Public Health Services and Systems Research Position Statement

I. ASTHO Supports Public Health Services and Systems Research

The Association of State and Territorial Health Officials (ASTHO) supports state and territorial health agencies’ participation in Public Health Services and Systems Research (PHSSR), with the goal of improving services and systems to optimize health outcomes in the United States. ASTHO plays an important role in PHSSR by informing public health policy and practice at the federal level with data from state public health practice, supporting states’ use of evidence-based practices by disseminating relevant findings, and gathering and reporting on data on state public health agencies.

Public Health Services and Systems Research has been defined as “a field of inquiry using quantitative and qualitative methodology to examine the impact of the organization, staffing, financing, and management of public health systems on the access to, delivery, cost, quality, and outcomes of population-based services and interventions.”¹

II. ASTHO Recommends

State Health Agencies

• Consistently use evidence-based practices wherever feasible and appropriate based on health status, funding, context, and other considerations.
• Utilize existing evidence to innovate and develop more effective and efficient public health policy and practice.
• Inform public health policy and practice at the federal level with data from state public health practice.
• Inform researchers of high priority knowledge and evidence gaps needed to improve public health policy and practice.
• Support local health department access to, understanding of, and use of research findings.
• Play a leadership role in translating PHSSR findings to policy and programmatic changes at the state and local levels.
• Participate in and encourage local health departments to participate in research projects that have the potential to provide practical findings to improve state health agency policies and practice.
• Disseminate state-based promising practices widely to benefit the entire public health system in the interest of improving health.
• Establish effective partnerships with academic, clinical, and non-traditional research partners.

Researchers

• Engage state health agency representatives at the conceptualization of research projects.
• Meaningful engagement that allows state health agency representatives to influence the research topics and methods must occur in order to maximize utility of findings to state health agencies and minimize burden on state health agencies.
• Co-author joint research proposals with public health practice partners, and collaborate to disseminate findings in an accessible and timely manner.
• Consider the immediate evidence needs of the governmental public health system when designing research projects. Minimize the length of studies to deliver findings to practitioners on a timely basis.
• Adhere to state-of-the-art ethical standards.

Federal Government and Funders

• Give priority to proposals that demonstrate meaningful engagement of state health agency staff in all stages of research, including conceptualization.
• Support the wide dissemination of findings with clear recommendations for policy and practice within six months of data collection.
• Provide substantial and sustainable financial and technical assistance resources to support the PHSSR-related activities of all levels of the public health system, including state and local health agencies, boards of health, and the national organizations that represent them (ASTHO, NACCHO, and NALBOH).
• Support state-level demonstration projects that allow states to test and study new ways to organize, finance, and deliver public health services.
• Support emerging researchers and non-traditional partners to increase diversity and health equity.
• Private foundations should follow the lead of the Robert Wood Johnson Foundation in recognizing the importance of and making substantial investments in PHSSR.
• Prioritize the following topics, which are critical to improving state public health practice²:

1. Identification of policies and interventions that are cost-effective, scalable, and sustainable ways to dramatically improve health outcomes.
2. Cost-effectiveness and return-on-investment studies.
3. Strategies to leverage medical and public health collaboration to increase the value (increase quality and lower cost) of health care.
4. Population health performance measurement.
5. Resource allocation methods.
6. Impact of public health system performance on health outcomes, including Identification of intermediate health outcomes that demonstrate the impact state public health has on distal health status.
7. Effects of alternative public health financing and funding mechanisms on system performance.
8. Relationship between system performance and social determinants of health.
9. Impact of accreditation on agency performance and health outcomes.
10. Successful strategies to make progress toward health equity.
11. Structural and functional components of the relationship between local, state, and federal public health agencies.

III. Background: Public Health Services and Systems Research

The field of Public Health Systems Research began to take shape in the early 21st century, with the Council on Linkages definition cited above. In 2007, Scutchfield and colleagues advocated for the inclusion of “Services” in the title of this emerging field to be more explicit about the focus on public health services and to establish PHSSR as a counterpart to the growing Health Services Research field.³

In 2009, AcademyHealth proposed a broad view of the word services in this context to include “programs, direct services, policies, laws, and regulations designed to protect and promote the public’s health and prevent disease and disability at the population level.”

ASTHO’s launch of the State Public Health Survey in 2007 made a significant contribution to the field by adding comprehensive information on the structure, organization and functions of state public health agencies. ASTHO is engaged in a data harmonization process with the National Association of County and City Health Officials (NACCHO) and the National Association of Local Boards of Health (NALBOH) to develop a single dataset with comprehensive and comparable data on state health agencies, local health agencies and local boards of health. ASTHO’s 2010 State and Territorial Public Health Survey will be combined with NACCHO and NALBOH surveys in such a coordinated dataset.

The movement toward voluntary national accreditation for public health agencies is driving an increased use of and participation in PHSSR. The Public Health Accreditation Board requires that accredited agencies use existing evidence, participate in research projects and disseminate findings to inform others in public health practice.

The CDC’s Guide to Community Preventive Services (Community Guide) is an example of the kind of findings that can be readily applied to practice. Such resources should be used whenever possible. Participation in PHSSR enables the body of public health science included in the Community Guide to grow, expanding the available tools for public health practice.

Approval History:

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Board of Directors. Position Statements are not voted on by the full ASTHO membership.

Performance Policy Committee Review and Approval: October 19, 2010

Board of Directors Review and Approval: December 6, 2010.

Policy Expires: December 6, 2013.

For further information about this Position Statement, please contact ASTHO Performance Policy staff.

Notes

1. Public Health Foundation.  2001. Public Health Systems Research. Ed. Council on Linkages http://www.phf.org/link/research.htm
2. These topics are not listed in any particular order. The list of topics was largely drawn from the following work: Lenaway D, Halverson, P, Sotnikov, S, Tilson, H, Corso, L, and Millington, W. 2006. Public health systems research: Setting a national agenda. AJ of Public Health 96 (3): 410-413.
3. Scutchfield FD, Marks JS, Perez DJ, Mays GP. 2007. Public health services and systems research.  American
4. Journal of Preventive Medicine 33:169-71.