Advancing a Public Health Services & Systems Research Agenda in 2024

Posted on September 5, 2024 by Hank Stabler

This entry is part 47 of 63 in the series Wide World of Public Health Systems

Advancing research that can provide answers to the research questions from the PHSSR cross-sector partnership domain will undoubtedly improve how public health agencies and organizations partner with other stakeholders and potentially leverage these partnerships to address gaps in public health services.

In December 2023, AcademyHealth, in collaboration with the American Public Health Association and with funding support from Kaiser Permanente, released a research agenda centered on advancing the field of public health services and systems research (PHSSR). Recognizing that AcademyHealth has focused on advancing health services research since its inception, this foray into identifying a comprehensive research agenda for the “sister discipline” (pg. 3) of public health systems research signifies a recognition from a leading US health services research organization that a well-functioning health system is fundamentally incompatible with a poorly functioning public health system. Based on the input of public health professionals, policymakers, and researchers across the US, the agenda focuses on seven domains: cross-sector partnerships & engagement; data information technology; financing & resources; workforce; law & governance; communication & narrative; and health equity. Within each domain are a series of key research questions that the participating researchers felt were most pressing for public health systems research to address.

This identification of a comprehensive PHSSR agenda is sorely needed. The domains cover basic, foundational concepts and functions to public health, but many of them lack empirical evidence that can inform what best practices are for public health agencies and organizations to consider and/or adopt. Take, for example, the cross-sector partnerships and engagement domain. While there are innumerable models of collaboration between public health and stakeholders from other sectors, there is very little research that explicitly ties multisectoral collaboration to improved community health outcomes that can be generalized across communities. We also need to know much more about the optimal process for public health-led collective efforts to take when it comes to engaging and integrating communities into leadership and decision-making positions, which we know is important for ensuring community buy-in to any subsequent public health intervention. Advancing research that can provide answers to the research questions from the PHSSR cross-sector partnership domain will undoubtedly improve how public health agencies and organizations partner with other stakeholders and potentially leverage these partnerships to address gaps in public health services.

The COVID-19 pandemic brought renewed attention to the need for a well-resourced public health system after many years of austerity had eroded health agencies’ ability to provide a basic level of service. During and after the pandemic, the level of available funding for health agencies increased substantially and provided agencies with financing that they had lacked for many years. Measuring the effects of this short-term increase in funding across the range of research domains laid out in the AcademyHealth PHSSR research agenda – and the potential impacts on community health — is absolutely critical. Many of the grant programs that injected needed funding into the public health system, such as the Public Health Infrastructure grant, are due to expire in the coming years and likely will not be replaced. Moreover, the Centers for Disease Control & Prevention (CDC), a primary funder of public health in the US, is also facing a 22% reduction in the department’s 2025 budget. We need PHSSR empirical findings now to at least inform policymakers of what we have learned about the benefits associated with investing in public health and avoid a return to the days of austerity.

We must also be realistic when it comes to the current state of PHSSR. Much like the sector it studies, PHSSR has seen a slow but substantial decrease in available resources to fund needed research studies. As discussed by Erika Martin and Betty Bekemeier in 2021 in their blog post for Health Affairs, PHSSR as a field had significant resources dedicated to it in the early 2000s and 2010s, including earlier iterations of a national research agenda; a national PHSSR research center that advanced and funded hundreds of PHSSR research grants; established mentored research development awards; a dedicated research journal; and a collaborative infrastructure in the form of several PHSSR-focused conferences. Much of this infrastructure no longer exists.

Some essential PHSSR resources are still readily available to researchers. The PHSSR data infrastructure that was established within the past two decades, such as the Public Health Workforce Interests and Needs Survey and the National Profile of Local Health Departments, have continued unabated and will be crucial for addressing the questions in the AcademyHealth research agenda. At the University of Minnesota Center for Public Health Systems (CPHS), we also house the Public Health Workforce Research Center (PHWRC). With funding from the CDC and the Health Resources and Services Administration and in partnership with public health systems researchers across the country, the PHWRC has worked to provide answers to the research questions identified by the AcademyHealth PHSSR research agenda.

Still, there is so much research needed to improve our public health system, now and in the long term. Again, much like the public health system that we study, PHSSR will probably need to get creative when it comes to finding resources to conduct our research. Perhaps we can better leverage the results of the external program evaluation results that are conducted on public health interventions across the country; currently, for example, the CDC recommends grantees allocate at least 10% of their budget towards program evaluation efforts. At CPHS, we have been able to utilize the evaluation of Minnesota’s Public Health AmeriCorps grant to better understand how we can best integrate programs like AmeriCorps into governmental public health agencies to support agencies’ public health capacity. While we can hope that public or private resources will be made available to advance PHSSR, innovative approaches will also be needed to address the research questions laid out by the AcademyHealth research agenda.

About the Author

Hank Stabler: Hank Stabler, PhD, is a researcher with the UMN Center for Public Health Systems with experience in program evaluation, policy analysis, and mixed methods research. Dr. Stabler’s research interests relate to hospital-community relationships and multisectoral collaboration. He holds a PhD from the University of Minnesota’s Health Services Research, Policy, & Administration program with a focus on Health Policy, and an MPH from the University of Michigan.