow those for crafting and
executing a communication plan prior to release of a final draft. If not, consider creating a communication
plan to identify audiences, tactics (electronic, print, social media, etc.), and distribution steps. The
communication plan will vary based on the audience. A report intended as a reference document shared
publicly to promote government transparency will likely have a more passive communication plan than a
report created to drive community action on the community health improvement plan. The CDC’s Health
Communication Playbook provides helpful information and tools that can be adapted to communicating
about the LHD’s annual report.
Confirm your plan meets local requirements and needs about who must receive the document and how it
is shared with them.
Considerations
•
Post annual reports on your website.
•
Develop infographics with key highlights and post to social media.
•
Engage a community member’s voice to entice people to read the full report.
•
Implement a process to receive feedback from your target audience.
•
Collaborate with other sectors and partners to distribute.
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Annual report examples
Below, are annual reports OPPA has reviewed that have served their health department and their
jurisdiction well. DHS has included these reports in communications to health departments as examples to
draw on. Note that some reports are not called “reports,” instead using alternate terms like “Snapshot”.
•
Appleton Health Department, City of
2021 Annual Report includes logo on cover page and name in document footer.
•
Crawford County
2021 Annual Report uses clear and relatable language.
•
Cudahy Health Department, City of
o
2020 Annual Report: The Cudahy Health Department organizes its annual report around
the Foundation Public Health Services model, the same model used as the organizing basis
for the DHS 140 rule language.
o
Summary infographic for the 2019 report.
•
Juneau County
2019 Annual Snapshot: Almost every page of Juneau County’s report could be used as a
separate infographic, making it a quick read.
•
Manitowoc County
Manitowoc County’s 2020 Annual Report shows data trends with simple graphs and limited
formatting.
•
Milwaukee, City of
City of Milwaukee Health Department annual reports (2020 and 2021) includes a section under
each program area for reflection on program performance.
•
Pierce County
Pierce County organized their 2020 Annual Report around an informative and concise
description of what the pandemic response meant for the department’s work.
•
Racine County Public Health Division
2021 Annual Report includes logo on cover page and in document footer.
•
Winnebago County
Winnebago’s 2019 Annual Report exists entirely online as a webpage and includes a video on
the webpage.
•
Wood County
2021 Annual Report includes population level impact along with individual measures (when
describing a pharmaceutical collection program).
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Connections to national models
As you implement or align with the foundational public health services capabilities, the national public
health performance standards, and/or seek Public Health Accreditation Board (PHAB) accreditation, the
annual report can be used to demonstrate how you communicate with the community and governing
body.
Ideas to keep in mind if you are implementing or aligning with national models:
Communicate the following:
•
What public health is
•
What public health does
•
Why it matters
•
What the health department brand is, using a common identity (logo)
Create a communications plan that:
•
Includes a mechanism for the community to provide feedback.
•
Uses a variety of communication channels and partners for distribution (including communities
that are not traditionally reached through typical public health channels).
•
Intentionally reviews documents for accessibility:
o
Literacy level
o
Visual impairment
o
Language
Use a health equity lens.
•
Describe the variety of populations in the LHD’s jurisdiction.
•
Discuss the challenges the jurisdiction’s populations face Work with community members to
identify indicators of interest and progress towards goals.
•
Use disaggregated data to highlight the issues faced by and efforts to reduce inequities experienced
by diverse populations.
•
Discuss how LHD work, programs, or initiatives do or do not address the challenges faced by
diverse populations. Use qualitative data and community-based participatory research to enhance
quantitative data.
•
Partner with other government agencies to identify, analyze, and report data about the social
determinants of health.
•
Determine standard definitions to use for equity terms to establish a common understanding.
Connect performance and outcomes.
•
Show linkages between strategic plan, health improvement plan, and performance management.
•
Demonstrate contributions of partners to public health and/or public health’s contribution to
partner policies (health in all policies).
•
Articulate the purpose of public health laws to foster awareness of their role in promoting and
protecting public health.
•
Share public health innovations.
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Change the conversation about health.
•
Work with communities experiencing inequities and others to develop, use, and promote a shared
narrative around health that focuses on the social determinants of health, power, and oppression
rather than individual responsibility and a biomedical model.
•
Talk about the role of policy, systems, and environmental change in addressing inequities.
•
Leverage data to:
o
Change the narrative of what creates health.
o
Inform and inspire policy change.
o
Support partnerships and engagement.
•
When developing agency publications, frame messaging in a way that:
o
Connects individual health outcomes to the social issues and inequities that drive those
outcomes.
o
Presents a solution to the problem.
o
Assigns primary responsibility for who can fix the problem.
o
Makes a practical policy appeal.
o
Uses stories and images to humanize the impacts.
o
Adapts communications to various audiences, including communities experiencing
inequities and decision makers.
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Resources
Legal
•
Wisconsin Stat. § 251.06(3)(h) — Report Submission Requirement: Board of Health
•
Wis. Admin. Code § DHS 140.04(2)(a) — Report Submission Requirement: DHS
Audience
Plain Language for Public Health (Public Health Communications Collaborative)
Primer on how to define your audience and goals (pages 3-5).
Content
•
Report organization
o
Accreditation domains (PHAB)
o
Foundational Public Health Services (capabilities and areas), (PHNCI)
o
Prevent, Promote, Protect: National public health identity
o
10 Essential Public Health Services (CDC)
•
Training
Independent-study online accessible documents training (WebAIM)
•
Fonts
o
How to pick a font (WebAIM)
o
Best fonts for web accessibility (Bureau of Internet Accessibility)
•
Visual impairment
o
Alt Text for Images (UNC School of Medicine)
o
Color contrast checker website (Web Content Accessibility Guidelines)
o
How to Design for Color Blindness (Get Feedback.com)
o
Accessibility Basics: Designing for Visual Impairment (envato tuts+)
Communications
Health Communication Playbook (CDC)
Helpful information and tools.
Other resources
•
How to Tell a Great Story in Your Annual Report (Column Five Media)
Blog post that summaries at a high level annual report creation.
•
FrameWorks Institute
Think tank with resources on framing and narrative.
•
Government financial reporting review: Best practice examples from 2020-2021 (HM Treasury,
UK)
Provides overview of best practices in government financial reporting in the UK.
•
HealthEquityGuide.org
Strategic practices to assist health departments in advancing health equity more meaningfully
and comprehensively.
•
Health Equity Guiding Principles for Inclusive Communication (CDC)
Guidelines for assisting public health professionals in creating inclusive communications.
•
Public Health Communications Collaborative
A collaborative of partners with a collection of tools to support public health communicators
in creating timely, clear, credible, and effective messages.