Core functions and effectiveness of the local public health system in the United States
Sinclair, Amber Hughes
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The history of the United States public health system includes a number of great successes that have improved the health status and increased the life expectancy of Americans. The history also tells of the complex, contentious, and oft-changing roles played by local public health departments (LHDs). In recent years, public health agencies at all levels have been asked to acknowledge a common set of roles and assess the efficacy of associated program efforts. The primary aims of the dissertation are to: 1) describe the history of the local public health system in the U.S. with emphasis on how essential roles (core functions) have changed over time, 2) describe the field of public health systems and services research with a review of core function effectiveness studies, and 3) examine the effects of three system characteristics on the perceived effectiveness of community delivery of assessment, policy development and assurance core public health functions. These three characteristics are a) the health department’s contribution to effort, b) the participation of other types of agencies/organizations, and c) the percentage of other agencies/organization types that participate. Results indicate that local health department contribution to effort and the participation of other types of agencies/organizations are significantly associated with health department directors’ perceived effectiveness of public health core functions. As these factors increase, perceived effectiveness increases. The significance of participation of individual types of agencies/organizations varies by core functions area, with the exception of local government agencies and hospitals being significant for all three core function areas. More participation of these types of agencies/organizations is associated with greater perceived effectiveness. This is the first study to look at how local public health department contributions to core functions and the participation of other community agencies/organizations impact the perceived effectiveness of community delivery of core functions. The research adds to the understanding of effectiveness of core functions in the nascent field of public health systems and services research.