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Albert MA, Churchwell K, Desai N, Johnson JC, Johnson MN, Khera A, Mieres JH, Rodriguez F, Velarde G, Williams DR, Wu JC. Addressing Structural Racism Through Public Policy Advocacy: A Policy Statement From the American Heart Association. Circulation 2024; 149:e312-e329. [PMID: 38226471 DOI: 10.1161/cir.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
During the COVID-19 pandemic, the American Heart Association created a new 2024 Impact Goal with health equity at its core, in recognition of the increasing health disparities in our country and the overwhelming evidence of the damaging effect of structural racism on cardiovascular and stroke health. Concurrent with the announcement of the new Impact Goal was the release of an American Heart Association presidential advisory on structural racism, recognizing racism as a fundamental driver of health disparities and directing the American Heart Association to advance antiracist strategies regarding science, business operations, leadership, quality improvement, and advocacy. This policy statement builds on the call to action put forth in our presidential advisory, discussing specific opportunities to leverage public policy in promoting overall well-being and rectifying those long-standing structural barriers that impede the progress that we need and seek for the health of all communities. Although this policy statement discusses difficult aspects of our past, it is meant to provide a forward-looking blueprint that can be embraced by a broad spectrum of stakeholders who share the association's commitment to addressing structural racism and realizing true health equity.
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GONDI SUHAS, CHOKSHI DAVEA. Cities as Platforms for Population Health: Past, Present, and Future. Milbank Q 2023; 101:242-282. [PMID: 37096598 PMCID: PMC10126988 DOI: 10.1111/1468-0009.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/12/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points
Cities have long driven innovation in public health in response to shifting trends in the burden of disease for populations. Today, the challenges facing municipal health departments include the persistent prevalence of chronic disease and deeply entrenched health inequities, as well as the evolving threats posed by climate change, political gridlock, and surging behavioral health needs.
Surmounting these challenges will require generational investment in local public health infrastructure, drawn both from new governmental allocation and from innovative financing mechanisms that allow public health agencies to capture more of the value they create for society.
Additional funding must be paired with the local development of public health data systems and the implementation of evidence‐based strategies, including community health workers and the co‐localization of clinical services and social resources as part of broader efforts to bridge the gap between public health and health care.
Above all, advancing urban health demands transformational public policy to tackle inequality and reduce poverty, to address racism as a public health crisis, and to decarbonize infrastructure. One strategy to help achieve these ambitious goals is for cities to organize into coalitions that harness their collective power as a force to improve population health globally.
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Affiliation(s)
| | - DAVE A. CHOKSHI
- New York University Grossman School of Medicine and City University of New York Graduate School of Public Health and Health Policy
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Lucumí DI, Mentz G, González C, Valenzuela L, Veira M, Tello K. Cardiovascular disease prevention capacity in Colombian local health departments. Glob Public Health 2023; 18:2267632. [PMID: 37820047 DOI: 10.1080/17441692.2023.2267632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
Prevention capacity of local health organisations is associated with the performance and outcomes in public health. In Colombia, where cardiovascular disease is the leading cause of morbidity and mortality, there is limited knowledge about the capacity of local health departments to prevent this condition. Efforts are needed to address problems, potential solutions and expected outcomes regarding cardiovascular disease. In this study, a conceptual model for cardiovascular disease prevention capacity in Colombian local health departments was developed, a questionnaire based on this model was validated, the overall cardiovascular disease prevention capacity in a subsample of these organisations was measured, and the association between cardiovascular disease prevention capacity and political, population, and organisational factors was examined. Once the acceptable performance of the questionnaire was verified, variability in cardiovascular prevention capacity was found among a subsample of local health departments. Furthermore, this study provides primary evidence regarding the association between the size of local health departments and overall cardiovascular disease prevention capacity in Colombia. Future studies should focus on measuring this capacity on a larger scale and developing, implementing, and evaluating interventions aimed at strengthening cardiovascular prevention capacity in Colombian local jurisdictions.
