Objectives. To examine changes in the scope of activity and organizational composition of public health delivery systems serving rural and urban US communities between 2014 and 2018. Methods. We used data from the National Longitudinal Survey of Public Health Systems to measure the implementation of recommended public health activities and the network of organizations contributing to these activities in a nationally representative cohort of US communities. We used multivariable regression models to test for rural–urban differences between 2014 and 2018. Results. The scope of recommended activities implemented in rural areas declined by 3.4 percentage points between 2014 and 2018, whereas it increased by 1.4 percentage points in urban areas. The rural–urban disparity in scope of activities grew by a total of 4.8 percentage points (P < .05) over this time. The disparity in network density grew by 2.3 percentage points (P < .05). Conclusions. Urban public health systems have enhanced their scope of activities and organizational networks since 2014, whereas rural systems have lost capacity. These trends suggest that system improvement initiatives have had uneven success, and they may contribute to growing rural–urban disparities in population health status.
Objective
To quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement.
Data Sources
We used 2018 National Longitudinal Survey of Public Health Systems data, a nationally representative cohort of the US public health systems.
Study Design
Social network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities. Two‐part regression models estimated predictors of tribal engagement.
Data Collection
A stratified random sample of local public health agencies was surveyed, yielding 574 respondents. An additional cohort of oversampled respondents was also surveyed to include jurisdictions from the entire state upon the request of their respective state health departments (n = 154). Analyses were restricted to jurisdictions with a nearby American Indian and Alaska Native (AI/AN) serving health facility, yielding a final sample size of 258 local public health systems.
Principal Findings
When an AI/AN serving health facility was present in the region, tribal organizations participated in 28% of public health networks and 9% of implemented public health activities. Networks with tribal engagement were more comprehensive in terms of the breadth of sectors and social services participating in the network and the scope of public health activities implemented relative to networks without tribal engagement. The likelihood of tribal engagement increased significantly with the size of the AI/AN population, the presence of a tribal facility with Indian Health Service funding in the region, and geographic proximity to reservation land (p < 0.10).
Conclusions
The vast majority of public health networks do not report engagement with tribal organizations. Even when AI/AN serving health facilities are present, reported engagement of tribal organizations remains low.
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