Sergey Sotnikov, PhD¹, Natalie Perry, DrPH¹, Dennis D Lenaway, MPH, PhD¹, Paul Halverson, DrPH, MHSA², and Ramal Moonesinghe¹. (1) Division of Public Health Systems Development and Research, Public Health Practice Program Office, Centers for Disease Control and Prevention, 2877 Brandywine Road, MS K-39, Atlanta, GA 30341, 770-488-2528, ann0@cdc.gov, (2) Public Health Practice Program Office, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-39, Atlanta, GA 30341-3724

Introduction: Human, financial, capital and other resources that are essential for delivery of public health services are not evenly distributed across rural and urban pubic health systems. This presentation intends to provide quantitative evaluation of the effects of rural/urban variations in the public health infrastructure capacities on performance of rural and urban public health systems.

Methods: We developed a statistical model in which public health systems performance scores are used as dependent variable. Four major elements of public health infrastructure (funding, labor force, informatics and organizational capacities) represented a set of explanatory variables. Performance data were obtained from National Public Health Performance Standards Program (NPHPSP) and covered 147 rural and urban health systems in three states. The 1996 NACCHO survey of public health infrastructure, Area Resource Files and CDC Health Alert Network program were the main sources of data for independent variables.

Results: Our analysis suggested that the major reason for rural/urban differences in performance of public health systems is the rural/urban gap in information technology. The joint effect of staffing levels, public health expenditures, educational level of a pubic health agency’s director and various organizational capacity and partnership measures has been also found to influence performance at statistically significant level. However, individual contribution of these factors to potential improvements in public health system performance was relatively minor.

Conclusions: Better Internet connectivity is a key factor that can effect performance improvements in rural public health systems. Also, support to public health systems need to be balanced, i.e. addressing the needs of all four major elements of the public health infrastructure.

Learning Objectives: Learning objectives

• Gain a better understanding of factors explaining rural-urban differences in health system performance.
• Identify elements of public health infrastructure in rural areas that need priority development.

Keywords: Performance Measures, Essential Public Health Services

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.