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Affiliation(s)
- Diego I Lucumí
- School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Graciela Mentz
- Anaesthesiology Department, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Carlos González
- School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Laura Valenzuela
- School of Government, Universidad de los Andes, Bogotá, Colombia
| | | | - Kelly Tello
- Cauca Department of Health, Popayan, Colombia
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Lamba S, Wolfson C, Cardona C, Alfonso YN, Gemmill A, Resnick B, Leider JP, McCullough JM, Bishai D. Past local government health spending was not correlated with COVID-19 control in US counties. SSM Popul Health 2022; 17:101027. [PMID: 35071725 PMCID: PMC8763410 DOI: 10.1016/j.ssmph.2022.101027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022] Open
Abstract
Context Wide variation in state and county health spending prior to 2020 enables tests of whether historically better state and locally funded counties achieved faster control over COVID-19 in the first 6 months of the pandemic in the Unites States prior to federal supplemental funding. Objective We used time-to-event and generalized linear models to examine the association between pre-pandemic state-level public health spending, county-level non-hospital health spending, and effective COVID-19 control at the county level. We include 2,775 counties that reported 10 or more COVID-19 cases between January 22, 2020, and July 19, 2020, in the analysis. Main outcome measure Control of COVID-19 was defined by: (i) elapsed time in days between the 10th case and the day of peak incidence of a county's local epidemic, among counties that bent their case curves, and (ii) doubling time of case counts within the first 30 days of a county's local epidemic for all counties that reported 10 or more cases. Results Only 26% of eligible counties had bent their case curve in the first 6 months of the pandemic. Government health spending at the county level was not associated with better COVID-19 control in terms of either a shorter time to peak in survival analyses, or doubling time in generalized linear models. State-level public spending on hazard preparation and response was associated with a shorter time to peak among counties that were able to bend their case incidence curves. Conclusions Increasing resource availability for public health in local jurisdictions without thoughtful attention to bolstering the foundational capabilities inside health departments is unlikely to be sufficient to prepare the country for future outbreaks or other public health emergencies. Substantial variation in county and state health spending in the US before the COVID-19 pandemic. County level non-hospital health spending before pandemic not associated with early control over COVID-19. State level spending on hazard preparation is associated with early control over COVID-19 in some model specifications. Results offer no support for pouring funds into public health system to prepare for future outbreaks.
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Watts RD, Bowles DC, Ryan E, Fisher C, Li IW. No Two Workforces Are the Same: A Systematic Review of Enumerations and Definitions of Public Health Workforces. Front Public Health 2020; 8:588092. [PMID: 33330331 PMCID: PMC7711128 DOI: 10.3389/fpubh.2020.588092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
The delivery and coordination of public health functions is essential to national and global health, however, there are considerable problems in defining the people who work in public health, as well as estimating their number. Therefore, the aim of this systematic review was to identify and explore research which has defined and enumerated public health workforces. In particular, how were such workforces defined? Who was included in these workforces? And how did researchers make judgments about the size of a workforce? In this systematic review, we identified 82 publications which enumerated a public health workforce between 2000 and November 2018. Most workforce definitions were unique and study-specific and included workers based on their occupation or their place of work. Common occupations included public health nurses and physicians, epidemiologists, and community health workers. National workforces varied by size, with the United States and Switzerland having the largest public health workforces per-capita, although definitions used varied substantially. Normative assessments (e.g., assessments of ideal workforce size) were informed through opinion, benchmarks or “service-target” models. There are very few regular, consistent enumerations within countries, and fewer still which capture a substantial proportion of the public heath workforce. Assessing the size of the public health workforce is often overlooked and would be aided by fit-for-purpose data, alignment of occupations and functions to international standards, and transparency in normative methods.
