Category Archives: Research
Frontiers in Public Health Services & Systems Research: Making Critical Research Accessible, Quickly
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Glen Mays, MPH, PhD, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health, talks about the launch of a brand new online journal covering public health systems and services research, and why it is so critical right now, to inform smart investments in public health and prevention. The new journal, Frontiers in PHSSR, is designed to disseminate the most critical early findings from PHSSR research much faster—making these findings accessible far in advance of the fully-developed scientific manuscript. To be eligible for inclusion in Frontiers, findings must have the potential to guide future public health practice, health policy, and research. Mays is the editor in chief of the new journal.
Portions of the post below are adapted from the opening commentary in Frontiers, authored by Mays, F. Douglas Scutchfield, Paul K. Halverson, William Riley and Peggy Honore.
The need for a strong and effective public health system in the United States is perhaps more urgent today than at any other time in our nation’s history. Preventable diseases and injuries account for more than three-fourths of the $2.6 trillion in health care expenditures incurred annually in the U.S. The growing prevalence of obesity, diabetes and other preventable conditions constrains the nation’s economic productivity and global competitiveness. The American public health system—the diffuse constellation of governmental public health agencies and their peers and partners in community-based settings and the private sector—is tasked with developing and delivering strategies that promote health and prevent disease and injury on a population-wide basis. They share the mission of creating conditions in which people can be healthy.
The public health system is uniquely positioned—but not optimally equipped or resourced—to take on these challenges. Only about 3 percent of the nation’s $2.6 trillion in annual health expenditures is devoted to public health activities. Some of our greatest uncertainties now lie in how best to organize, finance, and deliver effective public health prevention strategies to communities across the U.S. The field of public health services and systems research (PHSSR) has emerged to fill this void.
Frontiers in PHSSR
The American public health system and the populations it serves do not have the luxury of waiting the 15 years typically required to get research-tested solutions widely adopted into practice. The costs associated with missed opportunities for disease prevention and health promotion are straining government and household budgets now.
To help develop and grow this scientific learning community, we have launched a new, open-access, peer-reviewed journal, Frontiers in Public Health Services and Systems Research. This journal provides a platform for rapidly and widely communicating emerging findings and lessons learned from studies of public health services and delivery systems. Frontiers will feature brief descriptions of preliminary findings from ongoing or recently completed empirical studies and quality improvement projects that answer important questions regarding the organization, financing, and delivery of public health services.
In 2009, the Robert Wood Johnson Foundation, requested the Institute of Medicine (IOM) to convene a committee to consider three major topics in public health: measurement, law and policy, and funding. The last of these reports, which recommends new health targets and changes in how public health is funded and organized, was released last week and has been a key topic of discussion at this week’s Keeneland Conference.
Harvey Fineberg, MD, president of the IOM, delivered a keynote address on these three reports, as well as another recent report on the potential for collaboration between public health and primary care. NewPublicHealth spoke to Dr. Fineberg about the reports and next steps.
>>We're on the ground in Kentucky all week. Follow our coverage for the latest news.
NewPublicHealth: How will the findings from the three-report series on public health be helpful to public health service delivery going forward?
Dr. Harvey Fineberg: I think of these reports as the contemporary trilogy of public health. They each stand on its own and yet are also connected in a vital way.
The first report looks at how we can know where we stand in public health. It emphasizes the importance of a standard core set of indicators. The aim is to make them a guide for policy and practice of public health, and to monitor where we are and what needs to be done.
The second report was on the legal foundation that provides the authority for health agencies to protect the public’s health. It turns out that many of the statutes have been on the books for decades and don’t necessarily have the specifics for dealing with contemporary needs such as the challenge of dealing with obesity or emerging infectious diseases or bioterrorism. The report pointed to the ten essential services of public health which set a standard of practice, and spoke to what state laws would be needed to make the ten core functions operable.
The third report dealt with essentially the resources that would be needed to carry out public health services. And the committee found that we grossly under-invest in public health. They recommended a conservative estimate of doubling the national investment and proposed a fee on dollars that flow through the medical system to be captured and reinvested in prevention, which they said would ultimately protect and improve health.
NPH: How important was the evidence base to the committee in producing the reports?
Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation at the Robert Wood Johnson Foundation, was a keynote speaker at the Keeneland Conference yesterday and spoke about the evolution of public health services and systems research (PHSSR). NewPublicHealth asked Debra Pérez about that evolution.
