Public Health Delivery Systems. Evidence, Uncertainty, and Emerging Research Needs

Glen P. Mays, Sharla A. Smith, Richard C. Ingram, Laura J. Racster, Cynthia D. Lamberth, Emma S. Lovely

Research output: Contribution to journalReview articlepeer-review

95 Scopus citations


Abstract: The authors review empirical studies published between 1990 and 2007 on the topics of public health organization, financing, staffing, and service delivery. A summary is provided of what is currently known about the attributes of public health delivery systems that influence their performance and outcomes. This review also identifies unanswered questions, highlighting areas where new research is needed. Existing studies suggest that economies of scale and scope exist in the delivery of public health services, and that key organizational and governance characteristics of public health agencies may explain differences in service delivery across communities. Financial resources and staffing characteristics vary widely across public health systems and have expected associations with service delivery and outcomes. Numerous gaps and uncertainties are identified regarding the mechanisms through which organizational, financial, and workforce characteristics influence the effectiveness and efficiency of public health service delivery. This review suggests that new research is needed to evaluate the effects of ongoing changes in delivery system structure, financing, and staffing.

Original languageEnglish
Pages (from-to)256-265
Number of pages10
JournalAmerican Journal of Preventive Medicine
Issue number3
StatePublished - Mar 2009

Bibliographical note

Funding Information:
This review was prepared for AcademyHealth as part of the invitational conference entitled Advancing the Field of Public Health Systems Research, funded by the Robert Wood Johnson Foundation and held in Washington DC in June 2007. We appreciate the helpful comments provided by conference participants on an earlier version of this manuscript.

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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