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Affiliation(s)
- Rory D Watts
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Devin C Bowles
- Australian National University, Canberra, ACT, Australia
| | - Eli Ryan
- Council of Academic Public Health Institutions Australasia, Canberra, ACT, Australia
| | - Colleen Fisher
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Ian W Li
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Higashi J, Barry P. Not So Fast: Slowing Tuberculosis Decline in California. Am J Public Health 2019; 109:187-189. [DOI: 10.2105/ajph.2018.304886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Julie Higashi
- Julie Higashi is with the Tuberculosis Control Program, Division of Dental and Medical Affairs, Los Angeles County Department of Public Health, Los Angeles, CA. Pennan Barry is with the Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond
| | - Pennan Barry
- Julie Higashi is with the Tuberculosis Control Program, Division of Dental and Medical Affairs, Los Angeles County Department of Public Health, Los Angeles, CA. Pennan Barry is with the Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond
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Leider JP, Alfonso N, Resnick B, Brady E, McCullough JM, Bishai D. Assessing The Value Of 40 Years Of Local Public Expenditures On Health. Health Aff (Millwood) 2019; 37:560-569. [PMID: 29608371 DOI: 10.1377/hlthaff.2017.1171] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The US public and private sectors now spend more than $3 trillion on health each year. While critical studies have examined the relationship between public spending on health and health outcomes, relatively little is known about the impact of broader public-sector spending on health. Using county-level public finance data for the period 1972-2012, we estimated the impact of local public hospital spending and nonhospital health spending on all-cause mortality in the county. Overall, a 10 percent increase in nonhospital health spending was associated with a 0.006 percent decrease in all-cause mortality one year after the initial spending. This effect was larger and significant in counties with greater proportions of racial/ethnic minorities. Our results indicate that county nonhospital health spending has health benefits that can help reduce costs and improve health outcomes in localities across the nation, though greater focus on population-oriented services may be warranted.
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Affiliation(s)
- Jonathon P Leider
- Jonathon P. Leider ( ) is associate faculty in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Natalia Alfonso
- Natalia Alfonso is a research associate in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - Beth Resnick
- Beth Resnick is a senior scientist in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Eoghan Brady
- Eoghan Brady is a senior technical advisor in Global Health Financing at the Clinton Health Access Initiative, Inc., in Boston, Massachusetts. At the time this research was conducted, he was a doctoral candidate in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
| | - J Mac McCullough
- J. Mac McCullough is an assistant professor in the School for the Science of Health Care Delivery, Arizona State University, in Phoenix
| | - David Bishai
- David Bishai is a professor in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Padek M, Allen P, Erwin PC, Franco M, Hammond RA, Heuberger B, Kasman M, Luke DA, Mazzucca S, Moreland-Russell S, Brownson RC. Toward optimal implementation of cancer prevention and control programs in public health: a study protocol on mis-implementation. Implement Sci 2018; 13:49. [PMID: 29566717 PMCID: PMC5865376 DOI: 10.1186/s13012-018-0742-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/13/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Much of the cancer burden in the USA is preventable, through application of existing knowledge. State-level funders and public health practitioners are in ideal positions to affect programs and policies related to cancer control. Mis-implementation refers to ending effective programs and policies prematurely or continuing ineffective ones. Greater attention to mis-implementation should lead to use of effective interventions and more efficient expenditure of resources, which in the long term, will lead to more positive cancer outcomes. METHODS This is a three-phase study that takes a comprehensive approach, leading to the elucidation of tactics for addressing mis-implementation. Phase 1: We assess the extent to which mis-implementation is occurring among state cancer control programs in public health. This initial phase will involve a survey of 800 practitioners representing all states. The programs represented will span the full continuum of cancer control, from primary prevention to survivorship. Phase 2: Using data from phase 1 to identify organizations in which mis-implementation is particularly high or low, the team will conduct eight comparative case studies to get a richer understanding of mis-implementation and to understand contextual differences. These case studies will highlight lessons learned about mis-implementation and identify hypothesized drivers. Phase 3: Agent-based modeling will be used to identify dynamic interactions between individual capacity, organizational capacity, use of evidence, funding, and external factors driving mis-implementation. The team will then translate and disseminate findings from phases 1 to 3 to practitioners and practice-related stakeholders to support the reduction of mis-implementation. DISCUSSION This study is innovative and significant because it will (1) be the first to refine and further develop reliable and valid measures of mis-implementation of public health programs; (2) bring together a strong, transdisciplinary team with significant expertise in practice-based research; (3) use agent-based modeling to address cancer control implementation; and (4) use a participatory, evidence-based, stakeholder-driven approach that will identify key leverage points for addressing mis-implementation among state public health programs. This research is expected to provide replicable computational simulation models that can identify leverage points and public health system dynamics to reduce mis-implementation in cancer control and may be of interest to other health areas.
