Public Health Systems and Services Research: Building the Evidence Base to Improve Public Health Practice

Abstract

Public health services and systems research (PHSSR) is the American designation for a field that uses a number of research disciplines and perspectives to examine the organization of public health systems, how they are financed, how they deliver public health services, the quality and costs of services they deliver, and the impact of variations in all these areas on population health; it is closely related to health services research (HSR), and uses many of the same methods as HSR. This article traces the developmental path of PHSSR, identifies organizations that have been critical in its growth, provides examples of PHSSR that demonstrate the potential it has to improve public health practice, and discusses the future of PHSSR and the use of PHSSR to influence public policy. While there have been sporadic attempts to examine the public health system in the United States since the early 20 th century, PHSSR has only been a formally recognized area of scientific inquiry since the early 2000s. PHSSR has experienced rapid growth, and evolved from mainly descriptive research to inferential research, and towards yielding results that suggest causation rather that correlation. While PHSSR as a field shows great promise to improve public health practice, in order for it to fulfill that promise it is vital that PHSSR produce results that are of use to the practice and policy making communities.

Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform

“…5 Public health systems are composed of public-sector and non-governmental organizations. Although much PHSSR research had historically been based in the US, PHSSR is gaining strength in Canada, notably through the Core Public Health Functions Research Initiative in British Columbia, which has led to the development of a Canadian PHSSR agenda and to several interprovincial research projects.…”

“…Although much PHSSR research had historically been based in the US, PHSSR is gaining strength in Canada, notably through the Core Public Health Functions Research Initiative in British Columbia, which has led to the development of a Canadian PHSSR agenda and to several interprovincial research projects. 5,6 Improving performance should be a key goal of any public health systems reform. Performance is a multifaceted concept: in Table 1, we adapt Handler and colleagues' public health performance framework 7 in order to summarize elements and dimensions of performance often reported in the PHSSR literature, notably productivity, effectiveness, efficiency and equity.…”

“…Performance is a multifaceted concept: in Table 1, we adapt Handler and colleagues' public health performance framework 7 in order to summarize elements and dimensions of performance often reported in the PHSSR literature, notably productivity, effectiveness, efficiency and equity. 3,5,6,[8][9][10][11][12][13][14][15][16] Productivity is the relationship between structures and resulting…”

“…These factors are also consistently documented in leading peer-reviewed longitudinal studies, 15,16 and PHSSR analyses. 5,10,14 PHSSR is complex and common limitations may affect these findings. First, a majority of PHSSR performance studies to date are cross-sectional, restricting our ability to draw causal relationship.…”

Defining and Assessing Public Health Functions: A Global Analysis

“…The response from the public health community in the United States culminated in the publication of Healthy People 2000, which set a new course for public health management in the United States (31,47). Over the next decade, public health agencies and researchers have proposed different ways of articulating these functions into practice-based measurements, including the 10 organizational practices of public health (15), the Miller/ Turnock 20 (54), and the Essential Public Health Services (EPHS) (8).…”