>>Follow our continuing coverage of the Keeneland Conference.
NPH: Why is the field of PHSSR a priority for the Robert Wood Johnson Foundation?
Debra Pérez: Right now, I think more than ever we need evidence to provide decision-makers with the evidence for how best to apply limited resources. We know in the last year alone over 40,000 public health jobs were eliminated, so that means that health departments are struggling with staffing and infrastructure issues, and they need evidence to help them best apply the limited resources they have now.
NewPublicHealth: What’s the scope of the conference this year compared to previous years?
The annual Keeneland Conference kicked off today, where more than 300 public health services and systems researchers (PHSSR), public health officials and policy-makers have convened to discuss the latest issues in this growing field of research. PHSSR is aimed at establishing an evidence base to allow public health officials to make smarter, more-informed decisions with regard to resource allocation, staffing, operations and service provision.
NewPublicHealth is on the ground in Kentucky to capture the critical conversations and Q&As from leaders in the field. We spoke with F. Douglas Scutchfield, MD, director of the National Coordinating Center for PHSSR and the Peter Bosomworth endowed faculty in the University of Kentucky College of Public Health, to get his take on where the PHSSR field stands and the anticipated highlights of conference.
NewPublicHealth: What are the critical areas for public health as you head into the Keeneland Conference?
Dr. Scutchfield: I think there are several agendas that will be a backdrop against which Keeneland is taking place. One is a reformed healthcare system, with the Affordable Care Act and its implications for public health and public health’s relations with a variety of other service delivery systems, such as primary care and hospitals.
We will also see the rollout of a new research agenda, published as a supplement to the American Journal of Preventive Medicine,that will give us a new direction to pursue in terms of how we’re going to begin to try improving the infrastructure in the public health system.
NPH: What has been your sense in speaking with colleagues in the field about what kind of research is most in demand for public health leaders and decision-makers right now?
Public health departments have always been on the frontlines of keeping people safe and healthy. But given budget realities, how can they do more with less? And where should they invest to make the most dramatic improvements in people’s health?
The annual Keeneland Conference, which focuses on the increasingly critical field of public health services and systems research (PHSSR), begins today in Lexington, Ky., hosted by the National Coordinating Center for Public Health Services and Systems Research at the University of Kentucky College of Public Health and the Robert Wood Johnson Foundation, and will bring together leading researchers and public health professionals to help begin to answer those questions and more.
This year’s conference features speakers and researchers from across many health and public health fields including Harvey Fineberg, MD, president of the Institute of Medicine, Thomas Frieden, MD, director of the Centers for Disease Control and Prevention, Richard J. Umbdenstock, president and CEO of the American Hospital Association, Ms. Carole Moehrle, chair of the board of directors of the Public Health Accreditation Board.
Key topics at this year’s meeting include the PHSSR research agenda, in development for several years by dozens of contributors from across public health, which Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation of the Robert Wood Johnson Foundation, will announce during the Keeneland Conference; as well as an introduction to Frontiers, a new online PHSSR journal.
Among several important plenary sessions is one on recent Institute of Medicine recommendations on public health financing and the alignment of primary care and public health. Glen Mays, MPH, PhD, professor at the University of Kentucky, will talk about financing, and Lloyd Michener, chair of the department of family and community health at the Duke University School of Medicine, will talk about primary care and public health. Additional participants during those sessions include Robert Pestronk, executive director of the National Association of County and City Health Officials, Paul Jarris, MD, executive director of the Association of State and Territorial Health Officials, and Judith Monroe, MD, director of the Office for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention.
NewPublicHealth is on the ground in Lexington. Follow our coverage of sessions and plenaries as well as interviews with many conference participants including Debra Perez, Richard Umbdenstock, Professor Douglas Scutchfield of the University of Kentucky, Professor Glen Mays and Dr. Fineberg.
Follow the conversation on Twitter at #PHSSRKC12.
Weigh In: Are you tweeting from Keeneland? Let us know!
