Local Health Departments Addressing the Social Determinants of Health: A National Survey on the Foreclosure Crisis.

To examine local health department (LHD) engagement in addressing the social determinants of health by using the foreclosure crisis as an example. National survey of 166 LHD staff on the foreclosure crisis (2006-2014). About one quarter (28%) of respondents reported that their LHD had engaged in work related to the foreclosure crisis, 7% planned to engage, and 65% did not or were not planning to engage. Views about the role of LHDs in addressing the foreclosure crisis varied: 30% stated that LHDs should work on foreclosure. A substantial number of respondents reported that their LHD addressed foreclosure, or supported engagement, yet there are divergent perceptions of appropriate LHD roles. LHDs follow a pattern described by the diffusion of innovations theory: Innovative LHDs can share their work on foreclosure and housing, early adopters are poised to act, and others may follow if they have support.