Objectives: Public health system capital is defined by the scope of population health activities, network of multi-sector relationships, and coordination of actions that contribute to the implementation of core public health activities. A better understanding of public health system capital changes over time can lend the evidence needed to improve and strengthen the nation’s capacity to deliver public health services. This study presents an empirical method for classifying and comparing how public health delivery systems change over time.
Methods: We use a unique longitudinal dataset that combined the 2012, 2014, and 2016 waves of the National Longitudinal Survey of Public Health Systems. We use Sequence Analysis to identify and examine the various pathways by which public health delivery systems in the U.S. change over time.
Population Studied: Local governmental health agencies in the U.S.
Results: We identify several pathways for how public health system capital changes over time: (1) stable comprehensive; (2) increasing to comprehensive; (3) decreasing to conventional; (4) stable conventional; (5) increasing to conventional; (4) decreasing to limited; and (5) stable limited. Results also suggest that communities with public health systems that are stable comprehensive or increasing towards comprehensive are more likely to have a local board of health, higher per capita public health expenditures, younger population, lower poverty rate, and less uninsured.
Conclusion: The typology developed in this analysis can be used to inform policy that improves the structure of public health delivery systems in expanding the availability and effectiveness of activities that improve population health.