This week’s final plenary at the AcademyHealth annual National Health Policy Conference focused on the media’s role in health policy and featured Austin Frakt of The Incidental Economist (which is supported in part by the Robert Wood Johnson Foundation), Ezra Klein of the Washington Post and Merrill Goozner of The Fiscal Times. Frakt, a health economist, touched on virtually all of the points the speakers made during the one hour session, in a post on his blog the day of the plenary. Most important perhaps was that researchers need to do more than just issue a press release in order to disseminate their results. “I encourage researchers to get involved on Twitter and blogs. Promote the work of the community when it is timely and relevant,” wrote (and said) Frakt. Ezra Klein, who has an extensive following, invited researchers to email him and not shy away because they think he might be inundated. “Let me manage my inbox,” Klein said.
NewPublicHelath spoke with Frakt about the role of social media in reporting critical health information.
NewPublicHealth: Your training was not in health. What did you do before and did you get into the health field?
Austin Frakt: My training is in physics and engineering. I went through a PhD program in electrical engineering at MIT, and although what I was really doing was kind of applied math, I recognized during my studies that I really was interested in questions pertaining to policy. So I did finish my PhD, and the math and the rigor of it was valuable. I was intrigued by [health policy work at Abt Associates] and that’s where I ended up. It wasn’t that I was, at the time, particularly drawn to health, I just wanted to do something in the policy direction and I was particularly drawn to a rigorous, mathematical kind of evidence-based study.
NPH: And what made you focus on health policy?
AcademyHealth’s Public Health Systems Research Interest Group held a breakfast briefing yesterday, sponsored by the Robert Wood Johnson Foundation, during their National Health Policy Conference this week.
The session, “Evidence Matters: Research Findings to Inform Public Health Policy and Practice,” featured Glen Mays, PhD, the F. Douglas Scutchfield Endowed Professor at the University of Kentucky College of Public Health, and Randall R. Bovbjerg, a Senior Fellow at the Urban Institute’s Health Policy Center. The session was moderated by Paul Wallace, MD, Senior Vice President and Director of the Center for Comparative Effectiveness Research at the Lewin Group.
Paul Wallace pointed to two critical questions:
- What are the strategic opportunities for public health in the health care landscape?
- How do we preserve what we’ve got and anticipate the roadblocks?
Wallace reviewed events and decisions that created the current public health environment:
- Public health and health care delivery have not always been separate domains
- Health care took the biomedical route and left behind the social determinants of health, and “became quite enthralled” with technology
- In 1960 the Rockefeller Foundation made the strategic decision to create schools of public health, creating a philosophical and organizational schism between public health and health care
- The 1966 Fulsome Report looked at what it would take to find the common ground between public health and health care. Since then, every few years the issue of creating better alignment between public health and health care resurfaces, but none of those efforts have stuck.
What’s needed is not to merge or eliminate public health, said Wallace, but to find common ground between the fields. “How do we use public health as a convening area instead of a wrestling ground?”
Next steps discussed during the session include creating shared leadership and recognition that neither health care delivery nor public health is up to the task alone. New solutions are coming out of local experimentation. A good example is Chicago, which is working with public health, health care and other community partners to improve population health. “To be successful in population health, you need to have that third party. It doesn’t matter who it is; it could be schools or social services [for example],” said Wallace.
Glen Mays reiterated the need to make the business case—learning the value of investments in public health to inform policy decisions going forward, and reminded the group that only 3 percent of national spending goes toward public health and preventive services, while 97 percent goes toward medical care, treatment, rehab and long-term care.
Mays also says that public health needs to align themselves with emerging Accountable Care Organizations “because that is where the funding is.”
>>Read more on the value and return on investment in public health and prevention.
Weigh In: How is public health working with health care organizations in your community?
Lawrence Gostin wrote two of the founding books on public health law and developed some of the most influential public health model policies of our time. NewPublicHealth spoke with Lawrence Gostin, JD, Linda D. and Timothy J. O’Neill Professor of Global Health Law at the Georgetown University Law Center and director of the O’Neill Institute for National and Global Health Law, about his keynote address at this week’s Public Health Law Research (PHLR) Annual Meeting and emerging trends in public health law.
>>NewPublicHealth will be covering the PHLR Annual Meeting all week, including Q&As with some of the top researchers and influencers who are presenting. Follow our coverage here.
NewPublicHealth: What do you plan to speak about at the PHLR meeting?
Lawrence Gostin: I’m going to speak about global health law and global health governance. The idea is to talk about something that’s innovative and exciting and I have a proposal for a Framework Convention on Global Health, which is a global health treaty that the UN Secretary General has endorsed and many countries now are on board. So it’s an exciting, fascinating and vital time for global health. We’re really expanding the horizons beyond America to how we can make sure that all the world’s people have good health, and particularly those who are poor and vulnerable.
