Changes in public health programs over time…and how they relate to disparities in mortality

Background: Local health departments (LHD) and their leadership are in “pivotal positions” to reduce health disparities through prevention programs such as communicable disease control, food safety, and maternal child health services, yet LHD activities vary and have changed over time. We know little, however, about how changes in service impact health outcomes or what types of public health services most effectively reduce health disparities. We investigated changes in LHD services how these changes are associated with changes in mortality disparities. Methods: We conducted a regression analysis of secondary data with an exploratory panel time series design. While controlling for other factors, we used LHD services to estimate associations between changes to services and changes in 1993-2005 Black-White disparities for mortality. Services directly provided by LHDs were examined relative to change in breadth of activity within each of 10 domains of service and whether domains increased, decreased, or maintained breadth of activity from 1993 to 2005. The sample studied was made up of 558 counties, representing county-level data for LHDs and their jurisdictions. Results: The LHDs in 71.8% of the counties in the study sample, maintained or decreased the breadth of service in a majority of the program domains in their departments. There were no significant relationships with change in Black-White mortality disparities by jurisdictions characterized as those that tended to increase the breadth of their services (28%) versus those that remained stable/declined across the broad set of services. Specific increases in the breadth of Maternal Child Health activities and in the breadth of Health Services (e.g. primary care, mental health), however, had significantly beneficial relationships with reductions in Black-White mortality disparities for 15-44 year olds. Conclusions: Nurses are the largest discipline making up our public health workforce and the discipline most often serving as the chief executives within LHDs. LHD leaders are eager for evidence to support just decision-making regarding changes made to local service delivery that may disproportionately impact the populations they serve. Study implications suggest that services such as maternal child health and primary care, may be particularly important investments for reducing disparities among young adults.