- Visit the Systems for Action National Coordinating Center webpage for the most up-to-date information on the NLSPHS project: http://systemsforaction.org/national-longitudinal-survey-public-health-systems-nlsphs
Are We Measuring Up? Exploring Public Health Performance and Health Equity in the United States and Canada (PHSSR Research in Progress Webinar, May 19, 2016) REGISTER HERE
Since 1998, researchers have followed a nationally representative cohort of U.S. communities to examine the types of public health activities performed within the community, the range of organizations contributing to each activity, and the perceived effectiveness of each activity in addressing community needs. This information, obtained through a validated survey of local public health officials, provides an in-depth view of the structure and function of local public health delivery systems and how these systems evolve over time. Originally conducted with support from the U.S. Centers for Disease Control and Prevention, the National Longitudinal Survey of Public Health Systems (NLSPHS) was fielded for the first time in 1998, with a follow-up survey conducted in 2006 as part of a Robert Wood Johnson Foundation-funded project to develop an evidence-based typology of local public health delivery systems.
Each wave of the survey has been linked with data on local health departments collected from the prior year’s National Profile of Local Health Departments survey conducted by the National Association of County and City Health Officials (NACCHO), allowing for an in-depth view of how local health departments relate to the multi-organizational delivery systems in which they operate. These data, linked with still other data sources on community demographic, health, and economic characteristics, have supported a wide array of studies regardign the organization, financing, and delivery of public health services and provided considerable insight into policy and administrative mechanisms for improving the practice of public health.
A third wave of the NLSPHS was conducted in 2012 and data was linked with the 2010 NACCHO Profile Survey as well as the 2010 Survey of State Health Agencies conducted by the Association of State and Territorial Health Officials (ASTHO). An additional 2014 wave used the 2012 survey instrument and included a supplementary sample of small and rural nonmetropolitan communities last surveyed in 2006.
The resulting data (available from the Inter-University Consortium for Political and Social Research) is useful for tracking public health services status in light of environmental conditions such as the budget shortfalls and economic rescission and implementation of the Affordable Care Act (ACA). Local public health agencies and the PBRN networks use the data and measures for local analyses, particularly to construct a national comparison group used in comparative analyses of public health practice variation and using the survey instruments for state-focused analyses.
The survey collects data on organizational partnerships and communications, enabling social network analysis to examine the types of partnerships associated with successful health outcomes, and to determine the most effective approach to communications within a specific network. Significant 2012 survey results were:
- Economic constraints, when other factors were controlled, did not impact public health system partnership networks. Other factors such as population size and the existence of a board of health had a greater impact on the centrality of the networks, having implications for network development strategies and public health system communications.
- Reductions in the public health activities provided fell by nearly 5% in the average community between 2006 and 2012, and most sharply among communities experiencing the largest increases in unemployment and the largest reductions in governmental public health spending.
- Since federal resources and private sector contributions were not successful in providing continuous local public health service levels during the recession, new financing mechanisms may be necessary to ensure equitable public health protections during economic downturns.
Findings from the 2014 survey include:
- Comprehensive and highly-integrated public health systems appear to offer considerable health and economic benefits over time, with larger reductions in rates of infant mortality and deaths due to cardiovascular disease, diabetes, and cancer and 15% lower use of public health resources.
- Low-income communities were less likely to achieve comprehensive public health system capital, as were communities without local governance structures.
- Opportunities exist for improving population health through policy initiatives to build public health system capital, such as through the ACA’s hospital community benefit provisions and the IOM’s call for a minimum package of public health services.
- Communities that move from non-comprehensive to comprehensive system structures over the 16-year period experience 10-40% larger reductions in preventable mortality rates compared to communities that remain non-comprehensive
- Understanding the organization of public health delivery systems: an empirical typology (Milbank Quarterly, March 2010)
- Expanding Delivery System Research in Public Health Settings: Lessons From Practice-Based Research Networks (JPHMP, November-December 2012)
- National Longitudinal Survey of Public Health Systems: Comparative Report of 2012 Results (Report, December 2012)
- Overview of the National Longitudinal Survey of Public Health Systems (Report, January 2012)
- Defining Comprehensive Public Health Delivery Systems (Report, February 2015)
- Economic Shocks and Public Health Protections in US Metropolitan Areas (AJPH, April 2015)
- Inter-organizational Network Effects on the Implementation of Public Health Services (Research in Progress Webinar, March 2016 recording)
- Inter-organizational Network Effects on the Implementation of Public Health Services (8th Annual Conference on the Science of Dissemination & Implementation, December 2015)
- The Economics of Implementing Population Health Strategies: Progress in Public Health Services & Systems Research (7th Annual Conference on the Science of Dissemination & Implementation, December 2014)
- A Longitudinal Analysis of Local Health Department Efficiency (Poster presentation at APHA Annual Meeting, November 2014)
- The National Longitudinal Survey of Public Health Systems: Selected Findings and Applications for Monitoring the Affordable Care Act (Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services, December 2013)
- National Longitudinal Survey of Public Health Systems Instrument (2012 Research Instrument)
- Combining Efforts: Hospitals, Health Departments Team Up (Article by Paul Barr, Modern Healthcare, March 2013)