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Kovach KA. Age-Adjusted All-Cause Mortality in Counties Served by PHAB-Accredited Local Health Departments Compared With Counties Served by Nonaccredited Local Health Departments: 1999 to 2020. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:446-455. [PMID: 37097187 DOI: 10.1097/phh.0000000000001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVES To analyze trends in the age-adjusted all-cause mortality rate (AAMR) from 1999 to 2020 between counties served by a Public Health Accreditation Board (PHAB)-accredited local health department and a nonaccredited local health department to determine whether accreditation impacted the AAMR and whether there were differences in the AAMR preceding the first health departments being accredited in 2013. DESIGN Descriptive time trends and difference-in-differences analysis was used to explore differences in the AAMR between accredited counties and nonaccredited counties. Propensity score matching was used to develop a control group matched on county characteristics to address confounding. SETTING A national observational study using data obtained from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research, the American Community Survey, and a PHAB data set on accreditation status. PARTICIPANTS All US counties with data on the AAMR and county characteristics. INTERVENTION Accreditation by the PHAB. MAIN OUTCOME MEASURE The AAMR. RESULTS Difference-in-differences in the AAMR between accredited and nonaccredited counties were stable following the launch of the accreditation program in 2013, except for an improvement in 2020 in the total sample (32.2 deaths per 100 000 people, 95% confidence interval: 3.8-60.6, P = .03). Age-adjusted all-cause mortality rates were lower in accredited counties across the 22-year period. This was statistically significant every year in the total sample but only statistically significant in 2020 in the matched sample (P < .05). Prior to accreditation, the AAMR improved by 24.7 deaths per 100 000 people (P = .05) and 18.0 deaths per 100 000 people (P = .24) more among accredited counties between 1999 and 2008, among the total and matched samples, respectively. CONCLUSION Currently, PHAB accreditation has not had a substantial impact on the AAMR, and the AAMR was higher among nonaccredited counties preceding the first health departments being accredited in 2013.
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Dada OO, Bekemeier B, Flaxman A, de Castro B. Local Health Departments' Characteristics and Their Performance Scores in PHAB Accreditation Standards. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:375-383. [PMID: 35045009 DOI: 10.1097/phh.0000000000001458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Local health departments (LHDs) function to promote and protect population health by executing programs and activities through the 10 essential public health (PH) services in their operationalization of the core functions of PH systems-assessment, policy development, and assurance. PH accreditation supports LHDs by assessing their ability to promote community well-being through a set of standards and measures based on the 10 essential PH services. Prior studies show variation in LHD characteristics relative to their likelihood of participating in accreditation, but no studies have examined the variation in LHD accreditation scores to understand how LHD characteristics relate to performance improvement. OBJECTIVE This work examines variation in LHD accreditation scores relative to their organizational and jurisdiction characteristics. DESIGN Cross-sectional data were obtained from 250 LHDs from 38 states that underwent Public Health Accreditation Board (PHAB) accreditation review. ANALYSIS We used exploratory cluster analysis to identify and group LHDs with similar performance scores in PHAB accreditation standards. Descriptive analyses were undertaken to characterize each LHD cluster group's organizational structure, jurisdiction characteristics, and core PH function activity levels. We then employed multivariate regression analysis to confirm the cluster analysis results. RESULTS The analysis showed 3 clusters of PHAB accreditation performance scores (cluster 1 = 0.95; cluster 2 = 0.87; and cluster 3 = 0.71). Subtle differences in organizational and jurisdiction characteristics across clusters, notably in population size of the jurisdictions served, were observed. LHDs in cluster 3 tended to have jurisdictions with less than 250000 population size and serve more than 1 county. CONCLUSIONS Performance scores in PHAB accreditation can be a useful standardized metric for assessing LHD ability to promote community well-being. LHDs serving less than 20000 population size, which exhibit relatively lower performance than other LHDs, may require more targeted supports to close the gap in their performance score.