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Affiliation(s)
- Margaret Padek
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Peg Allen
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Paul C. Erwin
- Department of Public Health, University of Tennessee, Knoxville, TN USA
| | - Melissa Franco
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington DC, USA
| | - Benjamin Heuberger
- Center on Social Dynamics and Policy, The Brookings Institution, Washington DC, USA
| | - Matt Kasman
- Center on Social Dynamics and Policy, The Brookings Institution, Washington DC, USA
| | - Doug A. Luke
- Center for Public Health System Science, Brown School at Washington University in St Louis, St. Louis, MO USA
| | - Stephanie Mazzucca
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Sarah Moreland-Russell
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
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Eyler AA, Valko C, Ramadas R, Macchi M, Fershteyn Z, Brownson RC. Administrative Evidence-based Practices in State Chronic Disease Practitioners. Am J Prev Med 2018; 54:275-283. [PMID: 29162297 DOI: 10.1016/j.amepre.2017.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/24/2017] [Accepted: 09/07/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Research and lessons from community implementation have informed evidence-based practices that can improve the effectiveness of health initiatives. Administrative evidence-based practices (A-EBPs) facilitate the role of public health departments in implementing the most effective programs and policies. The purpose of this study is to describe A-EBPs in relation to characteristics of chronic disease practitioners in state health departments. METHODS Randomly selected chronic disease practitioners who worked in state health departments were invited to complete an online survey in 2016. The survey included questions on five domains of A-EBPs: workforce development, leadership, culture and climate, relationships and partners, and financial practices. State-level variables that could potentially affect the use of A-EBPs were collected and used in a regression model. RESULTS Analysis was conducted in 2016 on data from 571 respondents. Mean percentages of those who strongly agreed/agreed were lowest for financial practices (41.49%) and leadership (42.33%) with higher means for culture and climate (54.52%) and relationships and partners (58.71%). State poverty level was the only significant predictor of A-EBP scores after adjusting for other covariates in a regression model. CONCLUSIONS These results show several areas of high agreement with A-EBP within the domains measured as well as opportunities for improvement. Highlighting the importance of A-EBPs to public health leadership level may enhance practice. There is also need for developing plans for an aging workforce and cultivating partnerships with health care and other sectors. Findings can be used to target training for enhancement of A-EBPs within state health departments.
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Affiliation(s)
- Amy A Eyler
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Cheryl Valko
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Ramya Ramadas
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Marti Macchi
- National Association of Chronic Disease Directors, Atlanta, Georgia
| | - Zarina Fershteyn
- National Association of Chronic Disease Directors, Atlanta, Georgia
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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Local Health Departments' Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010044. [PMID: 26703693 PMCID: PMC4730435 DOI: 10.3390/ijerph13010044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 12/27/2022]
Abstract
Context: Health disparities are among the critical public health challenges. Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement. Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities. Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four activities. LHD characteristics significantly associated (p≤0.05) with the increased likelihood of performing activities to address health disparities were: recent completion of community health assessment, community health improvement plan and agency wide strategic plan. Other significant positive impacts on such activities included per capita expenditures, local governance, having one or more local boards of health, larger population size and metropolitan status of the LHD jurisdiction. Conclusions: Reduced infrastructural capacity of LHDs has resulted in fewer LHDs addressing health disparities in their jurisdictions. LHD characteristics associated with higher performance of activities for health disparity reduction identified by this research have important policy implications.
