Organization & Partnerships of the Public Health System

SESSION AUDIO:

Click the icon to download the podcast.

MODERATOR:
Linda Degutis, Dr.P.H., M.S.N.

PANELISTS:

Richard Hughes, M.P.H.
The Role of State Boards of Health in the Public Health System  
Co-Investigators: T. Wasserman, M.P.H. Candidate, C. Moscetti, M.P.H. Candidate, P. Jarris, M.D., M.B.A.

The statutorily prescribed functions and authorities of state boards of health (BOHs) and their relationships with state health officers (SHOs) and state health agencies (SHAs) vary significantly by state.  For example, BOHs differ with regard to policymaking and enforcement functions, SHA oversight authority, SHO-appointing authority and advocacy roles.  Research objectives were to understand and compare statutory functions of BOHs, identify various roles of BOHs and more fully understand BOH-SHA relationships.  Particular focus was given to BOH involvement in advocacy and the ability of SHAs to deploy individual board members in an advocacy capacity and maximize the advisory role of BOHs.  The authors used a mixed method approach, integrating legal research, media analysis and key informant interviews of both BOH members and SHA leadership to explore the varied activities, functions and responsibilities of BOHs in both theory and practice.  Extensive data were collected on all states with BOHs, including state statutes, historical records and print media.  Key informant interviews were conducted with current and retired BOH members as well as key SHA personnel, including SHOs, agency legislative liaisons and agency counsel.  The nature of BOH relationships with SHOs and SHAs and the role of BOHs in state legislative advocacy were closely examined.  Although BOHs once existed in all 50 states, the number has declined significantly to 21.  Findings indicate that BOHs, where they exist, continue to play a significant role in shaping health policy in both regulatory and legislative forums.  Specifically, BOH members were found to be influential in the state legislative process.  Strategies were identified for engaging and leveraging BOHs to advance health policy.  The findings illuminate important roles and relationships within the public health system and offer important implications for state health policy and essential organizational and advocacy considerations for SHAs.

Hector Rodriguez, Ph.D., M.P.H.

Organizational and Financial Influences on the Direct Provision of STD Prevention Services by Local Health Departments

Co-Investigators: A. Suh, B.S., B. Bekemeier, Ph.D., M.P.H., RN

Many local health departments (LHDs) have been modifying their organizational structures and processes in order to more effectively address the social and environmental influences on chronic disease prevalence and morbidity.  However, this shift in orientation might affect the organization and effectiveness of traditional LHD functions, including infectious disease prevention. This study employs data from the NACCHO Profile surveys from 1992 and 2005 to examine changes in the direct provision of STD prevention services by LHDs (n=1523), and clarify the LHD organizational and financial characteristics associated with changing arrangements. Four categories of LHD STD provision changes were created: 1) LHDs maintaining direct provision (n=389, 25.5%), 2) LHDs never involved in direct provision (n=369, 24.2%), 3) LHDs initiating direct provision (n=619, 40.6%) and 4) LHDs stopping direct provision (n=147, 9.7%).  LHD organizational and financial characteristics were compared across the four LHD categories. The direct provision of STD prevention services nearly doubled over time (31.9% to 60.9%).  LHDs serving smaller (p<0.001), city or town jurisdictions (p<0.001), and with higher proportion of revenue coming from local sources (p=0.02) were most likely to stop providing STD prevention services directly.  LHDs serving city/county and multicounty jurisdictions were more likely to initiate the direct provision of STD prevention services.  In multivariate analyses, LHDs serving city or town jurisdictions was the dominant predictor (5 times as county LHDs) of stopping the direct provision of STD prevention services over time.

The reorientation of LHDs to chronic disease prevention did not coincide with a mass discontinuation of direct provision of STD prevention services by LHDs.  Annual national STD incidence rates have not dramatically reduced over time in spite of the identification of effective surveillance and prevention methods, so future work should clarify the extent to which local organization of services is associated with STD incidence changes.

Amber Sinclair, B.A., M.S.P.H.

Delivery of Core Functions in Public Health Systems: System Characteristics and Effectiveness Over Time

Co-Investigators: A. Whitford, Ph.D., T. Richardson, Ph.D.

This project seeks to identify factors associated with local health department directors’ perceptions of community performance in delivering 20 public health core functions over time.  Data were obtained from the National Longitudinal Survey of Local Public Health Systems.  The survey was administered in 1998 and 2006 to health department directors from local jurisdictions having 100,000 or more resident population.  For each of the 20 core functions, the survey asked: 1) whether the service was provided in the community, 2) how well the community was performing the function, 3) what types of organizations contributed to providing the service, and 4) the proportion of contribution from the health department and the other types of organizations.  Previously published results from the 1998 survey found that overall, only two thirds of the 20 functions were performed in the jurisdictions surveyed, and the perceived effectiveness rating was just 35% of the maximum rating possible.  These troubling findings highlight a need to further evaluate and identify factors associated with perceived effectiveness.  This study builds on the 1998 survey findings with the addition of 2006 survey data as well as relevant linked data from the two closest years of the NACCHO Profile Surveys (1997 and 2005).  Results presentation will include measures for each time period, differences between the two periods, and multivariate statistical model findings.  The longitudinal research design allows for a unique opportunity to study changes and stability in a system environment and could provide valuable insights regarding the most important factors associated with an increase or decrease in effectiveness.  Further, a consideration of health risk factors as control variables in the modeling analysis could impact differences in measures of perceived effectiveness between communities.

Jacqueline Merrill, RN, M.P.H., D.N.Sc.

Preliminary Findings from a Network Analysis of an Emerging Field: Public Health Services and Systems Research

Co-Investigators: K. Carley, Ph.D., M. Bales, Ph.D.

The principal objective of this inquiry is to describe the emergence of the field of public health systems and services research (PHSSR) to gain actionable knowledge for developing the field.  The primary data source is a network survey conducted in January/February 2010 of the AcademyHealth PHSR-IG membership, RWJF grantees, and conference attendees. Secondary sources of data include abstracts submitted to AcademyHealth and Keeneland from the last 3 years, and publications/bibliographic data related to PHSSR.  Analysis will be performed with network analysis techniques, cluster analysis and co-authorship/citation analysis.  In the analysis we will identify composition and characteristics of the members; if experience is being leveraged; and if there is exchange of information and collaboration taking place across groups.  Preliminary findings will describe how information and influence flow in the PHSSR network.  We will describe how members cluster according to profession, institutional affiliation, memberships, and sources of funding. We will describe key groups and their ties to other research communities and to public health practice. We will present visualizations that illustrate key findings such as growth of the membership network, the subgroup structures, and authorship networks. We explore the growth of PHSSR as a community of practice— the network of connections between people with a shared domain of interest that are among the most important structures of any scientific field.  Community characteristics emerge when members engage in joint activities and learn from each other.  Practice characteristics emerge from a shared repertoire of resources, experiences, tools, and ways of addressing recurring problems.  Although people involved in PHSSR may have much in common, unless they interact and learn together, they do not form a community of practice. The findings from this study will help those engaged in PHSSR to understand the composition and dynamics of the community and identify gaps and barriers that need to be addressed for effective growth.