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Affiliation(s)
- Oluwatosin Omolara Dada
- University of Washington School of Nursing, Seattle, Washington (Drs Dada, Bekemeier, and de Castro); and University of Washington Department of Global Health, Seattle, Washington (Dr Flaxman)
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Heffernan M, Kennedy M, Gonick SA, Siegfried AL. Impact of Accreditation on Health Department Financial Resources. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:501-507. [PMID: 33208720 DOI: 10.1097/phh.0000000000001278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT There is limited data available on the financial benefits of public health accreditation. OBJECTIVE This study assessed the financial impacts reported by public health departments as a result of participating in the Public Health Accreditation Board (PHAB) national accreditation program. DESIGN Data from an ongoing survey of outcomes among health departments accredited for 1 year were linked to PHAB administrative data on health department characteristics to examine self-reported financial impacts of accreditation as of June 2020. SETTING Accredited public health departments in the United States. PARTICIPANTS Leadership from 214 unique state, local, Tribal, and Army installation health departments that had been accredited for 1 year by PHAB. MAIN OUTCOME MEASURES Improved utilization of resources, increased competitiveness for funding opportunities, and new funding resulting from accreditation. RESULTS One year following accreditation, 57% of all responding health departments reported improved utilization of resources whereas less than half reported improved competitiveness for funding (39%) and new funding (23%) as a result of accreditation. Health departments reporting new funding as a result of accreditation, compared with those that did not report new funding, were also more likely to report other outcomes from accreditation, including improved staff competencies, increased health department capacity to address health priorities and provide high-quality programs and services, increased use of evidence-based practices, new opportunities for external partnerships and collaboration, improved understanding of the health department's role among governing entities and policy makers, and improved credibility. Accredited local health departments (LHDs) with annual budgets less than $10 million reported new funding more often than LHDs with larger annual budgets. CONCLUSIONS Accredited health departments that reported new funding were also more likely to report other outcomes of accreditation, including improved staff competencies, new partnerships, and improved credibility. More research is needed to further understand the relationship between accreditation and financial impacts.
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Kovach KA, Lipnicky A. An Analysis of How Characteristics of Local Health Department Jurisdictions Influence Involvement in PHAB Accreditation: Implications for Health Equity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:449-458. [PMID: 33208717 DOI: 10.1097/phh.0000000000001248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore how characteristics of local health department (LHD) jurisdictions impact involvement in Public Health Accreditation Board (PHAB) accreditation and to characterize the implications for health equity. METHODS Data from the 2016 National Profile of LHDs survey were linked with data from the American Community Survey, National Center for Health Statistics, Behavioral Risk Factor Surveillance System, and the 2016 presidential election. Outcome measures included LHDs that were formally engaged in PHAB accreditation and LHDs that planned to apply for PHAB accreditation but were not formally engaged. Logistic regression was used to assess for the impact LHD jurisdictions' socioeconomic position, demographics, population health status, political ideology, and LHD organizational characteristics have on PHAB accreditation. RESULTS Approximately 37% of the participants were formally engaged (n = 297) and planned to apply (n = 337) for PHAB accreditation. Involvement in PHAB accreditation was equal among LHDs based on poverty and income inequality, but median household income was negatively associated. Diverse jurisdictions were more likely to be involved in PHAB accreditation but less likely to be involved after controlling for covariates. Jurisdictions with worse population health status were either as likely or more likely to be involved in PHAB accreditation. Jurisdictions with a greater conservative political ideology were less likely to be involved. CONCLUSION LHD involvement in PHAB accreditation varies by their jurisdiction's characteristics. This has implications for health equity based on socioeconomic, racial, and population health status. Policies and practices are needed to improve the uptake of PHAB accreditation in LHD jurisdictions impacted most by health inequities.
