Public Health System Performance Measurement: Are Standards Applicable to Rural Communities?

Research center:
Lead researcher:
Project completed:
December 2004
This project aims to increase understanding of how public health governance affects the structure of public health services, and how this in turn influences the strategies adopted for meeting community public health needs in rural areas. Since the early 1990s, public health advocates have been concerned about how a national health care plan might incorporate or co-exist with public health care functions.

A list of 10 essential services of public health was developed by the CDC. Recently, work has focused on formulating a systematic strategy for measuring public health practice with respect to these services at both the state and local levels. Many "public health" functions are conducted, at least in part, by hospitals, private practice physicians, and community groups as well as a variety of entities that are not focused strictly on health. The division of responsibilities in a community may result from state regulation, historical practice, local political dynamics, or other factors. With respect to public health practice, public health systems in rural areas differ from those in urban areas in terms of scope of services and functions, in part due to differences in the level of resources available (resulting in lower staffing levels and fewer specialized capabilities) and in part based on geography (i.e., the size of the area covered and geographic isolation). How these distinctly rural features combine with state public health governance and local features to meet local public health needs is not well understood.

The Walsh Center conducted a series of case studies of several states to address the following policy questions:

  • What are the different state-mandated structures for delivery of public health services?
  • How do these structures differentially affect rural and urban areas within a state?
  • How do different structures influence the type of services provided and the mix of resources available to rural communities?
  • How does the structure affect the range of entities providing public health services (e.g., community health centers, hospitals, community groups)?
  • What are the differences among rural communities that affect their ability to function effectively over time with respect to public health function?

A report and policy brief will be prepared for distribution to policymakers and persons on the Center mailing list.