From Measuring to Improving Public Health Practice

Abstract

Efforts to measure public health practice have taken on various forms and focused on different aspects of the system of public health practice over the past century. Before 1990, measurement was primarily based on a series of self-assessment instruments initiated under the auspices of the Committee on Administrative Practice of the American Public Health Association. These instruments emphasized measurement of immediate results of local public health services although they also provided information on local resources and capacity to perform. Following the Institute of Medicine's report in 1988, efforts began to focus on performance related to public health's core functions. These more recent assessments suggest that the system of public health practice must be improved to achieve the targets of effectiveness established for the year 2000. Ultimately, a comprehensive national surveillance system for public health practice will need to both measure and examine the relationships among inputs (resources, capacity, etc), core function-related processes, outputs (services) as well as outcomes.

Public Health Quality Measurement: Concepts and Challenges

“…However, there is a potential pitfall in defining public health for measurement purposes-a definition that simply, and empirically, mirrors current tasks in some LHDs may lack generalizability to other LHDs or may inadvertently help perpetuate outdated services. This can be a problem, especially since over the past century the U.S. public health system has sometimes experienced difficulties in adjusting to changing population health needs (e.g., the AIDS epidemic) and in adopting technological transformations (e.g., information technologies) (54,77).…”

“…The American Public Health Association (APHA) developed two important measurement tools: the APHA Appraisal Form and subsequently the APHA Evaluation Schedule. Both tools focused primarily on the services that LHDs and other agencies provided and were used to rate and compare LHD performance (77). The Appraisal Form is a means of voluntary self-evaluation that was developed in 1925 to formally assess citywide public health practices (8,9).…”

Recent Advances in Public Health Systems Research in the United States

“…This review of recent advances in public health systems research (PHSR) in the United States since 1988 updates a previous Annual Review article that described the long history of efforts to measure public health functions and effects since 1900 (94). In the current review article, the public health system is defined as the collective resources, infrastructure, and effort of all public, private, and voluntary entities and their respective roles, relationships, and interactions that contribute to the delivery of essential public health services to the population within a jurisdiction (21).…”

“…The myriad changes that have occurred in public health since that report's publication have been described elsewhere and are not repeated in this review (94). We note, however, that the emphasis of the 1988 IOM report on the governmental roles of assessment, policy development, and assurance became the new public health mantra; and many changes in the practice of public health and the public health system occurred as the result of the report's recommendations.…”

Public Health Systems and Services Research: Bridging the Practice-Research Gap

“…This need has led to emergence of the field of public health systems and services research (PHSSR). While the science of attempting to improve the administration and management of LHDs has a long history, well described in an article by Turnock et al, 16 the development of a scientific research discipline focused on the proper ways to organize, finance, and administer public health organizations or systems is relatively new. Several editorials and commentaries have focused on the definition and character of public health systems and services research to explain and define the field.…”