250512 Determinants of Geographic Variation in Public Health Preparedness: System Structure and Risk Exposure

Monday, October 31, 2011: 11:30 AM

Glen Mays, PhD, MPH , College of Public Health, University of Kentucky, Lexington, KY
OBJECTIVES: A growing body of evidence nationally documents wide variation in public health capacities across local areas, suggesting gaps in quality, efficiency, and interoperability as well as inequities in risk protection. Volume-outcome relationships may explain some of this variation if agencies realize economies of scale in performing public health activities and/or if they learn from experience in responding to relatively rare events. This study (1) estimates the magnitude of variation in public health preparedness capacities across U.S. communities; and (2) investigates how an agency's scale of operations and its frequency of exposure to emergencies affect local preparedness capacities. STUDY DESIGN: We used a national, cross-sectional survey of local health departments conducted during summer and fall 2010. We developed and validated a self-administered survey to measure agency capacities to prepare for and respond to public health emergencies from an all-hazards perspective. Multivariate hierarchical models were used to isolate the effects of agency scale and experience on composite measures of preparedness. FINDINGS: Composite measures of preparedness varied by a factor of 1.8 to 2.9 between the highest 20% and lowest 20% of agencies when ranked on capacity scores, with most of this variation persisting after adjusting for state-level fixed effects. Multivariate estimates indicated positive returns to scale in all eight domains ranging from 4.6% to 13.5% improvements in preparedness scores for each 10% increase in population size (p<0.05). Estimated returns to experience were statistically significant in four domains, ranging from 0.4% to 4.7% improvements for each 10% growth in declared events. CONCLUSIONS: Local capacity to respond to public health emergencies varies widely across U.S. communities and appears highly responsive to an agency's scale of operations and the volume of events experienced. Efforts to pool public health operations and experience through regionalization, consolidation, and strategic alliances may strengthen public health capacities significantly.

Learning Areas:
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe core emergency preparedness domains suitable for measurement and management. Assess the magnitude and significance of variation in emergency preparedness capacities found among local health departments nationally. Use preparedness measures to identify promising administrative, workforce, and partnership strategies for improving preparedness capacities of local health departments.

Keywords: Public Health Administration, Practice-Based Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed and conducted the study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.