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Jambroes M, Lamkaddem M, Stronks K, Essink-Bot ML. Enumerating the preventive youth health care workforce: Size, composition and regional variation in the Netherlands. Health Policy 2015; 119:1557-64. [PMID: 26358246 DOI: 10.1016/j.healthpol.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/25/2022]
Abstract
The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region. A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n=3220) were recruited through organisations involved in YHC (participation: 88%). The YHC workforce is multi-disciplinary, 62% had >10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range 688-1007). All essential public health operations were provided and could be clustered in an operational or policy profile. The operational profile prevailed in all regions. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need. The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries.
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Affiliation(s)
- Marielle Jambroes
- Academic Medical Center, Department of Public Health, J2, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Majda Lamkaddem
- Academic Medical Center, Department of Public Health, J2, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Karien Stronks
- Academic Medical Center, Department of Public Health, J2, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Marie-Louise Essink-Bot
- Academic Medical Center, Department of Public Health, J2, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Marton J, Sung J, Honore P. Does More Public Health Spending Buy Better Health? Health Serv Res Manag Epidemiol 2015; 2:2333392815580750. [PMID: 28462255 PMCID: PMC5287442 DOI: 10.1177/2333392815580750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: In this article, we attempt to address a persistent question in the health policy literature: Does more public health spending buy better health? This is a difficult question to answer due to unobserved differences in public health across regions as well as the potential for an endogenous relationship between public health spending and public health outcomes. Methods: We take advantage of the unique way in which public health is funded in Georgia to avoid this endogeneity problem, using a twelve year panel dataset of Georgia county public health expenditures and outcomes in order to address the “unobservables” problem. Results: We find that increases in public health spending lead to increases in mortality by several different causes, including early deaths and heart disease deaths. We also find that increases in such spending leads to increases in morbidity from heart disease. Conclusions: Our results suggest that more public health funding may not always lead to improvements in health outcomes at the county level.
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Affiliation(s)
- James Marton
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Jaesang Sung
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Peggy Honore
- Louisiana State University Health Science Center School of Public Health, New Orleans, LA, USA
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Wheat JR, Coleman VL, Murphy S, Turberville CM, Leeper JD. Medical Education to Improve Rural Population Health: A Chain of Evidence From Alabama. J Rural Health 2015; 31:354-64. [DOI: 10.1111/jrh.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John R. Wheat
- Department of Community and Rural Medicine, College of Community Health Sciences; The University of Alabama; Tuscaloosa Alabama
| | | | - Shannon Murphy
- Department of Psychology; The University of Alabama; Tuscaloosa Alabama
| | - Caleb M. Turberville
- Rural Medical Scholars Program; University of Alabama School of Medicine-Tuscaloosa; Tuscaloosa Alabama
| | - James D. Leeper
- Department of Community and Rural Medicine, College of Community Health Sciences; The University of Alabama; Tuscaloosa Alabama
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Schenck AP, Meyer AM, Kuo TM, Cilenti D. Building the evidence for decision-making: the relationship between local public health capacity and community mortality. Am J Public Health 2015; 105 Suppl 2:S211-6. [PMID: 25689215 DOI: 10.2105/ajph.2014.302500] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina. METHODS We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality. RESULTS Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children's services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05). CONCLUSIONS Our findings, in the context of other studies, provide support for investment in local public health services to improve community health.
