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Disparities in Public Health Resources in the Delta

Disparities in Public Health Resources in the Delta. Implications for Regionalization. Glen P. Mays, PhD, MPH Department of Health Policy & Management UAMS College of Public Health. Background: Local Public Health Resources and Performance.

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Disparities in Public Health Resources in the Delta

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  1. Disparities in Public Health Resources in the Delta Implications for Regionalization Glen P. Mays, PhD, MPHDepartment of Health Policy & ManagementUAMS College of Public Health

  2. Background:Local Public Health Resources and Performance • Wide variation in services performed by local public health systems • Wide variation in funding sources and levels for local public health services • Pressure for improving the effectiveness and efficiency of public health delivery

  3. Variation in Local Public Health Spending Median 20% 15% 10% 5% 0% Percent 0 100 200 300 Expenditures per capita, 1996-7 NACCHO, 1997

  4. Local Public Health Funding Sources NACCHO, 1997

  5. Variation in Local Public Health System Performance Performance of Local Public Health Systems, 1998 Mays et al. AJPH 2004

  6. Performance Varies with Size of Public Health Jurisdiction Spline Regression Estimates After Controlling for other Variables in the Model Investigate Inform Monitor Policy/plan Partnerships Mays et al. AJPH 2006

  7. Performance Varies with Local Per Capita Spending Percentage point  Mays et al. JPHMP 2004

  8. Rationale for Studying Public Health Resources in the Delta • Residents of the rural Lower Mississippi Delta experience disproportionately poor health and economic outcomes • Long history of failed interventions • Effective interventions require adequate public health infrastructure • Maintaining adequate infrastructure is difficult in small and rural communities

  9. IL MO KY TN AR MS AL LA The Delta Region Counties included in the 8 Lower Mississippi Delta states

  10. The Delta Region Population Characteristics of the Delta Region

  11. Study Objectives • Assess the extent and nature of disparities in public health resources in the Delta • Simulate the impact of regionalizing public health service delivery by pooling resources across small neighboring communities

  12. Methods • Data from a national survey of local public health officials conducted in 1998 (N=497, response rate 78%) • public health activities performed within the community • local public health agency expenditures • local public health agency staffing levels • Use regression models to compare spending and staffing levels between Delta and Non-Delta communities while controlling for differences in economic, health, and social characteristics • Simulate the effects of regionalization using regression estimates of how local spending and staffing levels affect the performance of public health activities in the community

  13. Regional Disparities in Public Health Spending in the Delta Unadjusted Estimates of Local Public Health Spending per Capita

  14. Regional Disparities in Public Health Spending in the Delta Estimates of Local Public Health Spending per Capita Adjusted for Community Characteristics Affecting Need

  15. Regional Disparities in Public Health Staffing in the Delta Unadjusted Estimates of Local Public Health Staffing Ratios

  16. Regional Disparities in Public Health Staffing in the Delta Estimates of Local Public Health Staffing Ratios Adjusted for Community Characteristics Affecting Need

  17. Simulated Effects of Consolidation Predicted Change in Public Health Performance Scores Due to Consolidation of Jurisdictions with <25,000 Residents

  18. Conclusions and Implications • Significant disparities in resources exist in the Delta region, but they are confounded by differences in community need • Inadequate public health resources may complicate efforts to develop sustainable interventions • Regionalized public health service delivery arrangements that allow agencies to pool their resources may help to address constraints

  19. Conclusions and Implications • A variety of organizational arrangements may prove helpful • Shared services • Mutual aid agreements • Joint ventures/alliances • Formal consolidation/mergers

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