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Economic Shocks and Public Health Decision-making: How Can Research Help?

Apr 7, 2011, 6:44 PM

Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today’s contributor is Glen P. Mays, Professor and Chair and director of research for the Department of Health Policy and Management in the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences.

The economic downturn — combined with a shifting political landscape and changing policy priorities — is forcing state and local public health professionals to confront difficult choices on a daily basis.

This raises a series of critical questions:

  • As budget cuts are made, how should public health officials make decisions on which activities to reduce and eliminate so as to minimize population health risks and harm?
  • Are there alternative ways of organizing, staffing and delivering core public health services, so that officials can better produce efficiencies and reduce resource needs?
  • Are there alternative ways of re-allocating the division of labor among state and local agencies, as well as among governmental and private-sector organizations, so as to maximize health protections and minimize costs?
  • How much discretion do public health officials have in using evidence and economic imperatives to reconfigure their delivery systems?

The many uncertainties surrounding these issues create an urgent demand for new research to inform policy and practice. Next week in Lexington, Ky., the 2011 Public Health Systems and Services Research (PHSSR) Keeneland Conference will provide a unique forum for research and practice communities to brainstorm, share preliminary findings and identify improved approaches for applying this type of evidence to the real world.

Among other research, the event will showcase the work of RWJF’s Public Health Practice-Based Research Networks (PBRN), which fields real-time and relevant studies to inform public health decision-making in a time of economic shocks and resource constraints:

  • A recent study from North Carolina demonstrates how local health departments have responded to reduced Medicaid support for maternity case management services by improving delivery efficiency rather than cutting services or clients.
  • Research underway in Colorado demonstrates how public health agencies are utilizing multi-organizational coalitions to deliver chronic disease prevention activities effectively and efficiently.
  • New research from Wisconsin shows that the public health activities most vulnerable to economy-related cuts are those financed through local taxes and not mandated by state law.
  • Research from Florida finds that cross-cutting, infrastructure-related public health capacities (such as surveillance and health assessment) are least likely to be funded by categorical funding streams — and therefore especially vulnerable to economy-related funding reductions.


Several other PBRN studies to be presented at the conference will address barriers and facilitators to evidence-based public health decision-making in the face of economic constraints.

These Keeneland Conference sessions will likely stimulate considerable discussion and debate concerning the health and economic impacts of changes in public health service delivery across the United States, as well as how research can be used to estimate and learn from these effects. Estimating these effects undoubtedly will require longer time lags and additional analytic horsepower, but studies to accomplish these tasks are already underway.

PBRNs are a relatively new concept within public health, operating “below the radar” in many communities. Nevertheless, they may prove to be the missing ingredient needed to drive science-based improvements in practice and practice-relevant advances in science. Researchers and practitioners who share this vision of an evidence-producing community of practice should be sure to attend the conference sessions and get involved.

Follow coverage of the 2011 PHSSR Keeneland Conference on NewPublicHealth.org and Scutch’s Blog.

Throughout the conference — April 12-14 — you can also get real-time updates on Twitter from @RWJF_PubHealth and @CPHSSR. Use the hashtag #PHSSRKC11.


This commentary originally appeared on the RWJF New Public Health blog.