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Affiliation(s)
- Kevin A Kovach
- Population and Community Health Department, American Academy of Family Physicians, Leawood, Kansas (Dr Kovach); and Master of Public Health Program, University of Kansas Medical Center, Kansas City, Kansas (Ms Lipnicky)
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Shah GH, Corso L, Sotnikov S, Leep CJ. Impact of Local Boards of Health on Local Health Department Accreditation, Community Health Assessment, Community Health Improvement Planning, and Strategic Planning. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:423-430. [PMID: 31348156 DOI: 10.1097/phh.0000000000000847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Local health departments (LHDs) are increasingly using national standards to meet the challenges presented by the complex environments in which these agencies operate. Local boards of health (LBoHs) might play an instrumental role in improving LHDs' engagement in activities to meet these standards. OBJECTIVES To assess the impact of LBoH performance of governance functions on LHDs having a current (completed within 5 years) community health assessment (CHA), community health improvement plan (CHIP), strategic plan, and level of engagement in the Public Health Accreditation Board (PHAB) accreditation program. METHODS Binary and multinomial logistic regression models were used to analyze linked data from 329 LHDs participating in both the 2015 Local Board of Health Survey and the 2016 National Profile of LHDs Survey. RESULTS Higher performance of LBoH governance functions, measured by an overall scale of LBoH taxonomy consisting of 60 items, had a significant positive effect on LHDs having completed CHA (P < .001), CHIP (P = .01), and strategic plan (P < .001). LHDs operating in communities with a higher score on the overall scale of LBoH taxonomy had significantly higher odds (P = .03) of having higher level of participation in the PHAB national voluntary accreditation program-that is, being accredited, having submitted application for accreditation, or being in the e-PHAB system (eg, by submitting a letter of intent). CONCLUSIONS LBoHs serve as governance bodies for roughly 71% of LHDs and can play a significant role in encouraging LHDs' participation in these practices. That positive influence of LBoHs can be seen more clearly if the complexity and richness of LBoH governance functions and other characteristics are measured appropriately. The study findings suggest that LBoHs are a significant component of the public health system in the United States, having positive influence on LHDs having a CHA, CHIP, strategic plan, and participation in accreditation.
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Affiliation(s)
- Gulzar H Shah
- Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Corso and Dr Sotnikov); and National Association of County & City Health Officials, Washington, District of Columbia (Ms Leep)
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Ellis Hilts K, Xia J, Yeager VA, Ferdinand AO, Menachemi N. Market characteristics associated with community health assessments by local health departments. Public Health 2018; 162:118-125. [PMID: 30029173 DOI: 10.1016/j.puhe.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Community health assessments (CHAs) have been promoted as a strategy for population health. This study uses the resource dependence theory (RDT) to examine how external market characteristics are associated with CHAs conducted by local health departments (LHDs) and subsequent partnering with hospitals for CHAs in the United States. STUDY DESIGN The RDT was used to guide the conceptualization of the market in the context of local public health. RDT emphasizes that organizations are not in control of all the resources they need and, to some extent, must rely on the external environment to provide those necessary resources. Binary measures were used to examine whether LHDs conducted CHAs and whether they did so in partnership with a local hospital. Independent variables were identified to measure the RDT constructs of munificence (resource availability in the environment), complexity (level of heterogeneity), and dynamism (level of environmental turbulence). METHODS Bivariate (Chi-squared and t-tests) and multivariate (logistic regression) cross-sectional analyses were conducted using secondary data from the National Association of County and City Health Officials 2013 Profile Survey, the 2013 County Health Rankings data set, and the Health Resources and Services Administration's Area Health Resource File. RESULTS Two of three variables measuring munificence were positively associated with having conducted a CHA; one variable was also related to doing so in conjunction with a local hospital. One measure of market complexity was negatively associated with having conducted a CHA. No measure of dynamism was related to the dependent variables. CONCLUSIONS Study results provide partial support for the use of RDT in understanding the relationship between market factors and LHDs' activities around CHAs. Local hospitals as partners and other market factors should be considered by LHDs when conducting CHAs. Findings from this work will be of interest to public health practitioners, policy-makers, and researchers interested in public health and population health improvement.
