Karl Timothy Johnson: Public Health Governance to Advance Public Health 3.0: Interrogating the Strategies and Structures of Local Governmental Health Departments to Address the Social Determinants of Health in North Carolina and Across the Country
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Johnson, Karl
- Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
- Abstract
- Background: The Public Health 3.0 (PH3.0) framework emphasizes the role that public health should have in addressing social determinants of health (SDOH). The local health department (LHD), as the principal governmental authority within local public health, has often been identified as the primary agency to address SDOH. However, the local and state governance arrangements within which an LHD operates strongly influence their capacity for strategies aimed at SDOH. Local boards of health (BOH) have a particularly powerful influence on the decision-making capacity of LHDs; different arrangements and functionality of BOHs may in turn influence an LHD’s work to advance PH3.0. Objective: To advance to goals of PH3.0, this dissertation sought to analyze the strategies by which LHDs have addressed SDOH as well as the local governance arrangements that may shape those strategies. Methods: First, I performed latent class analysis with nationally representative data on LHD activity to identify common profiles of LHD involvement with policy development, followed by logistic regression to estimate how local BOH functionality impacts the likelihood of inhabiting different profiles. Second, I reviewed recent Community Health Improvement Plans from LHDs across the country to analyze the characteristics of strategies addressing SDOH described in such plans. Finally, I conducted semi-structured interviews with LHD directors and BOH members from across North Carolina to assess how variations in their governance arrangement impacted their work in the community. Results: I found the BOH is a core though often underutilized institution to enable the LHD to improve and expand its role in addressing SDOH, whether through directly proposing and passing local public health rules or through partnership engagement with other local community organizations. Variations in local governance models substantially impact this ability, however, with appointed BOHs composed of medical professionals who are comfortable exercising oversight and authority being the most likely to aid the LHD in addressing SDOH in the community. Contribution and Significance: To advance community health and eliminate health disparities, local public health departments must address the SDOH. This research may support LHDs to better address SDOH in their community by improving their local governance arrangements and the relationships therein.
- Date of publication
- 2023
- Keyword
- DOI
- Resource type
- Rights statement
- In Copyright - Educational Use Permitted
- Advisor
- Hassmiller Lich, Kristen
- Wiesman, John
- Nickodem, Kristi
- Jensen, Todd
- Cilenti, Dorothy
- Degree
- Doctor of Philosophy
- Degree granting institution
- University of North Carolina at Chapel Hill Graduate School
- Graduation year
- 2023
- Language
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This work has no parents.
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