Rural, Micropolitan and Metropolitan Differences from the Arkansas Public Health Performance Standards Data

The CDC has spearheaded a national partnership initiative to develop public health performance standards (PHPS) in an effort to strengthen public health practice, systems-based performance, and public health infrastructure. This paper reports some of the results of the assessment in Arkansas. METHODOLOGY: Steering Committees were established to guide the assessment process. Staff received training in use of the NPHPSP "Local Assessment Instrument," and representatives of the "broadly defined public health system" were invited to participate. Participants (1931 statewide) assessed their local public health system against each of ten performance standards and each of thirty-one components included in the standards. Assessment responses were generated through a consensus process in meetings conducted during Jan-Mar 2006. Final scoring of responses was based on an algorithm developed by CDC. Arkansas' scores were compared with national norms from a database of existing local users of the instruments. There have been anecdotal reports that small jurisdictions have been reluctant to use the standards (and to engage in the accreditation movement) for fear they will be disadvantaged by them. Thus, the Arkansas responses were stratified by OMB geographic designations so that the results for Metropolitan, Micropolitan, and Rural areas could be compared. RESULTS: The average population was: 72,626 in 21 counties classified as Metropolitan, 31,440 in 23 Micropolitan counties, and 16,175 in 36 rural counties. Overall, Arkansas' local public health systems exceeded national norms for all 10 PHPS. Further, 81.3% of the state's 75 counties "Met" or "Substantially Met" the PHPS. However, contrary to some expectations, we didn't see large rural-urban disparities in performance. On average rural counties met or substantially met a greater number of standards (7.17) then their Micropolitan (7.11) and Metropolitan (6.90) counterparts [chisquare, p<0.05]. Similarly, on average rural counties "met or substantially met' a greater number of components of the standards (21.81) then their Micropolitan (21.22) and Metropolitan (21.14) counterparts [p, ns]. This trend is partially explained by the number of public health employees per 10,000 population (Metropolitan-5.36, Micropolitan-9.56, Rural-11.32). However, these "average results" mask differences that will be presented. The highest performance levels occurred in Standard-2: Diagnose and investigate health problems (93); Standard-6: Enforce laws and regulations (79), and Standard-3: Inform and educate (78). CONCLUSIONS: Arkansas' data demonstrate the usefulness of the PHPS in guiding improvement activities. The Urban/Rural comparisons show that performance reflects resource allocation and comparable performance in rural and urban areas. Possible reasons for this outcome will be suggested.