Public Health Systems and Surveillance

Assessing Changes in Local Public Health Functions

Building on our previous work, which developed and tested a methodology for collecting information about the performance of essential public health services in communities participating in the Community Tracking Study, we documented changes in the performance of essential public health services in 12 communities. We also conducted a longitudinal study of the impact of sweeping health system changes on the ability of local health departments in these communities to carry out essential public health, population-based services. The project used a case study methodology to examine changes in the organization of the public health system and its activities in the areas of assessment, policy development, and assurance. The case study addressed (1) arrangements or agreements between local health departments and managed care organizations to conduct population-based public health functions, (2) changes in the scope and volume of population-based public health functions carried out by the local health agency, (3) changes in local health agencies' budgets for personal and population-based services, (4) changes in the size and nature of the Medicaid and uninsured populations served by the local health department, (5) changes in public health capacity at the local level, and (6) the degree to which local health agencies perceive they are fulfilling the public health objective and carrying out essential public health functions. A series of issue briefs on the findings is available. Contact Publications for information.

Public Health Performance Standards Program Data Synthesis

We used data collected through the National Public Health Performance Standards Program to analyze variations in practice among state and local public health providers, and to estimate the relationships among public health system characteristics, public health performance, and public health outcomes. The project consisted of three major analytic components. Analysis-of-variance methods and principal-components analysis were used to examine how performance varies across state and local public health jurisdictions, and across different domains of public health activity. A series of multivariate econometric models estimated the organizational, financial, and population characteristics of public health systems that appear to explain local variation in public health performance. Finally, we developed a series of multivariate models to explore the relationships between local public health performance and selected public health outcomes.

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