Overview

New research from Systems for Action investigators at Johns Hopkins University analyzed state government expenditure data collected by the U.S. Census Bureau to estimate U.S. public health spending and found that the official government estimate (Public Health Activity Estimate) is an overestimation of how much is spent on public health. This heightens concerns about spending priorities: the U.S. spends far more on individual medical care than public health programs.

The results of this S4A study can inform decision-making about investments in public health to support COVID-19 response and recovery. Read the one-page report for more key findings and recommended action.

The research team at the University of Chicago is piloting a randomized controlled trial to establish and begin to evaluate a new model of care: the Comprehensive Care, Community and Culture Program (C4P). 

C4P seeks to both address social determinants of health and empower patients to better help themselves. In addition to receiving care from a physician in both the hospital and the clinic, C4P patients are regularly assessed for unmet social needs, such as housing, food insecurity, public benefits, social engagement. C4P patients also receive access to a community health worker to help address their unmet needs.

Read how the program improved health for older adults while reducing health care costs. The brief reviews what solution was tested, the research findings and recommendations for action based on this evidence. 

A growing body of research demonstrates that networks of community organizations, working together, can have profound effects on the health trajectories and social determinants of health. Evidence indicates that health and social interventions are more likely to succeed when they are implemented through strong multi-sector networks. To identify pathways for improving rural health, the Systems for Action Intramural Research Team used data from the National Longitudinal Survey of Public Health Systems to compare the structure and function of community networks in rural versus urban settings, and tracked changes in these networks over time. 

Read the evidence brief for the full findings and recommended action based on this evidence.

The Delaware Culture of Health Project aimed to increase healthcare access for the probation population by aligning health and social service systems. 

Key elements of the intervention included:

• a health navigator in the probation office to screen and refer probationers
• a cross-system “change team” to connect and empower multiple agencies
• an informational resource guide with health-related information
• a monetary incentive

Read how these strategies were associated with an increase in the proportion of individuals accessing care through a primary care physician. The brief reviews what solution was tested, the research findings and recommendations for action based on this evidence.

Details

Project: Implementing a Culture of Health among Delaware's Probation Population
Resource: Download
Date: 08/24/2020

Overview

The Delaware Culture of Health Project aimed to increase healthcare access for the probation population by aligning health and social service systems. 

Key elements of the intervention included:

• a health navigator in the probation office to screen and refer probationers
• a cross-system “change team” to connect and empower multiple agencies
• an informational resource guide with health-related information
• a monetary incentive

Read how these strategies were associated with an increase in the proportion of individuals accessing care through a primary care physician. The brief reviews what solution was tested, the research findings and recommendations for action based on this evidence. 

Overview

S4A investigators at Johns Hopkins University highlight the profound, systems-level issues that constitute the state of rural public health from the 1980s until the present day in the American Journal of Public Health Rural Health.

Read "The State of Rural Public Health: Enduring Needs in a New Decade" here.

Jonathon P. Leider et al. “The State of Rural Public Health: Enduring Needs in a New Decade”, American Journal of Public Health 110, no. 9 (September 1, 2020): pp. 1283-1290. https://doi.org/10.2105/AJPH.2020.305728

Overview

In "Exploring the capacity of community-based organisations to absorb health system patient referrals for unmet social need", the research team highlights potential strategies for strengthening system alignment as organisations continue to develop unmet social need referral strategies.

To read the article in full, click here.

Hogg‐Graham, R, Edwards, K, Ely, TL, Mochizuki, M, Varda, D. Exploring the capacity of community‐based organisations to absorb health system patient referrals for unmet social needs. Health Soc Care Community. 2020; 00: 1– 9. https://doi.org/10.1111/hsc.13109

Overview

S4A investigator JP Leider, PhD explains how COVID-19 has brought renewed media attention on the issue of underinvestment in public health spending in the United States.

Read Dr. Leider's commentary "Yet Another Post on Public Health Spending" in JPHMP Direct.

Overview

S4A investigators examine the need for improved systems alignment through the lens of Thomas Frieden’s “health impact pyramid, and catalog the types of misalignments and their social, political, and systems genesis. They also identify promising opportunities to realign US health spending toward the socioeconomic factor base of the health impact pyramid and emphasize the need to integrate and align public health, social services, and medical care in the United States.

Read the full article in the American Journal of Public Health's special supplement "Testing New Ways of Connecting the Nation's Fragmented Medical, Social, and Public Health Systems".

J. Mac McCullough, Jonathon P. Leider, Beth Resnick, David Bishai, “Aligning US Spending Priorities Using the Health Impact Pyramid Lens”, American Journal of Public Health 110, no. S2 (July 1, 2020): pp. S181-S185.

Overview

S4A investigators examine the accuracy of official estimates of U.S. governmental health spending by coding administrative spending records from 2000 to 2018 for public health activities according to a standardized Uniform Chart of Accounts.

Read the full article in the American Journal of Public Health's special supplement "Testing New Ways of Connecting the Nation's Fragmented Medical, Social, and Public Health Systems".

Jonathon P. Leider, Beth Resnick, J. Mac McCullough, Y. Natalia Alfonso, and David Bishai, 2020: Inaccuracy of Official Estimates of Public Health Spending in the United States, 2000–2018 American Journal of Public Health 110, S194_S196, https://doi.org/10.2105/AJPH.2020.305709