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Affiliation(s)
- K Ellis Hilts
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA.
| | - J Xia
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | - V A Yeager
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | | | - N Menachemi
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
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Drivers and Barriers for Adopting Accreditation at Local Health Departments for Their Performance Improvement Effort. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:e25-e35. [PMID: 28492448 DOI: 10.1097/phh.0000000000000567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT A national system of voluntary public health accreditation for state, local, and tribal health departments (local health departments [LHDs]) is part of a movement that aims to improve public health performance with ultimate impact on population health outcomes. Indiana is a good setting for the study of LHD accreditation adoption because several LHDs reported de-adopting accreditation in a recent statewide survey and because 71% of Indiana counties serve populations of 50 000 or less. DESIGN A systematic method of analyzing qualitative data based on the Performance Improvement Model framework to expand our understanding of de-adoption of public health accreditation. SETTING/PARTICIPANTS In 2015, we conducted a key informant interview study of the 3 LHDs that decided to delay their engagement in the accreditation based on findings from an Indiana survey on LHD accreditation adoption. The study is an exploration of LHD accreditation de-adoption and of the contributions made to its understanding by the Performance Improvement Model. RESULT The study found that top management team members are those who champion accreditation adoption, and that organizational structure and culture facilitate the staff's embracing of the change. The Performance Improvement Model was found to enhance the elucidation of the inner domain elements of Consolidated Framework for Implementation Research in the context of de-adoption of public health accreditation. CONCLUSION Governing entities' policies and priorities appear to mediate whether the LHDs are able to continue accreditation pursuit. Lacking any of these driving forces appears to be associated with decisions to de-adoption of accreditation. Further work is necessary to discern specific elements mediating decisions to pursue accreditation. This study demonstrates the added knowledge of Performance Improvement Model (PIM) to the CFIR framework. A large scale study is called to further clarify and discern supports of specific to the needs of individual LHDs for their performance improvement effort.
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Kwan K, Do-Reynoso V, Zarate-Gonzalez G, Goldman-Mellor S. Development and implementation of a community health survey for public health accreditation: Case study from a rural county in California. EVALUATION AND PROGRAM PLANNING 2018; 67:47-52. [PMID: 29197222 DOI: 10.1016/j.evalprogplan.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 09/16/2017] [Accepted: 11/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe the planning, development, pilot testing, fielding, and outcomes of a community health survey in a rural California county pursuing public health accreditation. DESIGN Community partners helped the local health department develop the community health survey. Extensive English- and Spanish-language pilot testing was conducted over a period of four months. Final survey fielding was conducted online and at 20 community sites. RESULTS 2189 completed surveys were collected. Total costs for developing and fielding the survey were approximately $25,000. Survey results indicated that alcoholism/drug abuse, breathing problems, and obesity were the primary health concerns of county residents. Benefits of conducting the community survey included strengthening inter-organizational partnerships between community partners, engaging a large and diverse respondent sample, and gathering information on a nuanced set of health indicators. Challenges included an unexpectedly high number of respondents and managing the needs of respondents with disabilities or poor literacy. CONCLUSION The information gathered from the community health survey was used in the implementation of a county-wide multi-agency strategic plan to address health priorities identified in the CHA. Engaging a broad set of community partners throughout the survey process was critical for ensuring the project's relevance and long-term regional impact.
