How changes at the local health department level are associated with improvements in health outcomes at the state level Public Deposited

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  • March 21, 2019
  • Erwin, Paul Campbell
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • The empirical evidence for guiding the resourcing of local public health departments (LHDs) and for what these agencies should be funded to do is limited primarily to cross-sectional studies of health department performance and effectiveness. There is relatively little published evidence showing an association between LHD activities or performance and health outcomes, and there is a lack of information from longitudinal studies on LHDs. The purpose of this study was to explore the association between changes in LHD resources and activities, and changes in health outcomes. A retrospective cohort design was used to analyze changes in LHD resources and changes in health outcomes at the state level. The National Association of County and City Health Officials (NACCHO) has collected data on LHD resources, such as expenditures and staffing, through multiple surveys. This study made use of a dataset which linked LHD responses in surveys conducted in 1997 and again in 2005. LHD data were aggregated to the state level, producing usable data for 42 states. Data for health outcomes were available through the America's Health Rankings reports for the same time period. Significant associations were found between overall LHD inputs and changes in state health rankings. In particular, increases in LHD expenditures were significantly associated with decreases in infectious disease morbidity at the state level (p = 0.037), and increases in full-time equivalent staff per capita were significantly associated with decreases in cardiovascular disease mortality (p = 0.014), when controlling for other factors. These results add to the empirical evidence that local public health activity is associated with improved health outcomes. These findings can be used to advocate for LHD support and may have policy implications for developing evidence-based standards for a National Public Health Accreditation Program.
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  • In Copyright
  • Greene, Sandra
Degree granting institution
  • University of North Carolina at Chapel Hill
  • Open access

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