Identifying Value-Added Population Health Capabilities to Strengthen Public Health Infrastructure

Rachel Hogg-Graham, Elizabeth Graves, Glen P. Mays

Research output: Contribution to journalArticlepeer-review

Abstract

Policy Points While the coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in delivery systems. The results of our study suggest that the public health system structure can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities can help communities efficiently use limited time and resources and identify the most effective pathways for building a stronger public health system and improving health outcomes over time. Context: While the novel coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in public health delivery systems. Information about the relative value in the implementation of recommended population health capabilities can help communities prioritize their use of limited time and resources and identify the most effective pathways for building a stronger public health system. Methods: We used a longitudinal cohort design with data from the National Longitudinal Survey of Public Health Systems to examine longitudinal and geographic trends in the delivery of population health capabilities and their impact on system strength across communities in the United States. We used linear probability models to ascertain whether the delivery of certain capabilities added value to public health system strength. Findings: Those communities with the strongest classification of public health system structure in both urban and rural areas implemented the largest set of population health capabilities. Results from the linear probability model indicate that a set of population health capabilities are associated with increased public health system strength. Key activities include allocating resources based on a community health plan, surveying the community for behavioral risk factors, analyzing the data on preventive services use, and engaging community stakeholders in health improvement planning (p < 0.01). Conclusions: The results of this study suggest that public health systems can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities may help communities increase their public health system's capacity and improve health outcomes.

Original languageEnglish
Pages (from-to)261-283
Number of pages23
JournalMilbank Quarterly
Volume100
Issue number1
DOIs
StatePublished - Mar 2022

Bibliographical note

Funding Information:
: This research was supported by funding from the Robert Wood Johnson Foundation through the Systems for Action National Program Office, ID 75708, and funding from the US Centers for Disease Control and Prevention (Contract # 75D30118C03568 00001). Funding/Support

Publisher Copyright:
© 2022 Milbank Memorial Fund

Keywords

  • longitudinal studies
  • public health
  • public health administration

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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