NPH: That’s very interesting. What is the treaty about?
A key session on the last day of NACCHO Annual 2011 was an invitation to attendees to weigh in on the preliminary research agenda for Public Health Services and Systems Research (PHSSR)--and that invitation is now being extended virtually as well.
Over the last few months, groups of interdisciplinary researchers under the direction of the Robert Wood Johnson Foundation, the Centers for Disease Control and Prevention and the Center for PHSSR Research at the University of Kentucky have worked together to create a preliminary agenda to assess the current state of PHSSR and set an updated research agenda, just posted to the Center’s site. The field of PHSSR helps to address critical limitations that exist in the U.S. public health infrastructure and provide a strong evidence base to help identify what works in public health and to support system improvements.
The preliminary agenda will be online for virtual comments for thirty days, during which users who come to the site are invited to vote on the final agenda items. After the comment period ends, feedback from sessions at public health meetings in the last few months, as well as the online comments now underway, will be used to inform and refine the research agenda. The agenda will be finalized and distributed in fall 2011.
The research categories include workforce; organization and structure; finance and technology; and data and methods.
Before voting, read an issue brief about the research agenda and read the suggestions and comments already posted on the site.
Public Health Systems Research is the discipline that examines the organization, financing, and delivery of public health services and the impact of those activities on population health. The AcademyHealth PHSR Interest Group, which has grown to over 2,000 members, marked its tenth anniversary this week with a series of panel discussions about the field. NewPublicHealth spoke with two key presenters: Paul Erwin, M.D., co-principal investigator of the National Coordinating Center for PHSSR at the University of Kentucky; and Bridget Booske, senior scientist at University of Wisconsin’s Population Health Institutes and deputy director of the County Health Rankings.
NewPublicHealth: What did your presentation highlight?
Paul Erwin: I’m talking about health coalitions and in particular, examining health coalitions from the perspective of their being the organizing corollary for a local public health system. That’s important because health and health outcomes are the result of a number of different complex factors and if we want resolve these major problems, they can’t be solved by one entity alone. It’s all of the organizations, and individuals and entities that impact the health of the public at the community level.
NPH: And what is your current focus at the National Coordinating Center for PHSSR Research?
Paul Erwn: I’m working on providing a practical perspective on research, on the translation of research. In the last few months, we’ve gathered a working group together of people who have experience in the practice and academic worlds to answer questions such as who is successfully translating research into practice, how is it being done, what are the barriers, best practices and models for how we can support the practice world in this key area.
Taking this focus has importance in several key areas such as public health accreditation [which will launch in the fall of 2011.] One of the standards for accreditationhas to do with advancing new knowledge. The work we’re doing now at the Center has implications regarding improving the practice world’s capacity to deliver on this particular standard.
NPH: Bridget, what research did you present to the Interest Group?
Bridget Booske: The work is on media response to the release of the County Health Rankings in 2010, which is very important in terms of trying to engage broad segments of the community. The media is a key resource for reaching other stakeholders. We learned that we got very broad coverage in the better resourced communities, so we have to get more media coverage in less resourced communities. It’s harder to reach small media, but we need to keep working at it.
NPH: In what ways is the media coverage of the County Health Rankings important?
Bridget Booske: We want the media to continue to help us with the initial coverage, of the County Health Rankings, but we also have found that follow-up stories and letters to the editor to continually get the message out will only helps us improve the health of the community.
And it’s not just about getting the governmental public health folks, to write those letters and op-eds; we’ve had pretty attention grabbing op-eds from other key players such as hospital CEOs and head of local chambers of commerce. That’s great. We want to get other voices in there as well.
NPH: What input are you looking forward to from research colleagues at the PHSR Interest Group meeting?
Bridget Booske: I’m looking forward to getting input from other researchers in terms of how we really assess what we’re doing with the County Health Rankings. We have a logic model that says we’re trying to get attention from the media and have people use the information toward broad community attention and then to in turn implement evidence-based policies. We know we can get the media and we need researchers to help us with the rest of the logic model and ultimately to help improve what we do.
Read previous NewPublicHealth.org Q&As with newsmakers and difference makers in public health.