Local Public Health System Capabilities and COVID-19 Death Rates

Abstract

Objectives: Efforts to contain the health effects of the COVID-19 pandemic have achieved less success in the United States than in many comparable countries. Previous research documented wide variability in the capabilities of local public health systems to carry out core disease prevention and control activities, but it is unclear how this variability relates to COVID-19 control. Our study explored this relationship by using a nationally representative sample of 725 US communities. Methods: We used data collected from the National Longitudinal Survey of Public Health Systems to classify each community into 1 of 3 ordinal categories indicating limited, intermediate, or comprehensive public health system capabilities. We used 2-part generalized linear models to estimate the relationship between public health system capabilities and COVID-19 death rates while controlling population and community characteristics associated with COVID-19 risk. Results: Across 3 waves of the pandemic in 2020, we found a significant negative association between COVID-19 mortality and public health system capabilities. Compared with comprehensive public health systems, intermediate public health systems had an average of 4.97 to 19.02 more COVID-19 deaths per 100 000 residents, while limited public health systems had an average of 5.95 to 18.10 more COVID-19 deaths per 100 000 residents. Conclusion: Overall, communities with stronger public health capabilities had significantly fewer deaths. Future initiatives to strengthen pandemic preparedness and reduce health disparities in the United States should focus on local public health system capabilities.

Factors limiting US public health emergency authority during COVID‐19

“…Each state is responsible for assuring the core functions of public health, at times adopting federal guidance 34,35 . Depending on their governance structure, states may wield centralised oversight of state public health, or allocate authority to local public health officials 34–37 . However, when a situation presents that is of concern to the public, leadership at any level of government can declare a public health emergency to implement policies, allocate resources or deploy services 35 …”

“…34,35 Depending on their governance structure, states may wield centralised oversight of state public health, or allocate authority to local public health officials. [34][35][36][37] However, when a situation presents that is of concern to the public, leadership at any level of government can declare a public health emergency to implement policies, allocate resources or deploy services. 35 In 2020, as COVID-19 emerged, spread, and began to strain the U.S. healthcare system, the federal government and every state declared a state of emergency, and all but one state implemented at least one emergency order (e.g., stay-at-home orders, mask mandate, travel restriction) in an attempt to mitigate disease spread.…”

Evaluating Community Capability to Prevent and Control COVID-19 Pandemic in Shenyang, China: An Empirical Study Based on a Modified Framework of Community Readiness Model

“…Some communities have offered sufficient and satisfactory residents' demand-oriented services while other counterparts have not. The variation of the performance is mainly due to the different levels of communities' preventive and controlling capabilities [12]. As a result, the main questions that this research addresses are (i) How can community capability be evaluated in China?…”