Use of Network Analysis to Measure Public Health Systems Networks

Local health departments are primarily responsible for provide public health services to the entire community, however many of the problems that affect the well being and health of the community cannot be solved by any one organization. In 2003, the Institute of Medicine argued for an expanded role of governmental public health agencies and the increased involvement of COs, educational institutes, and community health units to address the public health needs of Americans. This study examines the relationship between public health system networks density and centrality in four domains: service delivery, population characteristics and public health spending and revenue.

The study population included 2,864 local health agencies operating in 1993, 1997 and 2005 and that responded to a 1998 and 2006 survey who met the National Association of County and City Health Officials definition of a local health department.

This study found large variations in public health systems networks centrality and density. Public health systems network were denser in 2006 (15%) compared to 1998 (0.3%). An increase in public health system densest was associated with providing a large scope of public health preventive services, serving a large population, and increase in public health expenditures and state revenue, and governed by a board of health. Public health systems were more centralized in 2006 (13%) compared to 1998 (3%). An increase in public health system centrality was related to an increase in state revenue, larger scope of preventive services, increase in income per capita, a large workforce and an increased number of insured. Collaborations are greater in seeking federal and state funds, workforce capacity and providing public health preventive services than treatment and specialty services. These findings indicate that public health systems density varied by 0-15% and centrality varied by 3-13% over time.