The new PHSSR research agenda aims to help build “the evidence base that lays the foundation for and demonstrates the value of a high-performing public health system leading to improved health outcomes for all.”

As public health leaders have found, it is hard to fight a pandemic and subsequently “reimagine” our public health systems absent adequate evidence on optimal strategies for building and sustaining high-performing public health systems. Yet, much like our public health systems themselves, we entered the pandemic with an outdated and underfunded body of evidence to guide and support the effective delivery and performance of public health practice. But efforts have been underway to reimagine public health services and systems research (PHSSR) to support the evolution of our post-pandemic public health systems.  

PHSSR is the field of study that generates the evidence needed to guide the development and maintenance of effective governmental public health practice, policy, and infrastructure. Since early in this century public health practitioners and policy makers have used the evidence generated through PHSSR for building and strengthening its voluntary accreditation system through the Public Health Accreditation Board, demonstrating the association between public health system structures and population health capabilities, showcasing transformation and innovation in public health, measuring performance, understanding the public health workforce and funding needs, assessing public health interventions to address structural racism, showing return on investment, and much more. Renewed attention was needed, however, to the research questions relevant to practice and the funding needed for this area of study.

In January 2023 AcademyHealth initiated a year-long process, funded by Kaiser Permanente and in partnership with the American Public Health Association, to build from the field’s 2012 PHSSR Research Agenda and create a new, updated agenda that will drive new funding and evidence to guide a reimagined public health system. The three-phase process included multiple engagement points that engaged over 200 participants with audiences of public health practitioners, researchers, policymakers, healthcare partners, funders, and others. Oversight was provided by a Guiding Council of 16 public health leaders that included representation from academic PHSSR, funding institutions, public health associations, community organizations, policy groups, and health departments. The three phases of engagement included 1) a literature review and key informant interviews to “Scope and Frame” the process; 2) a deliberative dialogue of 56 attendees to “Ideate and Validate”  research domain definitions and explore preliminary questions which were subsequently used in a digital process with a larger group of participants to refine and prioritize questions; and 3) a cross-agency salon with representatives from federal agencies that are past or potential future funders of PHSSR studies to “Activate and Sustain” momentum.

The new PHSSR research agenda aims to help build “the evidence base that lays the foundation for and demonstrates the value of a high-performing public health system leading to improved health outcomes for all.” The agenda includes seven domains, each with a prioritized list of research questions. Five of these domains were similar to those in prior research agendas from 2004 and 2012. These five were Cross-sector Partnerships & Engagement, Data & Information Technology, Financing & Resources, Workforce, and Law & Governance. Two additional domains emerged as areas with growing attention for public health systems. One of these–Communication & Narrative—was identified as a new area of emphasis given the need for research regarding effective public health communication in a politically polarized environment. The second of these—Health Equity—was repeatedly embedded in questions in the other domains and was of consistently high interest among participants. Health Equity was, thus, made both a standalone cross-cutting domain with its own list of questions and a core principle to embed throughout PHSSR.

This research agenda is an opportunity to garner the support of funders and in a way that aligns with evidence needed to be responsive to community needs, relevant to the real-world demands of public health practitioners, and amenable for integration into public health policy. The next steps for making use of this agenda are key. A webinar held in February 2024 helped launch the new agenda and related report to an audience of funders, researchers, and others. Subsequent conference presentations will also be held. But this agenda requires actions taken by academics, policymakers, funders, and practitioners to fund the research, generate studies, engage in practice-based research and policymaking, assure practical applications, mentor new investigators, and grow the field of PHSSR. Only with ongoing attention to all of these audiences and actions will we truly make highest use of this first step in reimaging PHSSR toward assuring a high performing, equity-focused public health system that integrates lessons learned from the COVID-19 pandemic.

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Erika Martin, PhD, MPH, is Vice President of Research and Product Development at the Public Health Accreditation Board. Her research uses quantitative and qualitative methods to evaluate programs and policies, with expertise in public health services and systems, infectious disease, public health data systems and open data platforms, and evidence-based practice. She has extensive experience collaborating with public health partners to transform scientific findings, data, and tools into program impact. Articles she’s written have appeared in leading health and public policy journals such as the New England Journal of Medicine, JAMA, Journal of the American Medical Informatics Association, Health Affairs, American Journal of Public Health, and Journal of Policy Analysis and Management.