Public Health Service Disparities: An issue of social justice

There has been significant work completed on the factors that contribute to health care disparities, highlighting both disparities by geographic areas and demographic sub-groups. However, there has been limited analysis of this type of disparity with regard to basic public health services. The existing analysis of the quality of local health departments by NACCHO and the Public Health Accreditation Board are important components in the effort to strengthen the country's public health infrastructure. However, the analyses overlook issues of disparity that exist between areas with basic public health services and those that lack even a basic local health department, and the social and economic factors that contribute to it.

Using the case of Pennsylvania which has the lowest public health workforce in the country, this paper uses GIS mapping to identify areas of public health service disparity. The analysis first maps the entire state by areas with high and low number public health workers per capita (as an indirect measure of access). The analysis then construct various layers of data to establish spatial correlation between the areas of disparity and a) socio-economic characteristics, b) political representation, c) demographic characteristics, and d) levels of existing health services.

The initial results show that significant disparity exists. In certain areas of the state a single zip code boundary changes the complement of public health workers from 24 per 100000 to 2. The initial results also show that these disparities are positively correlated with limited political representation, lower population density, and rapid population growth.