Helping Health Departments Make Smart Decisions with Limited Resources: Q&A with Douglas Scutchfield
Now more than ever public health officials and policy-makers need to make smart decisions about where to invest our limited public health resources, and public health services and systems research helps to uncover the data that points the way to sound decisions about the financing, staffing and structure of health departments.
Today, eleven new research projects on public health systems and services research were announced, to illuminate the best strategies and practices to enable state and local health departments to be effective and efficient in keeping people healthy and safe. The new grants, funded by the Robert Wood Johnson Foundation (RWJF), will examine the impact of budget reductions and program cuts on the health of the population. The grants will be administered by the National Network of Public Health Institutes, with guidance from the National Coordinating Center for Public Health Systems and Services Research, an RWJF-funded center housed at the University of Kentucky College of Public Health.
Research on best practices and strategies for delivering public health services continues to emerge. The Robert Wood Johnson Foundation’s Public Health Practice-Based Research Networks announced a new series of studies to focus on how to reduce health disparities in the delivery of public health and prevention strategies, and about roles that the public health system can play in eliminating health disparities.
NewPublicHealth spoke with Professor Douglas Scutchfield, MD, Director of the National Coordinating Center for Public Health Systems and Services Research, about the new grants and the importance of public health services and systems research.
NPH: What’s the goal of public health services and systems research (PHSSR) and of these specific grants?
Dr. Scutchfield: In order to improve the public’s health we have to be more efficient and effective in our efforts to try to improve health status, and unless and until we look at some of the issues surrounding the infrastructure of public health, then we’re not going to be able to answer those critical questions about efficiency and effectiveness in the public health system.
PHSSR provides these kinds of insights, in a way that is particularly applicable for state and local health departments. This research also has policy implications, and the extent to which we are able to convey to policymakers the results and implications of these research projects may well have substantial implications for policy and policy development.
These are trying times in any public service environment, and there’s a trend in these grants to look at kind of the natural experiment that we’re seeing in the economic downtown and its impact on public health and how best to cope with that. A substantial number look at how best, at the state and local levels, to cope with health department budget cuts both generally and in some very specific areas, notably maternal and child health. Another thing we’re seeing is a changing health care environment, and at least some of these grants look at handling changes that are the result of health system reform.
NPH: Why is this such a critical time for this research?
Dr. Scutchfield: It’s important to recognize that we’re going through a very tumultuous time in terms of the health care system—that the public health system is the backbone of our ability to maintain our health and our health status, and the extent to which we’re able to do so through these trying times is going to be important.
There’s some indication, for example, that in some areas we’re actually seeing a downturn in life expectancy and I don’t think anybody wants to see that kind of thing occur as a result of all of these changes in the economic system. If that’s the case, then public health is key in order to maintain and improve health in these difficult times.
NPH: Who will benefit most from the research and findings created by the grants?
Dr. Scutchfield: It’s absolutely imperative that the results of these get translated to action on the part of people who practice public health—who actually are providing the services. These grants are intended to inform their decision-making, to help them understand and facilitate their capacity to deal with services and to rapidly evolve the public health system. So I think probably the most important thing that we need to think about is making sure that the results of these grants get transmitted to individuals who can operate on them—particularly state and local health directors, but also policy-makers and other public health officials.
NPH: Given the current economic environment, are there any studies that you expect will generate particular interest?
Dr. Scutchfield: One study by the Johns Hopkins School of Public Health looks at the extent to which states are able to utilize mechanisms to protect public health in an economic downturn—what sorts of budget-setting and priority-setting processes, what sort of scenarios and consequential public impacts might have on outcomes at a state level.
At the same time, another group is looking at the implications of the economic climate at the local health department level. A team at the University of Washington School of Public Health is working with several of our PBRNs [practice-based research networks] to see how looking at how specific local health departments are going about the process of trying to cope with any of these economic changes, and if there are particular strategies that they have used or developed that appear to have broad applicability.
NPH: How is the National Coordinating Center for PHSSR helping with ongoing federal research into public health service delivery?
Dr. Scutchfield: One of the major functions of the National Coordinating Center is to, on a periodic basis, review the available literature on PHSSR and to make relevant studies available through the National Library of Medicine and through our websites.
In addition, two studies have been commissioned by the federal government to examine issues related to the financing of public health activities in the U.S. Both studies are seeking to review empirical literature, data, and related evidence concerning financing mechanisms and spending patterns for public health activities in the U.S., and the health and economic effects of these investments—who pays, how much, for what, through what financing mechanisms, how do these patterns vary across the U.S. and change over time, and what are their health and economic effects. We anticipate that our various resources are going to be used, and we’ve already had some contacts and discussions with researchers conducting one of the studies. And I anticipate hearing from GAO [Government Accountability Office] as well to help provide the information that will allow them to effectively look at the literature and try to draw some conclusions around these issues of financing public health services.