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Affiliation(s)
- Anna P Schenck
- Anna P. Schenck is with the North Carolina Institute for Public Health and the Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Anne Marie Meyer is with the Epidemiology Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Tzy-Mey Kuo is with the Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill. Dorothy Cilenti is with the Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina
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Lovelace KA, Aronson RE, Rulison KL, Labban JD, Shah GH, Smith M. Laying the groundwork for evidence-based public health: why some local health departments use more evidence-based decision-making practices than others. Am J Public Health 2015; 105 Suppl 2:S189-97. [PMID: 25689208 DOI: 10.2105/ajph.2014.302306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined variation in the use of evidence-based decision-making (EBDM) practices across local health departments (LHDs) in the United States and the extent to which this variation was predicted by resources, personnel, and governance. We analyzed data from the National Association of County and City Health Officials Profile of Local Health Departments, the Association of State and Territorial Health Officials State Health Departments Profile, and the US Census using 2-level multilevel regression models. We found more workforce predictors than resource predictors. Thus, although resources are related to LHDs' use of EBDM practices, the way resources are used (e.g., the types and qualifications of personnel hired) may be more important.
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Affiliation(s)
- Kay A Lovelace
- Kay A. Lovelace and Kelly L. Rulison are with the Department of Public Health Education, The University of North Carolina at Greensboro. At the time of the study, Robert E. Aronson was with The University of North Carolina at Greensboro. Jeffrey D. Labban is with the Office of Research, School of Health and Human Sciences, The University of North Carolina at Greensboro, Greensboro. Gulzar H. Shah is with the Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Smith is with the Health Surveillance and Analysis Unit, Guilford County Department of Public Health, Greensboro
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Public health spending and population health: a systematic review. Am J Prev Med 2014; 47:634-40. [PMID: 25084684 DOI: 10.1016/j.amepre.2014.05.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/18/2014] [Accepted: 05/15/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT This systematic review synthesizes what is known about the relationship between public health spending and population health outcomes, as well as the pathways that may explain how outcomes vary with spending. It also discusses the limitations of the existing literature and identifies areas in need of future research. EVIDENCE ACQUISITION Studies included in this review were retrieved through an iterative process, primarily through key word searches in two literature databases (PubMed and JSTOR) conducted in 2013. All retrieved studies underwent initial and secondary screening. Articles were included if they (1) examined the link between spending and outcomes or (2) explored pathways that mediate the relationship between spending and outcomes. EVIDENCE SYNTHESIS Seventeen empirical studies and five literature reviews published between 1985 and 2012 were included in this review. Existing evidence suggests that increases in public health spending are associated with improved population health, at least for some outcomes. However, there is little evidence to suggest that increased spending contributes to meaningful reductions in health disparities. Moreover, the pathways through which greater spending translates into better outcomes are not well understood. CONCLUSIONS Although the complexity of the public health delivery system makes it difficult to demonstrate definitive associations between spending and outcomes, financial investments in public health have the potential to improve community health. Additional research is needed to explore the pathways that mediate this relationship. This research would benefit public health practitioners who need evidence on how to best spend financial resources to achieve better health outcomes.
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Erwin PC, Shah GH, Mays GP. Local health departments and the 2008 recession: characteristics of resiliency. Am J Prev Med 2014; 46:559-68. [PMID: 24842732 DOI: 10.1016/j.amepre.2014.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 2008 recession had a significant impact on local health departments (LHDs), with more than half of such agencies experiencing job losses and program cuts. PURPOSE To identify potential modifiable factors that can protect LHDs from job losses and budget cuts during future economic crises. METHODS This retrospective cohort study used data from 2005 and 2010 surveys of LHDs. The outcome of interest was financial resiliency for maintaining budgets during the recession and was based on the ratio of observed to predicted expenditures (O/E) per capita for 2010. Logistic regression was used to model the resiliency of the LHD with independent variables grouped around domains of organization, revenues, and services, with stratification by size of the LHD jurisdiction. Data were analyzed in 2013. RESULTS Of the 987 LHDs in the final data set, 328 (33.2%) were categorized as resilient and 659 (66.8%) as non-resilient. Overall, resilient LHDs received a higher percentage of revenues from non-local sources compared to non-resilient LHDs (p<0.05) and had a more diversified service mix, with significantly (p<0.05) more treatment, population, and regulatory services. In the final regression models, findings differed substantially across the stratifications of LHD jurisdictional population size, with no single independent or control variable significantly associated with resiliency across all population categories. CONCLUSIONS Funding streams and service mix may be modifiable characteristics, suggesting possible means for LHDs to weather future economic stress; however, these characteristics may be unique to the size of the population served.
