Recent studies have found that racial health disparities are a direct result of the residential segregation, racial differences in socioeconomic status, health care access, and other social determinants of health that affect segregated minority groups. This study analyzed local health departments' (LHDs') efforts to decrease health disparities in their communities by using negative binomial regression models to examine the relationship between residential segregation and LHD health disparity activity engagement from the 2016 National Profile of LHDs—National Association of County & City Health Officials (NACCHO) and the 2017 County Health Rankings (CHRs). Significant associations were found between the incident rate ratios of activities performed by LHDs and the nonwhite/white residential segregation index, use of CHRs, LHD governance, per capita expenditures, and race of LHD top executive. The findings will help improvement in collaborative efforts between community agencies and LHDs in order to improve health disparity responsiveness.