The Association of Changes in Local Health Department Resources With Changes in State-Level Health Outcomes

Erwin, Paul Campbell; Greene, Sheila; Mays, Glen P.; Ricketts, Thomas C.; Davis, Maryland V.

doi:10.2105/ajph.2009.177451

Cited by 66 publications

(40 citation statements)

References 23 publications

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“…[11][12][13] These reviews are of good methodological quality and the significant association between the four aforementioned factors and public health performance was measured using appropriate statistical and econometric methods. These factors are also consistently documented in leading peer-reviewed longitudinal studies, 15,16 and PHSSR analyses. 5,10,14 PHSSR is complex and common limitations may affect these findings.…”

Section: Public Health Systems Under Attackmentioning

confidence: 66%

“…Performance is a multifaceted concept: in Table 1, we adapt Handler and colleagues' public health performance framework 7 in order to summarize elements and dimensions of performance often reported in the PHSSR literature, notably productivity, effectiveness, efficiency and equity. 3,5,6,[8][9][10][11][12][13][14][15][16] Productivity is the relationship between structures and resulting…”

Section: Public Health Systems and Their Performancementioning

confidence: 99%

“…Evidence-informed public health system elements associated with improved performance • Financial investments in public health have the potential to improve community health 12 • 10% increase in local public health spending significantly associated with decreased mortality of between 1.1% and 6.9% 12,16 • Increases in local health department expenditures significantly associated with decreased infectious disease morbidity • Local health departments with higher staff per population served perform better on delivering essential public health services 13 • Increase in local public health staffing -full-time equivalents per capita -significantly associated with decreased cardiovascular mortality 12,15 3. Population size ↑Productivity 11,13 • The size of the jurisdiction served by a public health agency is the strongest predictor of performance in delivering essential public health services 13 • Optimal population size for a public health jurisdiction: between 50,000 and 500,000 • Administrative evidence-based practices are associated with increased delivery of essential public health services and are identified in five major domains: workforce development, leadership, organizational climate and culture, inter-organizational relationships and partnerships, and financial processes 11 …”

Section: Validity and Relevance Of These Four Factorsmentioning

confidence: 99%

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Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform

Guyon

Perreault

2016

Can J Public Health

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Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.KEY WORDS: Public health; public health administration; evidence-based practice; public health practice; Canada; Quebec La traduction du résumé se trouve à la fin de l'article.

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Section: Public Health Systems Under Attackmentioning

confidence: 66%

Section: Public Health Systems and Their Performancementioning

confidence: 99%

Section: Validity and Relevance Of These Four Factorsmentioning

confidence: 99%

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Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform

Guyon

Perreault

2016

Can J Public Health

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“…To date, little research has examined the relationship between health system performance and activities on health outcomes, outside of a few examples. [40][41][42][43][44] Building the evidence base surrounding the effect of public health system inputs on health outcomes would help public health agencies use efficiency to inform, not drive their efforts, and allow them to target their efforts and resources toward improving specific health outcomes that are most relevant to their communities.…”

Section: Information and Communication Technologiesmentioning

confidence: 99%

Public Health Systems and Services Research: Building the Evidence Base to Improve Public Health Practice

Scutchfield

Ingram

2013

Public Health Rev

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Public health services and systems research (PHSSR) is the American designation for a field that uses a number of research disciplines and perspectives to examine the organization of public health systems, how they are financed, how they deliver public health services, the quality and costs of services they deliver, and the impact of variations in all these areas on population health; it is closely related to health services research (HSR), and uses many of the same methods as HSR. This article traces the developmental path of PHSSR, identifies organizations that have been critical in its growth, provides examples of PHSSR that demonstrate the potential it has to improve public health practice, and discusses the future of PHSSR and the use of PHSSR to influence public policy. While there have been sporadic attempts to examine the public health system in the United States since the early 20 th century, PHSSR has only been a formally recognized area of scientific inquiry since the early 2000s. PHSSR has experienced rapid growth, and evolved from mainly descriptive research to inferential research, and towards yielding results that suggest causation rather that correlation. While PHSSR as a field shows great promise to improve public health practice, in order for it to fulfill that promise it is vital that PHSSR produce results that are of use to the practice and policy making communities.

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“…[10][11][12][13] Scholars have also published outcomes-based analyses that incorporate spending into modeling and demonstrate a positive relationship between increased public health spending and better health outcomes. [14][15][16] In addition to improved health outcomes, these LHD-level analyses have also demonstrated that improved performance and effectiveness in LHDs is correlated with increased spending. 11,12,[17][18][19][20] Only a few researchers have holistically examined state or local public health spending, in part because of the historical lack of data harmonization.…”

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confidence: 98%

Public Health Spending in 2008

Leider

Sellers

Shah

et al. 2012

Journal of Public Health Management and Practice

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In recent years, state and local public health department budgets have been cut, sometimes drastically. However, there is no systematic tracking of governmental public health spending that would allow researchers to assess these cuts in comparison with governmental public health spending as a whole. Furthermore, attempts to quantify the impact of public health spending are limited by the lack of good data on public health spending on state and local public health services combined. The objective of this article is to integrate self-reported state and local health department (LHD) survey data from 2 major national organizations to create state-level estimates of governmental public health spending. To create integrated estimates, we selected 1388 LHDs and 46 states that had reported requisite financial information. To account for the nonrespondent LHDs, estimates of the spending were developed by using appropriate statistical weights. Finally, funds from federal pass-through and state sources were estimated for LHDs and subtracted from the total spending by the state health agency to avoid counting these dollars in both state and local figures. On average, states spend $106 per capita on traditional public health at the state and local level, with an average of 42% of spending occurring at the local level. Considerable variation exists in state and local public health funding. The results of this analysis show a relatively low level of public health funding compared with state Medicaid spending and health care more broadly.

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The Association of Changes in Local Health Department Resources With Changes in State-Level Health Outcomes

Cited by 66 publications

References 23 publications

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform

Public Health Systems and Services Research: Building the Evidence Base to Improve Public Health Practice

Public Health Spending in 2008

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