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Affiliation(s)
- Paul C Erwin
- Department of Public Health, University of Tennessee, Knoxville, Tennessee.
| | - Gulzar H Shah
- Jiann-Ping Hsu College of Public Health, Georgia South University, Statesboro, Georgia
| | - Glen P Mays
- University of Kentucky College of Public Health, Lexington, Kentucky
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Local health department assurance of services and the health of California's seniors. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:550-61. [PMID: 23838898 DOI: 10.1097/phh.0b013e31828e25e5] [Citation(s) in RCA: 3] [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 examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. DESIGN Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators. Assurance was measured by an index of 5 services, either directly provided or contracted by LHDs: cancer screening, injury prevention, comprehensive primary care, home health care, and chronic disease prevention. Multilevel regression models estimated the association of LHD assurance of services and each of 6 older adult health indicators, controlling for individual, LHD, and county characteristics that included key social determinants of health, such as poverty. SETTING Fifty-seven California counties. PARTICIPANTS 33,154 older adults (age 65 and older). MAIN OUTCOME MEASURES Colorectal cancer screening, mammography, healthy eating, physical activity, and multiple falls among older adults. RESULTS Local health departments provided or contracted a median of 2 of the 5 services. In adjusted analyses, LHD assurance of services was generally unassociated with the seniors' health behaviors, screening, and falls. Greater LHD expenditures per capita were associated with significantly better mammography screening rates (adjusted odds ratio [AOR] = 1.22, P < 0.01) compared to jurisdictions in the bottom one-third of per capita LHD spending. Greater county-level poverty (a social determinant of health) was associated with greater junk food consumption (AOR = 1.14, P < 0.01) and worse fruit and vegetable consumption (AOR = 0.97, P < 0.01). Highly impoverished counties were consistently in the bottom quartile of performance across all indicators. CONCLUSIONS The LHD's assurance of select services known to promote and protect the health of older adults does not appear to translate into higher rates of colorectal cancer screening, mammography, healthy eating, physical activity, and fewer falls among seniors. County-level poverty is most strongly associated with older adult health, underscoring a key barrier to address in local senior health improvement efforts.
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Health districts as quality improvement collaboratives and multijurisdictional entities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 18:561-70. [PMID: 23023281 DOI: 10.1097/phh.0b013e31825b89fd] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Local health departments are increasingly challenged to meet emerging health problems at the same time that they are being challenged with dwindling resources and the demands of accreditation. OBJECTIVE To assess the capacity of Multicounty health districts to serve as "Quality Improvement Collaboratives" and support local health departments to meet accreditation standards. DESIGN The study used an online survey tool and follow-up phone calls with key informants in health districts and county health departments in Georgia. Data collection was primarily based on an instrument to measure Quality Improvement Collaboratives that was adapted and tested for use with public health agencies in Georgia. SETTING The Georgia PBRN conducted this study of health districts and county health departments. The Georgia Department of Public Health supports 18 health districts and 159 county health departments (GA DPH, 2011). The health districts range in county composition from 1 to 16 counties in each district. PARTICIPANTS Key informants comprised district and county health department staff and county health department board members were identified by 13 participating health district offices. RESULTS Key opinion leaders from both the rural and nonrural counties agreed that the Districts were important for providing essential services and supporting quality improvement collaboration. Psychometric testing of the Quality Improvement Collaborative assessment public health instrument yielded high scores for validity and reliability. CONCLUSIONS AND IMPLICATIONS Regionalization of local public health capacity is a critical emerging issue for public health accreditation and quality improvement. This study demonstrated the utility of regionalization across traditional local geopolitical boundaries.
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