Center Research

About the Research

Systems for Action (S4A) is a national program of the Robert Wood Johnson Foundation (RWJF) that aims to discover and apply new evidence about ways of aligning the delivery and financing systems that support a Culture of Health.


Affordable Care Act Implementation and Multi-Sector Contributions to
Public Health Delivery Systems

Principal Investigators: Glen P. Mays, PhD, MPH & James P. Ziliak, PhD

The Affordable Care Act established new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the degree and nature of change in multi-sectoral contributions to public health activities; and (2) the extent to which these system changes are attributable to key ACA provisions including coverage expansions, Prevention and Public Health funding, and adoption of public health accreditation standards.

National Longitutindal Survey of Public Health Systems

Principal Investigator: Glen P. Mays, PhD, MPH

Since 1998, the National Longitudinal Survey of Public Health Systems (NLSPHS) has followed a nationally representative cohort of U.S. communities to  measure the implementation and impact of multi-sector population health improvement activities. The survey asks local public health officials in each community to report information on a set of 20 activities that are nationally recommended for monitoring, protecting and improving health status at the population level.