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Affiliation(s)
- Kevin Kwan
- Department of Public Health, University of California, Merced, Merced, CA, United States.
| | - Van Do-Reynoso
- Department of Public Health, University of California, Merced, Merced, CA, United States; Madera County Public Health Department, Madera, CA, United States
| | | | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, Merced, CA, United States
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Public Health Agency Accreditation Among Rural Local Health Departments: Influencers and Barriers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:49-56. [DOI: 10.1097/phh.0000000000000509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rurality, Quality Improvement Maturity, and Accreditation Readiness: A Comparison Study of Colorado, Kansas, and Nebraska Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 24:E15-E22. [PMID: 29227416 DOI: 10.1097/phh.0000000000000678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare local health department (LHD) accreditation readiness (AR) and quality improvement (QI) maturity in 3 states, between LHDs with varying levels of rurality, and across an LHD staffing-level continuum. DESIGN This was a cross-sectional comparative study that included an online survey administered to LHD directors in Colorado, Kansas, and Nebraska. The survey included 10 questions assessed on a 5-point Likert scale covering 3 QI domains and 13 questions covering 5 AR domains. The median score for both QI maturity and AR was calculated by each state, by the number of full-time equivalent staff employed at the LHD, and by a measure of rurality and population density. SETTING AND PARTICIPANTS A total of 156 LHDs from the states of Colorado, Kansas, and Nebraska. MAIN OUTCOME MEASURE(S) QI maturity and AR scores. RESULTS A majority (59%) of the surveyed LHDs plan to apply or have already applied for Public Health Accreditation Board (PHAB) accreditation. The overall QI maturity and AR scores were highest in Nebraska, as was the intent to seek PHAB accreditation and current use of PHAB standards. Across levels of rurality and staffing, LHD QI maturity scores were similar; however, AR scores improved as LHD staffing levels increased and rurality decreased. CONCLUSIONS Small LHDs and rural LHDs have QI maturity levels that are comparable to larger, less rural LHDs, but their AR is much lower. As accreditation has been found to have positive benefits, it is important that all LHDs have the capacity and resources to meet the performance standards required of accredited LHDs. Small, rural LHDs may need additional resources and support in order to improve their ability to be accredited and/or certain accreditation requirements may need modification to make accreditation more accessible to small LHDs.
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Hale NL, Klaiman T, Beatty KE, Meit MB. Local Health Departments as Clinical Safety Net in Rural Communities. Am J Prev Med 2016; 51:706-713. [PMID: 27344107 DOI: 10.1016/j.amepre.2016.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/28/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services. METHODS Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015. RESULTS Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care. CONCLUSIONS Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.
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Affiliation(s)
- Nathan L Hale
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee.
| | - Tamar Klaiman
- Health Policy and Public Health, University of the Sciences, Philadelphia, Pennsylvania
| | - Kate E Beatty
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee
| | - Michael B Meit
- Public Health Research Department, NORC at the University of Chicago, Chicago, Illinois
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Meyerson BE, King J, Comer K, Liu SS, Miller L. It's Not Just a Yes or No Answer: Expressions of Local Health Department Accreditation. Front Public Health 2016; 4:21. [PMID: 26909344 PMCID: PMC4754618 DOI: 10.3389/fpubh.2016.00021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022] Open
Abstract
The identification and exploration of moderators of health department accreditation remain limited by current dichotomous conceptualizations of pursuit.
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Affiliation(s)
- Beth E Meyerson
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington , Bloomington, IN , USA
| | - Jerry King
- Indiana Public Health Association , Indianapolis, IN , USA
| | - Karen Comer
- The Polis Center, Indiana University-Purdue University at Indianapolis , Indianapolis, IN , USA
| | - Sandra S Liu
- College of Health and Human Sciences, Purdue University , West Lafayette, IN , USA
| | - Laura Miller
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington , Bloomington, IN , USA
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Harris JK, Beatty K, Leider JP, Knudson A, Anderson BL, Meit M. The Double Disparity Facing Rural Local Health Departments. Annu Rev Public Health 2016; 37:167-84. [PMID: 26735428 DOI: 10.1146/annurev-publhealth-031914-122755] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Affiliation(s)
- Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614;
| | - J P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205;
| | - Alana Knudson
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Britta L Anderson
- NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Michael Meit
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
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