In New Hampshire, the public health infrastructure is much like the state’s size: Small. There are only two comprehensive local health departments and without sales or income tax, funding resources can be scarce.
As such, local public health efforts depend heavily on formal and informal linkages between community-based organizations and the state health department. And with limited resources, effectiveness is crucial. Such was the case when the state received funding from the U.S. Substance Abuse and Mental Health Services Administration to address New Hampshire’s underage and binge drinking problem. To tackle the problem, the state was divided into 10 regions, where regional coordinators were funded to build local prevention networks, according to APHA member Lea Ayers LaFave, PhD, RN, a senior project director for John Snow Inc. at New Hampshire’s Community Health Institute.
“We were charged with developing these networks starting with pretty much nothing, so we wanted to track their development as they were put into place and as they matured over time,” LaFave said. “The resources being put into play are actually coming from the community, and so any way that the community can see and get feedback about the connections they’re making, that just helps feed the fire.”
To stoke the prevention flames, LaFave turned to a young field of research known as public health services and systems research, which addresses the organization, structure, financing and delivery of public health services and their impact on people’s health. Specifically, she connected with a researcher in the field who had developed a tool for measuring collaboration among organizations that comprise a public health system. By pinpointing gaps in community connections, the tool aids regional networks in ensuring that all the necessary community components are represented to effectively prevent underage drinking, LaFave said.
“We can help organizations see themselves as part of a bigger entity,” she told The Nations’ Health. “There’s something very profound about seeing the connections or the lacks of connections when you look at the (data).”
New Hampshire is just one of many communities now benefiting from public health services and systems research. Unlike other realms of public health research that focus on discovering interventions, the heart of public health services and systems research lies in translation — in other words, “once we know what programs and policies work to improve health, how do we organize, finance and deliver them in the most efficient ways,” said APHA member Glen Mays, PhD, MPH, a co-principal investigator with the National Coordinating Center for Public Health Services and Systems Research at the University of Kentucky, which began in 2007 with funding from the Robert Wood Johnson Foundation. While Mays said the field is still emerging, “it’s one that actually has a long tail.” He noted that during the early 20th century, researchers were already studying how to best organize and finance municipal health departments — in fact, he said APHA conducted similar research in the 1950s.
The research field is gaining more and more practitioners as well. For example, the research nonprofit AcademyHealth hosts a Public Health Systems Research Interest Group that now boasts more than 2,700 members.
“We need this kind of research, especially as public health is redefining its roles and responsibilities in the context of a new health system,” said Mays, who is also a professor of health services and systems research at the University of Kentucky College of Public Health. “There’s a need, particularly now, for a continuous cycle of studying implementation and feeding back those results as quickly as we can to create a learning public health system.”
Another aspect that sets the research apart is its hyper-responsiveness to community needs. Public health services and systems researchers engage public health practitioners on the front end “to build a research agenda that focuses on the questions that are germane and relevant to what practitioners are actually seeing and challenged by in the field,” said APHA member Paul Campbell Erwin, MD, DrPH, a co-principal investigator with the coordinating center and director of the University of Tennessee’s Center for Public Health.
Erwin is engaged with Tennessee’s practice-based research network, which is now part of a multi-site study of six networks across the nation. The study, which began in April 2012, is focused on the geographic variations in the delivery of public health services and the impact on health. The goal is to look for meaningful variations to ultimately uncover best practices.
“There’s just a different kind of philosophy and attitude in (this field of research) that really pays attention at the outset to what does this research mean for, say, a county health director,” Erwin said. “Does this have any utility or is this just something of interest to the academician that many have no value in the practice setting?”
In Idaho, public health services and systems research has helped reaffirm the state’s regional approach to public health, said Carol Moehrle, RN, district director of public health for Public Health-Idaho North Central District. Moehrle, who also serves on the coordinating center’s advisory committee, said the research can be especially helpful to smaller, rural public health districts — “districts that may get left out (of research) otherwise.”
“This research is so pertinent because we’re living it right now,” she told The Nation’s Health. “They’re using actual local public health departments as the test models. That’s why it’s so much easier to relate to — it’s real-time research.”
In fact, up until recently, very little research had delved into the practice of local public health and even less has been designed as a collaboration between researchers and local practitioners, said APHA member Robert Pestronk, MPH, executive director of the National Association of County and City Health Officials. However, the young field of research is being developed with an eye to change that, he said. Pestronk noted that while gains in local public health practice are possible, it will depend, in part, on how easily local public health workers can access the research and translate it into practice.
“There’s an eager adoption of the idea of quality improvement,” he told The Nation’s Health. “But I think it’s more of a question of having the information in digestible forms, of having staff with the time to pay attention to and discover what’s being discovered.”
And investigators at the coordinating center are doing just that. They recently debuted an open-access, rapid-cycle journal called Frontiers in Public Health Services and Systems Research that is modeled after the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. F. Douglas Scutchfield, MD, director of the national coordinating center at the University of Kentucky, also reported that a major project is now under way to study the barriers to and facilitators of translating research in practice, and the results are expected in the next few months.
Scutchfield noted that practitioners are not the only ones hungry for such research. Increasingly, Scutchfield said, public health is being called upon by policymakers to demonstrate its return on investment in a fiscally strapped environment, and the research is starting to make a difference.
“It’s critically important that we be able to provide objective evidence that public health matters,” said Erwin at the University of Tennessee. “In this day and age, with the focus on (return on investment), we must make the case for public health.”
For more information on public health services and systems research, visit www.publichealthsystems.org or http://uknowledge.uky.edu/frontiersinphssr.
- Copyright The Nation’s Health, American Public Health Association
