Publications | S4A

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. Since 1998, the National Longitudinal Survey of Public Health Systems or NALYSYS has followed a nationally representative cohort of U.S. communities to measure the implementation and impact of multi-sector population health improvement activities. The following studies were conducted by the S4A intramural team using NALSYS data.

Equity-Focused Efforts of Local Public Health Systems and Disparities in Community Health

Disparities in health delivery continue to act as barriers to equitable outcomes in health. Public health system efforts connect local health systems to their network and community members. Public...
The Growing Divide in the Composition of Public Health Delivery Systems, in US Rural and Urban Communities, 2014-2018

We examined changes in the scope of activity and organizational composition of public health delivery systems serving rural and urban U.S. communities between 2014 and 2018. Urban public health...
Evaluating Inclusiveness in Multi-Sector Public Health Networks: The Case of Tribal Organizations

Public health networks that include tribal organizations have the potential to better serve American Indian/Alaskan Native residents living in and outside of tribal lands. In this study, we aim to...
Investigating the Dynamics of Local Public Health System Capabilities and its Implications on Public Health

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...
Health Reform Implementation and Comprehensive Population Health Systems

The Affordable Care Act began in 2011 to establish new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion...
Preventable Death Rates Fell Where Communities Expanded Population Health Activities Through Multisector Networks

The US health system faces mounting pressure to improve population health. Research suggests a need for greater coordination and alignment across the sectors that deliver medical, public health, and...
Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities

Preventable health conditions account for more than 75 percent of annual health care expenditures in the U.S., yet less than 5 percent of these expenditures are devoted to public health programs and...
Multi-Sector Population Health Activities Reduce Income-related Disparities in Life Expectancy

Landmark research by Raj Chetty and colleagues at Health Inequality finds wide geographic and intertemporal variation in the relationship between income and life expectancy in the U.S., using 1.4...
The Effect of Uncompensated Care Costs on Hospital Contributions to Population Health Improvement Activities

The Affordable Care Act (ACA), along with Medicaid expansion, was expected to reduce the rising burden on hospitals from uncompensated care provision to uninsured people while creating new resources...
Rural vs. Urban: Differences in the Implementation of Population Health Activities

Research indicates that the United States lags behind other high-income countries in public health. This lag relates directly to variable health system quality across U.S. communities, which have...
Classifying Multi-Sectoral, Multi-Organizational Health Communication Networks

Facilitating population health and well-being requires organizations and individuals to share information and strategies across systems. Local public health agencies, healthcare providers, and their...